Understanding dropout through a psychodynamic lens
One of the more perplexing moments in therapy is this:
A client begins to engage more consistently.
They are making meaningful connections.
Something emotionally real is being touched.
And then—
they cancel sessions, withdraw, or stop coming altogether.
From the outside, this can easily be understood as therapy “not working.”
But from a psychodynamic perspective, something more complex may be unfolding.
When Therapy Begins to Work
Therapy does not only bring relief—it also brings contact.
As the work deepens, clients often come closer to:
- Vulnerability
- Dependence on another person
- Previously avoided emotional states
- Long-standing relational patterns
These experiences can feel unfamiliar, and at times, overwhelming.
What was once managed through:
- Overthinking
- Emotional distance
- Control or avoidance
begins to shift into something that is felt more directly.
And for many, this shift is not immediately experienced as helpful—it can feel destabilising.
Resistance Is Not Always Obvious
In psychoanalytic thinking, this moment is often understood as an intensification of resistance.
Resistance is not simply refusal or lack of motivation.
It is the psyche’s way of protecting itself from experiences that feel too threatening, too exposing, or too unfamiliar.
As therapy approaches something meaningful, resistance can take subtle forms:
- Missing sessions
- Arriving late or cancelling at the last minute
- Feeling suddenly “too busy”
- Questioning the usefulness of therapy
- Withdrawing emotionally
Rather than indicating failure, these moments may signal:
“Something here matters, but it also feels risky.”
Rather than indicating failure, these moments may signal:
Therapy is not just about discussing problems—it is also about being in a relationship.
As the therapeutic relationship develops, it can evoke:
- Fear of dependence
- Anxiety about being known or understood
- Concerns about being judged or misunderstood
- Long-standing expectations from earlier relationships
These are often not conscious.
A client may not think, “I am afraid of needing this space.”
Instead, they may feel an urge to step back, disengage, or leave.
In this sense, the decision to end therapy may itself be shaped by the very patterns that brought the person to therapy.
What Research and Psychoanalytic Thought Suggest
Psychoanalytic literature has long recognised that resistance often intensifies at points of therapeutic movement, not stagnation.
- Sigmund Freud described how transference and resistance emerge as therapy deepens, particularly when unconscious material begins to surface
- Jacques Lacan highlighted how the therapeutic process can destabilise familiar ways of relating, making withdrawal a possible response
- Glen O. Gabbard emphasises that dropout can occur when therapy begins to activate difficult affect or dependency concerns
- Jonathan Shedler notes that psychodynamic work often brings gradual but emotionally significant shifts, which may initially feel uncomfortable
- Michael J. Lambert and colleagues have also observed that dropout is not always linked to lack of improvement, but can occur during periods of emotional activation
Together, these perspectives suggest that leaving therapy is not always about lack of progress—it may sometimes be a response to it.
When Leaving Becomes Part of the Pattern
For some, therapy ends just as something important begins to emerge.
This does not mean every dropout should be interpreted or pathologised.
People leave therapy for many valid and practical reasons.
But in certain instances, it may be useful to ask:
What was beginning to happen just before the decision to leave?
Was there:
- A new awareness?
- A shift in the relationship?
- An emotion that felt difficult to stay with?
Sometimes, the act of leaving can mirror familiar patterns:
- Withdrawing when things get close
- Avoiding dependence
- Stepping back when something feels emotionally significant
A Different Way of Understanding Dropout
When viewed this way, therapy ending is not always a sign that “nothing was happening.”
At times, it may reflect the opposite.
Therapy may become difficult precisely because it is beginning to matter.
Holding this perspective allows both therapists and clients to approach such moments with curiosity rather than judgment.
Final Reflection
Therapy is not only about insight or symptom relief.
It is also about tolerating new ways of feeling, relating, and being known.
And that can be challenging.
Sometimes, leaving therapy is not a failure of the work.
It is part of the very dynamic the work is trying to understand.
