Patients who abandon psychological therapy and why they should not – Online Psychologists

All of us psychologists have found that, even in the face of our many recommendations of the possible consequences, A certain proportion of our patients abandon psychotherapy before it has actually come to an end.. This is what, in other branches of health sciences, would be called a “voluntary discharge.” And, although it is true that many of them end up resuming therapy again, it is also true that they have taken steps backwards on the path they had taken.

Among the latter are: teenagersIn this case, we can speak, as many other times, of the magical thinking; Many young people believe that simply by crossing the therapist's door or sitting on his couch, all their problems will be cured in three or four sessions. Lack of adherence to treatmentdue to lack of attitude; if you don't put in your 50%, you will have to face the harsh reality, not even psychologists have «magic powders» that solve problems effortlessly.

Married patients are less likely to abandon treatments since the partner usually acts as an assistant and, sometimes, even, depending on the type of pathology, as a co-therapist. Giving this responsibility to the partner without pathology means that any attempt to desist the patient will be nullified, explaining the benefits of the treatment and the consequences of not doing so.

They also leave prematurely patients with low educational level. Most of the time because psychological jargon is complicated for them, because they do not understand the purpose or objective of the therapy and, above all, because The only thing they know is that “the pills” work very well for them. or they do not work at all. Therefore, they load psychiatric treatment with “power” and strip psychotherapy of its power, since they will have been forced to do it by psychiatric order or by family insistence.

Contrary to what one might think, many times, perhaps too many, they abandon psychotherapeutic treatment. patients with severe psychopathologies or even severe symptoms of a psychopathology that, in principle, would have an easy solution. Abandonment causes the aggravation of these pathologies and, too often, we are not aware of the damage we are inflicting on ourselves, but the family is not particularly insistent either.

Having seen those who discharge themselves voluntarily, we might ask ourselves why they do so, or what leads them to end a treatment that they initially began freely and voluntarily?

When we talk about demand, in psychology, we refer to the reason that leads a patient to consult a psychologist. It may happen that this reason, when it comes to the consultation, occupies a central position in the patient's life, but as time goes by a new perception is adopted that allows the problem to be minimized or relativized, ceasing to be central and, therefore, of concern. However, this does not mean that it is absolutely resolved.

There are different schools of thought in psychotherapy. Normally, each of us is assigned to one of them, for example, cognitive-behavioral. However, designing a treatment means take into account the peculiarities of each patient; his character, the object of his demand, whether he had already been motivated by it from home or not…

What cannot be done is to apply the same suit to all patients who come to our office because some will find it too short, others will find it too long, others will tear it, others will find it too loose… These will end up feeling that the therapy «is useless» or «doesn't do anything for me» or «I don't notice anything different», they will become demotivated and will end up giving up.

This is one of the most important functions of the psychotherapist during the first sessions: leveling expectations to a reasonable level so as not to end up causing abandonment because the patient did not satisfy the idea with which he came to the consultation and which is part of that «magical thinking» that we have already talked about, the simple fact of sitting on the therapist's couch or walking through his door already remedies his problem.

Except in certain cases, such as couples therapy, it is difficult to give an exact number of sessions since many unexpected factors may occur throughout the treatment, both on the part of the patient and the psychologist, or it may happen that the patient does not respond to the treatment.

In this case, the patient would drop out, not because of noncompliance, but because of lack of motivation or, especially, unfulfilled expectations. Therefore, maintaining a goal over time, even if approximate, helps the patient to be faithful to psychotherapy and, also, to household chores.

In psychotherapy, the quality of the relationship established between the patient and the psychotherapist is essential, since if the patient perceives that there is no connection with the psychologist, that he does not understand him or that his problems are minimized, the treatment will fail due to the patient abandoning it.

Cognitive-behavioral psychotherapy, in the intersession space, is based on “homework” that patients must complete outside the consultation. However, Many of them believe that the treatment ends when the session ends. and they do not think about it again until the next session, either out of laziness, because they consider the exercises to be unnecessary or that they “will serve no purpose.” This means that the treatment will be delayed, the expectations we talked about earlier will not be met, and, as a result, frustration and demotivation will appear, leading to abandonment.

Frequently, patients who stop their treatment suddenly They hold the psychologist responsible for the abandonmentwhich does not mean that this is always the case, but it is true that, in some cases, certain attitudes can unintentionally end psychotherapy. Most of these patients claim that there have been problems such as lack of professional competence, the personality of the therapist or the contradiction between his or her discourse and the values ​​of the patient.

Even though the patient thinks about dealing with the issue of demand and often even says, “But I have already overcome that and I don't want to talk about it,” what the symptom is telling us is that, in reality, it is not as overcome as he thinks and, therefore, it is necessary to talk about it.

This is where one of the points of conflict begins. We have a patient who refuses to talk about something necessary, a psychologist who needs the patient to express his emotions and free himself in order to continue, and the psychotherapy that is stopped, does not advance, generating frustration, both in the psychologist and in the patient, who prefers to abandon psychotherapy.

Contrary to what it may seem, many patients abandon therapy just when they begin to improve because They think they don't need it anymorewhich means there is a very high probability of relapse. This is because there is usually a certain denial of change, in the same way that there is a denial of delving deeper into the symptom.

We cannot forget that any type of pathology that has been dragging on for a certain period of time, we end up internalizing it and that is when change can be scary in the same way that everything that we do not control, that is new, is scary, although this is a process that occurs at an unconscious level.

Some patients are not satisfied with the opinion of one professional, but seek the opinions of different professionals. But, in this search, something of utmost importance, which has already been repeated in this article, is not taken into account: not all psychologists belong to the same theoretical school and, therefore, there are not many coincidences between a psychoanalyst and a cognitive-behavioral psychologist.

Obviously, it is important to listen to several bells but we cannot forget that too often we do not choose the sound that would be useful to us but the one we want to hear.

This is the case of patients who abandon therapy to start another one, but surprise! From a different theoretical school. In fact, these are patients who go from one psychologist to another in search of confirmation of their beliefs or opinions, and the psychologist can already sense, more or less, that they will abandon therapy when one of their first sentences is “you are the third psychologist I have had. I left the other two… I will tell you later.”

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