Why people quit therapy: five reasons and two critical moments

The message arrives on a Sunday evening: “I won’t be able to come this week. I’ll be in touch.”

Therapists know messages like this. Sometimes they mean exactly what they say — a sick child, work, a cold. And sometimes it is the last we hear from someone. They don’t get in touch. The next appointment stays empty. A story that had begun to open hangs on a half-finished sentence.

With this post I begin a series of five on ending therapy early — on why people leave, when that is right and when it is not, what a therapist must not do, and how to leave in a way that gives you something. I am writing it for people considering therapy, for those who are in it and tempted to leave, and for those who once left and still wonder whether it was right.

Dropping out is not the same as ending

First, a distinction I think matters. Ending therapy is planned: client and therapist agree that the work is done or that it is time for a break, and they talk about the ending over a few final sessions. I wrote about this in When and how to end therapy.

Dropping out, on the other hand, is one-sided: one of the two — almost always the client — leaves before what was agreed. Sometimes with a message, sometimes with one last session, often without a word. In the profession we also call this premature termination. It is not necessarily bad. But it always deserves attention, because it says something about the relationship it ended.

How often it happens

More often than people think. In a 2012 meta-analysis, Joshua Swift and Roger Greenberg combined 669 studies with almost 84,000 participants and found that roughly one in five clients ends therapy prematurely. Older estimates were even higher — in some studies almost half of therapies were cut short, depending on how dropout was defined.

This figure is not meant to frighten anyone. It is meant to let you know: if you are thinking about leaving, you are not an exception and there is nothing wrong with you. But it is worth understanding why it happens — because the reasons are very different and each calls for a different response.

Five groups of reasons

Practical reasons. Therapy costs money and time. When a job is lost, a child is born or a parent falls ill, therapy is often the first thing to go. These are real reasons and should be taken seriously. But often a solution can be found that the person had not considered: less frequent sessions, a short break with an agreed return, online sessions. If you don’t say the reason, your therapist has no chance to help look for one.

Relief. People often come to therapy in a crisis. When the crisis passes, it is understandable that they feel they no longer need therapy. Sometimes that is true. But sometimes the crisis is only the tip of the iceberg: once it calms down, the pattern that caused it becomes visible — and it will bring the next crisis again. I wrote about the difference between putting out fires and looking for causes in From putting out fires to understanding causes.

Poor fit. You don’t connect with the therapist, the approach doesn’t suit you, you don’t feel understood. This is one of the most legitimate reasons to leave, and I write more about it in the third post of this series, When it is right to leave.

Something went wrong. The therapist said something that hurt you. It seemed they weren’t listening. They forgot something important. The hurt builds up, and one day it seems easier not to come than to say it. These are the most regrettable dropouts, because they can often be repaired — and the repair itself can be healing. I wrote about what research says on repairing ruptures in the therapeutic relationship in Will your therapist tell you what they feel?.

It’s too much. And finally the reason people mention least and often don’t recognise themselves: therapy has just come close to something essential, and that has become unbearable. This is the reason the second post in the series, When it’s too much, is about. Here just this: leaving at that moment does not feel like running away. It feels like a clear decision that you “don’t need this any more” or that “therapy isn’t for you”.

When people most often leave

Research shows two critical moments. The first is right at the start: after the first or second session. People often leave then because they expected something else — advice, quick solutions, a diagnosis — or because they didn’t connect with the therapist. Swift and Greenberg found dropout was more common when the client’s expectations of therapy had not been clarified at the outset.

The second critical moment is harder to measure, but therapists know it well: when therapy deepens. After a few weeks or months, when the relationship is safe enough for long-closed topics to open. That is exactly when, for many people, everything they have learned about being vulnerable in front of another person switches on. It is understandable that this is when leaving is most tempting.

What helps make leaving unnecessary

Researchers studying premature endings have also looked at what reduces them. A few findings recur in almost every review.

