Psychotherapy: Sticking With It by Dr. Joshua K. Swift
Psychotherapy works! Thousands of empirical studies have clearly demonstrated the effectiveness of this form of treatment for many different mental, behavioral, and general health problems and concerns. However, seeking out and attending psychotherapy is not always easy and it takes a lot of courage to take those first steps to set up an initial appointment to meet with a therapist. Perhaps that is why about 60% of adults who experience a mental health concern fail to seek out help for their problems. Even when clients do start treatment, approximately 20% of them will drop out prematurely.
A number of barriers can stand in an individual’s way of seeking out psychotherapy when there is a need and completing it once they have begun. These barriers may include perceived stigma by others, monetary and time commitments associated with attending, ambivalence about wanting to change, trepidation about being judged by a therapist, and fear of the painful emotions that might come when facing and discussing one’s problems. Despite the potential costs associated with attending psychotherapy, there are many benefits of attendance. When compared to clients who choose to drop out of treatment, those who complete it often report greater satisfaction with treatment and life.,  In addition, research has indicated that those who complete therapy experience greater overall well-being and life functioning, and fewer problematic symptoms compared to those who prematurely terminate., , 
Clearly, the benefits of attending and completing psychotherapy are present, but what should you do if you are thinking about dropping out? The following research-supported recommendations may help you make the most out of treatment when thoughts of premature termination occur:
Imagine attendance. One unique study found that clients who were asked to imagine attending therapy were more likely to complete it. Picturing yourself showing up for sessions can help give you the courage to face the barriers you might experience in psychotherapy.
Remember that thoughts of dropping out are normal. Because psychotherapy is not always easy and because there are some costs associated with attendance, thoughts of premature termination are actually quite common in clients. However, just because you experience thoughts of dropping out doesn’t mean you have to act on them.
Be patient. A lot of people mistakenly think that psychotherapy might provide a quick fix for their problems. Although many clients do experience some positive feelings associated with starting treatment, lasting change often takes many more sessions. Throughout the course of therapy, you will likely experience some ups and downs—gains as well as setbacks. Setbacks don’t always mean that therapy is not working; in fact, they sometimes represent progress.
Remind yourself of the benefits that you are getting from attending. If you are experiencing a setback or are not noticing progress as quickly as you would like, try reminding yourself of all of the things you are getting out of therapy. Perhaps the benefits include progress that accompanied earlier sessions and that will likely come again, being able to just let out all of the problems you are facing, or being able to talk to someone who listens and really seems to care. Remembering these benefits will help pull you through some of the downs that might occur.
- Talk to your therapist. Whenever you experience some dissatisfaction with therapy or you have thoughts about dropping out, make sure to share these thoughts and feelings with your therapist. By working collaboratively, your therapist might be able to make some adjustments to address your concerns. Even if the fit with your current therapist is not right and a change is needed, by talking to your therapist you are able to experience closure and a healthy ending to the therapeutic relationship—and your therapist might be able to help you find another provider that is better suited to your needs.
Joshua K. Swift, Ph.D. is currently an Associate Professor at the University of Alaska Anchorage; however, in August 2015 he will start in a new position at Idaho State University. He is also a licensed Psychologist in both Idaho and Alaska. He is the author of the book Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes as well as over 40 other academic journal articles. More information on his research and practice can be found at www.psychotherapyresearchlab.com. He can be contacted via email at Joshua.Keith.Swift@gmail.com.
 National Alliance on Mental Illness. (2008). Use of Mental Health Services and Treatment among Adults. Retrieved from http://www.nimh.nih.gov/statistics/prevalence/use-of-mental-health-services-and-treatment-among-adults.shtml
 Swift, J. K., & Greenberg, R. P. (2015). Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes. Washington, DC: APA Books.
 Bjork, T., Bjorck, C., Clinton, D., Sohlberg, S., & Norring, C. (2009). What happened to the ones who dropped out? Outcome in eating disorder clients who complete or prematurely terminate treatment. European Eating Disorders Review, 17, 109-119. doi:10.1002/erv911
 Pekarik, G. (1992). Relationship of clients’ reasons for dropping out of treatment to outcome and satisfaction. Journal of Clinical Psychology, 48, 91-98. Doi:10.1002/1097-4679(199201)48:1<91;:AID-JCLP2270480113>3.0.CI;2-W
 Cahill, J., Barkham, M., hardy, G., Rees, A., Shapiro, D. A., Stiles, W. B., & Macaskill, N. (2003). Outcomes of clients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133-143. doi:10.1348/014466503321903553
 Lampropoulos, G. K. (2010). Type of counseling termination and trainee therapist-client agreement about change. Counseling Psychology Quarterly, 23, 111-120. doi:10.1080/09515071003721552
 Swift, J. K., Callahan, J. L., Levine, J. C. (2009). Using clinically significant change to identify premature termination. Psychotherapy, 46, 328-335. doi:10.1037/a0017003
 Sheeran, P. Aubrey, R., & Kellett, S. (2007). Increasing attendance for psychotherapy: Implementation intentions and the self-regulation of attendance-related negative affect. Journal of Consulting and Clinical Psychology, 75, 853-863. doi:10.1037/0022-006X.75.6.853
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