Clinician Burnout and Flourishing: Predicting Client Dropout in a Practice-Research Network

Abstract

This study examined the association between therapist-level flourishing and burnout with early client dropout. 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 US-based digital mental health network. Early dropout was operationalised 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. 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]). 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.