Therapy as a Week-to-Week Journey.
As a clinician, I’ve observed a fascinating pattern in how clients decide whether to continue therapy: it is often a week-to-week process characterized by carefully considering their emotional states and thoughts after each session. This ongoing evaluation is essential for understanding the dynamics of their emotional well-being. Clients deeply reflect on their feelings—before, during, and after sessions—influencing their choice to remain on the therapeutic path. Their reflections can vary widely, including the intensity of their issues, their motivations, encouragement from loved ones to attend therapy, and their understanding of how therapy works. Ultimately, clients make weekly choices about their participation. A clinician doesn’t automatically have the privilege of seeing a client every week; that decision is based on the client's unique needs and timeline for therapy.
This participatory method of evaluating their experiences establishes collaboration between the therapist and the client. It encourages building trust and rapport, essential for effective therapy, by actively involving clients in the decision-making process for each session, thus decreasing the chances of ambiguity.
In the article "How Therapists Fail: Why Too Many Clients Drop Out of Therapy Prematurely," authored by Bernard Schwartz, PhD, and John Flowers, PhD, these themes are explored in greater detail, shedding light on the reasons behind client attrition in therapy and the essential role of ongoing engagement. Discussing that the relationship between therapist and clients will outweigh the therapeutic modalities. However, between 20 and 57 percent of therapy clients do not return after their initial session. Additionally, 37 to 45 percent of clients attend therapy only twice.
Expectations from the Mental Health Industry
The mental health field often imposes a significant expectation that once a client commits to starting therapy, they will smoothly progress through the entire process. However, this assumption overlooks the intricate and sometimes unpredictable nuances that can arise within the therapeutic experience. Personal circumstances, emotional readiness, and past experiences can profoundly affect their decision-making, often leading to misunderstandings about the nature of their commitment. Therapy is not always linear, and each individual’s journey through therapy is unique.
Viewing therapy through this lens is not harmful; it provides valuable insight for clients as they reflect on their journey. This weekly contemplation allows them to weigh the benefits and challenges they face, helping them make informed choices about their therapeutic path.
Various Reasons for Decisions
The internal conflict—the push and pull of wanting to avoid the discomfort of confronting personal issues versus the release and clarity that can come from therapy—plays a significant role in their therapeutic journey. Understanding this pattern can help clients and therapists work together more effectively, creating an environment where emotional exploration and healing can occur. While there is considerable emphasis in various resources on the benefits of therapy—such as the support it offers and the insights gained from discussing personal challenges—there seems to be a lack of focus on what clients genuinely feel during and after each session. These emotional aspects play a role in their motivation to return. This perception can lead to feelings of obligation rather than a genuine desire to engage.
Although premature termination of therapy happens frequently, it should not be viewed as a failure. This situation reflects clients' understanding of therapy before they converse about vulnerable aspects of their lives. It also indicates their desire to feel in control of what is happening within the therapy space.
