Flourishing therapists predict lower premature terminations, recent study finds

The Danielsen Institute’s collaboration with Dr. Jesse Owen and his team led to this new publication on therapist flourishing as a predictor of lower rates of client premature termination of psychotherapy. Dr. Seungbin Oh from the Boston University School of Medicine led this study with a sample of over 12,000 clients. The abstract below also summarizes some effects for years of experience, caseloads, and racial disparities. This project was supported by the virtue and flourishing grants from the Templeton Foundation.

Citation

Oh, S., Bugatti, M., Hines, M., Sandage, S.J., & Owen, J. (in press). Clinician burnout and flourishing: Predicting client dropout in a practice-research network. Clinical Psychology & Psychotherapy.

Abstract

Objective: This study examined the association between therapist-level flourishing and burnout with early client dropout.

Method: Participants included 141 therapists (Mage = 46.1; 82.8% White; 80.7% female) and 12,988 adult clients (Mage = 37.8; 41.9% White; 62.5% female) using a U.S.-based digital mental health network. Early dropout was operationalized as attending fewer than three sessions. Therapists completed self-report measures of burnout and flourishing. Multilevel logistic regression examined therapist-level predictors of early dropout, accounting for nested client data.

Results: Approximately 27.8% of clients dropped out early. Therapists accounted for 9.4% of the variance in client dropout. Therapist flourishing was significantly associated with lower dropout rates (OR = 0.90, 95% CI [0.814, 0.998]), while therapist burnout was not (OR = 1.01, 95% CI [0.758, 1.353]). More years in practice (OR = 1.02, 95% CI [1.013, 1.031]) and larger weekly caseloads (OR = 1.02, 95% CI [1.003, 1.033]) were both significantly linked to higher early dropout rates. Dropout was significantly lower for White clients (OR = 0.827, 95% CI [0.736, 0.929]) and White therapists (OR = 0.711, 95% CI [0.539, 0.938]).

Conclusions: Therapist flourishing may support early client retention, while higher caseload, more experience, and racial/ethnic disparities are associated with increased dropout. Findings highlight the need for wellness promotion, structural support, and culturally responsive practices in psychotherapy.