“The one that got away”- therapists’ experiences when patients suddenly drop out from psychotherapy: a thematic analysis

Objective The objective of the study was to examine how therapists in clinical practice experience sudden dropouts from psychotherapy. Method We interviewed 12 licensed psychotherapists regarding sudden dropouts. The interviews were analysed using thematic analysis (TA). Results Three main themes and seven subthemes were identified. The first main theme was: Struggling to understand and explain the dropout. The subthemes were: “the patients’ problem was too difficult” , “trouble cooperating” and “problematic emotional bond”. The second main theme was: Continuing when something is wrong. The subthemes were: “ difficulties maintaining presence” , “emotional withdrawal and sense of failure as a therapist”. The last third main theme was: Therapists processing feelings after the dropout. The subthemes were: “ doubting your own capacity” , “to be abandoned” , “sense of relief and lessons learned”. Conclusions Sudden treatment dropouts often elicit negative emotions such as guilt, shame, and sorrow. They may also bring a sense of relief. Abrupt termination of therapy can affect therapists both professionally and personally, with the impact sometimes persisting long after the client has dropped out from therapy.