with children because perhaps the
treatment is going great with the child
and they are really connecting, but
parents decide they won’t bring the
child in anymore. When working with
children, it’s important to remember
that our strategies need to be used
with the parents or adults in charge.
They are the ones looking for the
changes; they are the ones who want
to be hopeful that things will get
better for their child.
How can clinicians keep things
in perspective when patients
Greenberg: Therapists should remind
themselves that the experience isn’t
unique, that there are ways of getting
more feedback from clients on how
therapy is going for them, that they
can consult with colleagues on why
they are having frequent dropouts
and how things are going. By talking
to a number of colleagues, you
usually discover similar things are
happening for them. That helps to
cushion the loss.
Swift: It’s also good to remember
that clients are the ones in charge.
Although you can use these strategies
and put forth your best effort, some
clients are going to decide that they
just don’t want therapy right now.
That is the client’s decision and you
can’t take too much ownership.
Dropouts are often over-utilizers
of services. Some bounce around
from one type of treatment, clinic or
therapist to another.
What can a clinician do if
dropouts keep happening?
Greenberg: Therapists should consult
with other colleagues to determine
Eight strategies to keep patients on track
In their book “Premature Termination in Psychotherapy,” Joshua K. Swift,
PhD, and Roger Greenberg, PhD, list eight practical strategies with strong
empirical support for reducing the likelihood of early dropout.
The strategies are simple, but many are not emphasized in training
and often aren’t practiced by seasoned clinicians, say the authors.
“When I present our research on this topic, probably the most
common comment I get afterward is that these strategies don’t seem
too difficult, I just never thought to do them and nobody ever said to do
them,” says Swift.
1. Provide role induction: Clients who are confused about how
therapy works may be more likely to drop out. Educate them about
appropriate therapy behavior — what you expect from the client and
what the client can expect from you.
2. Incorporate client preferences into the treatment decision-making
process: Help clients feel more invested in therapy by talking with
them about treatment options. Balance their preferences with the best
3. Help plan for appropriate termination: Give your clients
information on how long treatment typically lasts and discuss a possible
timeline for their therapy. Discussing an endpoint promotes a client’s
commitment to treatment and can help him or her feel comfortable
speaking up if they have thoughts of ending therapy early.
4. Provide education about patterns of change: Forewarn clients
that they might feel tempted to end therapy prematurely when they
experience a setback or experience “surface-level” improvements and
feel the work is done.
5. Strengthen early hope: When clients have hope that therapy will
produce change, they are more committed and more likely to work past
the type of setbacks that can lead to dropout.
6. Enhance motivation for treatment: Directly address clients’
motivation from session to session and use motivational interviewing
and other strategies to help them continue coming back even when they
7. Foster the therapeutic alliance: Be warm, empathic and accepting
and pay close attention to how a client’s needs and expectations may
shift. Repair ruptures in the therapeutic bond as soon as they occur.
8. Discuss treatment progress with your clients: Studies show that
therapists aren’t always the best predictors of patient progress. That’s
why clinicians should also have a system of client feedback in place,
either through in-session discussion or objective self-reports, to gauge
progress and identify problems before they result in dropout.
— Jamie Chamberlin