Research

Research and literature reviews on therapy, compiled by Freudche.

May 27, 2026 · 7 min read

When the kindest treatment lands as the coldest

Autonomy-promoting policy (autonomiebevorderend beleid, also called hoogrisicobeleid) is a deliberately designed treatment for a very small group, on the order of 0.5 to 3 people per 100,000 residents a year (Michiels et al., 2024), living with complex, chronic suicidality for whom repeated forced crisis admissions can escalate harm rather than contain it. In the summer of 2024 the Dutch patient platform MIND opened a meldpunt about how that policy is carried out and collected 126 reports across 25 institutions, analysed by Bureau Lenz and published 4 December 2024. The reports describe, as lived experience, care that landed as cold, as over-demanding, as confirmation of feeling worthless, and that in cases did not reduce suicidality and was felt to intensify it. This is not how GGZ treats everyone and it is not what therapists do. It is one specific policy, and the people it was built for are the ones who described the cold. The article holds both truths: a treatment can be evidence-reasoned on paper and felt as abandonment in the room.

therapeutic-process Engagement

May 25, 2026 · 6 min read

The signal that tells you if your work is landing is the one you can't see

The therapeutic alliance predicts outcome at r = .278 across 295 studies, the strongest within-therapy signal we have for whether the work is reaching this particular patient. Yet 19.7% of patients leave early, and 93% have lied to their therapist at least once. The rupture in the alliance is detectable in principle, trained observers coding recordings agree on it at ICC .85 to .98, and invisible in the moment, where therapist and patient agree on the bond at only r = .36. The signal of whether your work is landing is the one you can least see while you are doing it.

therapeutic-process Engagement

May 25, 2026 · 6 min read

The therapist is the last to know the last session was the last

Of 100 people who contact a mental health clinic, fewer than 17 are still in therapy by session 10, and between 20% and 57% who attend a first session never come back for a second. The dropout research suggests therapists often feel the drift but stay silent. 76% sense a client is leaving; only 23% say a word. The patient walks out without a closing session, and the one window for repair shuts before anyone opens it.

therapeutic-process Engagement