What to do when a client stops coming to therapy

Experiencing client dropout can be jarring, but there are steps you can take to help you move forward in your practice — with or without that client in your caseload. Here are some things to try.

Consider your client’s perspective.

When a client stops coming to therapy, it’s important to reflect on what might be keeping them from attending their sessions. “Explore potential barriers to attending treatment, and get curious about the patient’s perspective,” says Maddie Tong, a licensed social worker and Headway’s senior associate of clinical education. “What may be coming up that’s inhibiting them from attending therapy consistently?” 

As you’re pondering this question, think about your recent sessions with this client, Tong suggests. Ask yourself: Were there any signs that this client wasn’t satisfied with their treatment? Did you or the client have any concerns about attendance or continuing therapy? Considering these points may offer valuable insight.

Check in with yourself.

Client dropout can be upsetting for therapists, who may struggle with taking the client’s decision to step back personally. “Therapists are human, and these relationships with clients are just that — they are relationships,” Tong says. “Having a client unexpectedly drop off or ‘ghost’ can kick up feelings of rejection, failure, [or] inadequacy.”

Take time to reflect on how you feel about the situation, and don’t hesitate to reach out to a fellow therapist if you need support. “Processing with a supervisor or a colleague is an important part here, as no therapist is the ‘right’ therapist for every single client out there. And that’s OK,” Tong says.

Reach out to your client.

Your client can tell you better than anyone why they’ve decided to discontinue therapy. Whether you communicate face-to-face during a session, on the phone, or in an email, “use the therapeutic alliance/relationship to explore [the topic] non-judgmentally with your client,” Tong advises. “The therapeutic rapport is key here as to not come off as blaming, but to address this in a joining way that [makes it] clear your intention is to support the client’s progress towards treatment goals.” Ensure you thoroughly document this conversation for your records, she adds.

Stick to protocol.

When in doubt, check your written policies on communication and termination and make sure you’re adhering to guidelines — especially when it comes to documenting follow-up attempts and discharge. 

“Make sure you’re noting the amount of (and type of) outreach attempted, whether or not the client responded to outreach attempts, how you arrived at the decision to terminate and discharge if the client is not responsive, any follow-up you plan on doing,” Tong suggests.