Approximately 20% to 60% of psychiatric clients drop out of therapy prematurely, often after only one or two sessions. Common reasons include unmet expectations, financial constraints, lack of therapeutic alliance, or fear of emotional exposure. The well-being of the therapist has documented impacts on client outcomes and retention, but few studies have examined how the therapist’s optimal mental health (flourishing) and other professional characteristics relate to client dropout.
While most prior client retention research has focused on therapist stress or burnout, a new study from Boston University Chobanian & Avedisian School of Medicine has found that clients were less likely to drop out of treatment early (attending fewer than three sessions) when therapists felt that they themselves were doing well across life and work (flourishing).
The work is published in the journal Clinical Psychology & Psychotherapy.
“Our findings suggests that therapist-related factors may exert a stronger influence on early retention, underscoring a need for more attention to therapist-level characteristics in efforts to reduce premature termination by clients,” says corresponding author Seungbin Oh, Ph.D., LPC, NCC, assistant professor of psychiatry at the school.
The researchers combined two sources of data from a large digital psychotherapy network. Researchers merged surveys from therapists (measuring their well-being) with digital platform records of their actual sessions with adult clients. They then used a statistical model that accounted for many clients being treated by the same therapist to test whether therapist flourishing, burnout, caseload, experience, and race and ethnicity were related to early dropout.
They found that a therapist’s flourishing predicted early client dropout, highlighting the role of the therapist’s well-being in establishing and sustaining client engagement. Specifically, each one-point increase in flourishing was associated with a 10% decrease in the odds of early client dropout. Therapist burnout was not significantly associated with an increased rate of client dropout.
According to the researchers, these findings suggest that therapist well-being matters, since approximately 9% of the differences in early dropout situations were linked to the choice of therapist, above and beyond client characteristics.
“We also found higher early dropout among racially and ethnically minoritized (groups that have less power, access, and resources due to systemic oppression) clients and therapists, highlighting the need to understand how culture, access and the therapy environment shape whether clients feel safe and supported enough to continue therapy,” adds Oh.
The researchers hope this study helps mental health systems invest not only in reducing therapist burnout, but also in supporting therapist flourishing so that more clients feel engaged and supported in the earliest sessions of therapy.
“If we can improve early retention and reduce inequities in who stays in care, more people can receive the full benefits of psychotherapy and improve their quality of life,” says Oh.
More information
Seungbin Oh et al, Clinician Burnout and Flourishing: Predicting Client Dropout in a Practice?Research Network, Clinical Psychology & Psychotherapy (2026). DOI: 10.1002/cpp.70258
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