5 Reasons Why People Drop Out of Therapy

It is estimated that a staggering 40 to 60 percent of psychotherapy clients drop out of treatment before processing it with their therapist and meeting their goals.

But why would a client just up and leave a treatment? This was the central question of a study led by researcher Emily Janes of Texas Tech University and her collaborators. Given that an astonishing 50 percent of clients never return to treatment after their intake session—and are vulnerable to worsening symptoms—having insight into negative therapy experiences, especially those that lead to a sudden and premature departure from treatment, could be useful for clinicians and clients alike.

To explore premature therapy discontinuation, Janes and her team employed a cutting-edge approach: They collected 29 video posts on TikTok with the hashtag “badtherapist” and performed a content analysis. The results were illuminating. The analysis revealed five themes, which are summarized below.

Theme 1: Invalidation

This theme broke down into two subthemes:

1. Invalidation of client experience: Some creators believed that their therapist didn’t take their experiences and concerns seriously. One TikTok user shared that their therapist diminished the lasting effects of their childhood trauma, remarking: “You had plenty of time to get over that trauma—it’s already been six years.”
2. Invalidation of an aspect of client identity: Some posters felt their therapist invalidated core components of their identities, including gender identity and sexual orientation. One participant, for example, described an experience of invalidation by their therapist because of their physical appearance:

She looks at those socks and she looks back at me and she says ‘That’s not very trans of you,’ and I was like ‘What?’ And she said, ‘Well, if you were really a boy, you wouldn’t wear those. That’s why no one believes you.’

Theme 2: Biases

Some creators said that their therapist’s biases about marginalized groups were disclosed in session, which negatively affected their experience of treatment. One participant’s therapist reportedly blurted out during session, “Oh, God, don’t tell me that you’re one of those people who believe there’s more than two genders!”

Theme 3: Boundary Violations

Seven TikTokers cited violations of boundaries and ethics in their treatment. Their videos referenced incidents in which they felt that their confidentiality was broken without their consent and/or that their provider disclosed information about themselves that undermined the treatment. Consider the experience of a suicidal participant, who felt inhibited from talking about their struggles because their therapist was taking up the space:

Every single time I went in to talk to this woman, all she did was talk about herself. Like, I couldn’t get a word in edgewise. This woman was narcissistic as f---.

Theme 4: Including Religious Beliefs Without Client Agreement

Some users felt uncomfortable with their therapist’s use or discussion of religion in session. Some said their therapist suggested that religion was a possible “cure” for mental illness, even though such a view was not compatible with the clients’ beliefs. One creator recalled their therapist saying: “You wouldn’t be depressed or suicidal if you had a personal relationship with God.”

Theme 5: Denial of Trauma

Some participants opened up about their experiences with trauma to their therapist, who reportedly responded with invalidations, rationalizations, and/or blame. One TikToker recounted their therapist doubting that a family member could be the perpetrator of abuse, remarking: “I know you said you were sexually abused by a family member, but are you sure? You sure that really happened? I don’t really think he would do something like that.”

When a client drops out of therapy, they are often deemed as being a “resistant” patient. It’s true that there are some who find the therapeutic process too difficult or overwhelming. Yet, as this study clearly demonstrates, therapeutic spaces are co-created—and therapists can be the reason why a client drops out.

Janes and her collaborators conclude their study with a cautionary note for mental health clinicians: They should be aware that the treatment they provide could be the subject of discussion on social media—and in great detail. As such, they should make every effort to repair ruptures as soon as possible and avoid “bad therapist” behaviors.