Clear expectations at the start. When the therapist explains in the first sessions how therapy works, roughly how long it takes, that sometimes you have to go through a harder phase, and what the client can expect, people leave less often. Unsurprisingly: if you know that being unsettled after a hard session is expected, you won’t take it as a sign that therapy isn’t working. I wrote about what to expect in What to expect from individual therapy at three, six and twelve months.

Regularly checking how you are. Therapists who regularly ask clients how they experience therapy and the relationship — not just how life is going — notice in time when something is getting stuck. The American researcher Michael Lambert showed that systematically monitoring progress significantly reduces the share of people who get worse in therapy or leave. A simple “how was it for you with me today?” at the end of a session does more than it seems.

Room for dissatisfaction. People leave less often when they know they may say that something bothers them. This doesn’t happen by itself. The therapist has to invite it explicitly — and when the client first says something, respond in a way that makes them dare to say it again next time.

How a silent exit feels to the therapist

You may also be curious about the other side. When a client disappears without a word, the therapist is left with questions that will not be answered. Did something go wrong? Was it flight or relief? Is the person all right? Most therapists send one short message — that they are here, that the client can get in touch at any time, and that they would be glad to have a closing session if the client wants one. You don’t have to reply to such a message. But it is good to know it is not meant as pressure, but as an open door.

For my part, after a silent exit I get in touch once and then not again. The decision is yours. But the door stays open — even a year or two later.

What happens to those who leave

I want to be honest in both directions here. It is not true that everyone who leaves has lost something. Some people leave because they got what they needed — sometimes in a few sessions. Some find another therapist they connect with better and take a big step there. Some return to the same therapist after a year or two, more ready.

But it is also true that research consistently shows that people who end therapy prematurely on average report less improvement than those who complete it. And many who leave without a word are left feeling that “therapy doesn’t work” — which can put them off seeking help ever again. That seems to me the biggest loss: not just one interrupted therapy, but a closed door to all the ones that might follow.

How it sounds when someone says it

Leaving that is talked about is something completely different from leaving without a word. This is how a conversation might sound when a client comes to say they are thinking of ending (a composite, not a real person):

“I think I’m going to stop. I’m better now. And the money …”
“Thank you for coming to tell me. Can we look at both — the money and the fact that you’re better?”
“The money isn’t really the problem. But last time, when we talked about my mum … I don’t know. I don’t want to go there.”
“That’s important. We can go more slowly. Or take a break — but knowing why.”

However such a conversation ends — with leaving, a break or carrying on — the client leaves with understanding, not with a sense of defeat. That is the essence of everything I will write in this series.

Exercise: before you send the message

If you are thinking of ending therapy, take ten minutes for these questions first. They are not meant to talk you out of leaving. They are meant to help you leave with clarity.

1. When did the wish to leave first appear? After a particular session? A particular topic? Something the therapist said?
2. Which of the five reasons comes closest? Practical, relief, poor fit, hurt, too much? There may be several.
3. What would you want your therapist to know? Write it down, even if you won’t tell them.
4. What feels hardest about telling them in person? The answer to this alone is often important.
5. What would help you to be able to come back one day — to them or to someone else?

The last post in this series, How to tell your therapist you’re leaving, is about how to leave in a way that gives you something.

Where the line is: when to leave at once

In this series I will say several times that it is good to talk about leaving. But there are exceptions. If the therapist has crossed boundaries — suggested contact outside therapy, touched you in a way you didn’t like, humiliated you, broken your confidentiality or asked you for something unrelated to therapy — you don’t have to come to one more session to sort it out. You can leave at once. The fourth post, What a therapist must not do, covers what a therapist must not do and where you can turn. There is also a short explanation in the knowledge base under ending therapy early.

What to remember

• Ending is planned and agreed; dropping out is leaving one-sidedly before what was agreed.
• Roughly one in five clients ends therapy prematurely — you are not an exception.
• The reasons are practical, relief, poor fit, hurt or “too much” — and each calls for a different response.
• People most often leave at the start or when therapy deepens.
• Leaving that is talked about gives more than leaving without a word — except when a therapist has crossed boundaries.