How Therapists Fail: Why Too Many Clients Drop Out of Therapy Prematurely

How Therapists Fail: Why Too Many Clients Drop Out of Therapy Prematurely

by Bernard Schwartz, PhD and John Flowers, PhD

If we could learn from all of our less-than-optimal therapy outcomes, we'd really acquire some true clinical wisdom.  Here are some practical tips to increase your odds of success.
Depending on which study you read, between 20 and 57 percent of therapy clients do not return after their initial session. Another 37 to 45 percent only attend therapy a total of two times. Although many factors contribute to premature client termination, the number one cited reason by clients is dissatisfaction with the therapist. The problem of the “disappearing client” is what Arnold Lazarus has called “the slippery underbelly to the successful practice of psychotherapy that is almost never discussed in graduate programs or medical schools.”
Continue Reading Article
This article was adapted from the book How to Fail as a Therapist: 50+ Ways to Lose or Damage Your Patients, © 2010, Bernard Schwartz and John. V. Flowers. Reprinted with permission.
CE Test
Bernard Schwartz Ph.D. is a licensed clinical psychologist who has a lifetime of experience working with children as a teacher, educational therapist and child psychologist. He is the author of a number of books on child-parent relations including the highly successful How to Get Your Children to Do What You Want Them to Do. His most recent book, How to Fail as a Therapist, describes the most common errors beginning, and even experienced clinicians make. This book, with a foreword by Arnold Lazarus, has been widely adopted as a supplementary text by colleges throughout the country. Dr. Schwartz is a professor of psychology at Brandman University in Orange, California.

Dr. John Flowers was a graduate of and Woodrow Wilson Fellow from the University of Southern California. He is presently a professor at Chapman University, where he has been director of graduate training. He has published dozens of articles in journals such as: Behavior Therapy, Community Mental Health, Journal of Educational Research, Psychotherapy: Theory, Research and Practice, The Counseling Psychologist, and Contemporary Psychology. Dr. Flowers is the author of a number of books including: Help Your Children Be Self-Confident, and most recently Psychotherapists On Film.
I really loved the ideas about how to make assignments work better. I especially liked the idea about not calling them assignments, but activities or experiments. I use assignments (or sometimes I call it hw) a lot but always felt weird with both words because I felt it implied a huge power imbalance that I wasn't going for. Also, the other suggestions to help clients find a way to remind themselves of experiments is excellent. I have found a lot of my clients create alarms on their phones to remind themselves. Excellent article! I almost never write reviews, but was just so impressed I felt the need.
Charity C.
Very good article, however I would have delved first into the basics of what clients regularly subjected to, and which often becomes problematic. The following are "basics" and should always be adhered to: Therapists: -Don't be chronically late to your appointments! If your sessions are running behind, come out of the "late-running" session and inform the next patient that you are running late. Apologize for your lateness and don't let it become a chronic problem. If you have to miss a session, let the patient know as far ahead of time as you are able. -Don't take phone calls during your sessions. -Don't conduct months of therapy with one patient, then ask your patient to if she/he is willing to switch to marital therapy with you. Suggest another therapist. -If there is an agreed-upon schedule from individual to marriage counseling, make sure you treat your former "individual patient" with the same regard as when he/she was in individual therapy. That means equal time for each member of the couple and actively soliciting reactions from both members of that couple.
This article is worth reading and thinking about for every therapist. Many of the authors’ points seem to me to fall under the categories of common sense or common courtesy, but in my experience with therapy, therapists so often do not incorporate these common sense and common courtesy behaviors into their practice. Therapists I have tried all too often fell into the traps of the “infallibility error,” “emphasizing therapeutic techniques over relationship building, ” or “underutilizing clinical assessment instruments.” I suspect that the “infallibility error” often co-occurred with other types of errors. In particular, the therapists seemed to expect me to accept their opinion unquestioningly. If something they did didn’t make sense to me and I asked a question about why they did it, they typically either changed the subject, gave me an answer suitable for an eight-year-old (rather than an intelligent, well-educated adult in her forties, fifties, or sixties), or gave a reply such as “I have my reasons” or “Do you realize you are asking me to give up my control?” So much of what they said seemed capricious and arbitrary. It was not at all helpful – in fact, I’d say it was harmful.
Mary S.
These points are really elementary, but they are so relevant! I've met so many therapists as I've tried to find help healing my C-PTSD--16, all told--and most of them have been "infallible," hung up on technique to the point where they have not seen me as an intelligent human being, etc. Worst of all, when our relationships have failed, they have been so arrogant that they have left me to assume the total responsibility for the failure. Not very realistic! It takes two to tango, as they say. Even in therapy! Thus, each failed therapeutic relationship has exacerbated my feeling of being a failure as human being and has led me to get help once again. Now, I finally have a therapist who has given me an accurate diagnosis and knows how to help me. She is also willing to be a human being and take her part of responsibility for our relationship. This has led to a wonderful working relationship, and I'm healing my C-PTSD! I"m happy!
Jean Fairgrieve
Add your review:

Name :

To prevent automated submissions, please answer the following:
0 + 2 =

CE credits: 1
Learning objectives:

  • Learn about five of the most common therapeutic errors made by clinicians—both beginners and “master” therapists.
  • Describe well-researched strategies which have been proven to reduce dropout rates and increase positive treatment outcomes.
  • Identify your current strengths and weaknesses as a clinician.
Order CE Test

  • $15.00 or 1.0 CE Point
    Add to Cart