One thing I didn’t realize would be part of my work as a therapist is the inevitability of clients who quit therapy. Or having clients end therapy sooner than I had planned or anticipated given their treatment plan.
Who’s To Blame When Clients Quit Therapy?
I remember the first time I had clients drop off prematurely from therapy, I took it personally. I questioned my treatment plan, my approach to counseling, and even whether I was cut out to be a therapist. This is where imposter syndrome can rear its ugly head.
But fear not! We all go through this. And it’s completely normal for clients to quit therapy. But it is important that we do our due diligence when this happens rather than internalizing it or sweeping it under the rug.
When clients quit, most therapists either:
- Blame the client (“They weren’t ready”)
- Internalize blame (“I did something wrong”)
Both perspectives reflect the same issue of allowing our emotions to dictate the explanation rather than collecting data to better understand what happened.
What To Do Before Clients Quit
First, before clients ever get to the point of quitting therapy, I always like to go over the end of therapy when we first start meeting.
Even if I propose a course of treatment that involves a certain number of sessions, I let clients know during the intake session that they have the ultimate authority over how long they choose to attend counseling.
I make it clear that they can let me know if they ever feel the course of treatment isn’t going the way they had hoped, so we can collaborate and problem-solve what is coming up.
This helps minimize “ghosting” from your clients. Instead, you can either shift the course of treatment accordingly or collaborate on how they will end or transfer their counseling.
4 Tools to Help When Clients Quit Therapy
I’d like to share some tools to help you cope when the inevitable happens, and clients quit therapy. I also have some ways to help you improve the quality of your work going forward.
1) Observe Your Emotions
- If a client has already ended treatment with you and you were caught off-guard by them ending, I recommend taking space to notice your own emotional reaction.
- Are you taking it personally? Are you left wondering if you weren’t doing the best job or questioning your entire career choice as a therapist? Or are you angry with your client? Maybe you are assuming the client wasn’t ready or is avoiding what’s in their best interest? Or maybe you’re upset because you’ve been working so hard to build up your caseload and you can’t afford to lose a client right now? Whatever reactions you’re having, take note of them and allow yourself to feel them.
2) Name Potential Reasons Why They Left
- Allow yourself to step outside of your emotions and reflect back on potential reasons why this client may have chosen to end counseling with you.
- Take into account aspects about their presenting issue, their patterns and current life circumstances, as well as aspects about your treatment plan and approach with them. Was there anything about their situation that might have led them to end early? Was there anything about your approach that might have contributed as well?
- Try your best to take an open-minded approach and let every potential possibility be available to consider.
3) Consult With Others
- Whether with a trusted peer or with a supervisor or consultation group, seek professional consultation.
- Present all the information you have collected so far including your observations about why the client might have left as well as your emotional reaction.
- Invite their feedback. Do your best not to make this into an echo chamber where you present a strong case to persuade them to see it from one perspective. Rather, try to explore more than one perspective with your consultation support.
4) Implement Relevant Changes
- Based on the feedback from your consultation support and your own observations, consider whether you need to follow up with that client directly or not.
- Determine if there might be something you’d like to incorporate differently in the future.
- Sometimes, there isn’t any change that needs to happen. You can have a sense of closure that you did your due diligence in the situation by following all the previous steps.
Is Quitting Becoming A Pattern?
If you’re noticing a pattern of clients quitting therapy prematurely, then I strongly suggest you follow the steps above again using a birds-eye view of your entire caseload rather than an individual client.
Take a look at your caseload as a whole over the last 6 months or year and notice what percentage of folks ended prematurely. Notice how you feel about that, make observations from different perspectives for why that may be, and explore the pattern in a consultation group.
It may simply be that you work with a higher-risk population who has a tendency to end therapy early. Or there may be additional factors at play. It’s important to tackle these items head-on so you can make changes where needed rather than potentially sweeping a more glaring issue under the rug.
If one of the issues you find as you look at your client population is that there is a pattern of clients getting stuck and not improving, I have a video that dives deeper into what to do when therapy clients don’t improve.
Remind yourself that a client ending therapy, however they may have chosen to do so, can be a form of self-advocacy.
You’re Not Alone
We’ve all been through the experience of clients ending therapy sooner than we planned. I hope these tools help you find closure and address any systemic issues in your approach that may need to be addressed. And if nothing more, I hope you feel validated that clients “quitting” therapy is very much par for the course, but we do need to do our due diligence to ensure we’re prioritizing client care.
Until next time, from one therapist to another: I wish you well!
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Photo by Jopwell on Pexels