Inconsistent therapy attendance is a problem for clients and clinicians. Clients who don’t attend therapy consistently, whether because of their own actions or therapist reasons, may experience difficulty making therapy work effectively for them. Most of the literature regarding inconsistent therapy attendance has examined the demographics of those who are inconsistent and some of the reasons that may contribute to inconsistency. There are only two known studies (Defife et al., 2010; Erekson et al., 2015) that have attempted to examine the impact of inconsistent therapy attendance on therapy outcomes. This study investigated whether inconsistent therapy attendance patterns had a significant impact on client outcomes, as measured by total OQ-45 (Lambert et al., 1994) score. Participants were drawn from counseling center clientele at a large, private, religious university and included 11,794 clients with attendance data for 67,329 scheduled sessions. Hierarchal linear model was used to first determine if the intercept, linear, and quadratic trends had enough initial OQ-45 score variation from client to client to warrant investigating predictors, and second, to determine if consistency, as well as consistency over time, have an impact on the full score OQ-45 starting points and recovery curves. The impact of consistency was found to be significant on the intercept and linear trend of OQ-45 scores. Clients with perfect consistency scores were found to have OQ-45 starting points that were, on average, 10 points lower than their inconsistent peers. In addition, clients with higher levels of consistency across time were found to decrease their symptomology by an average of 2.19 points per session attended, while clients with high inconsistent attendance patterns did not have a significant increase or decrease in OQ-45 score per session. Implications of this study could extend to policies regarding consistency, as well as session limits that could help increase consistency.



College and Department

David O. McKay School of Education; Counseling Psychology and Special Education



Date Submitted


Document Type





therapy, outcomes, consistency



Included in

Counseling Commons