Many clients leave before therapy has a chance to work.
Clinics can see when clients stop participating. What they usually cannot see is the experience that led to it.
Anesi gives clients a structured way to reflect on their expectations and early experience in therapy, and gives therapists visibility into how that experience unfolds while therapy is still getting underway.
The Current State of Early Therapy
The earliest sessions are where engagement is most fragile.
Clients disengage at every stage of the treatment process, but the first few sessions are especially consequential. Research suggests that once clients remain for at least three sessions, the likelihood of attrition begins to decrease.
Anesi is focused on what happens after a client enters care. Of those who complete intake, approximately 65% attend the first treatment session, and only about 60% of those who do attend remain by session 3.
These clients have already made meaningful investments of effort, hope, and trust — yet many leave before therapy has much opportunity to help. Why?
Source: Barrett et al. (2008).
The Missing Perspective
Therapy involves two experiences — not one.
Therapists can assess symptoms, observe behavior, and track attendance. But they only have access to how the client is experiencing therapy itself — whether it feels relevant, helpful, aligned, supportive, or like a good fit — when the client expresses it. Even experienced therapists identify clients' hidden negative feelings less than half the time.
Clients may not recognize these aspects of their own experience clearly, feel comfortable raising them, or say anything before deciding not to return. Research also suggests that therapists are less likely to identify negative reasons for termination and may miss concerns that clients leave unspoken.
The client experiences
- Whether therapy matches what they expected
- Whether the work feels relevant and helpful
- Whether they feel supported and understood
- Whether doubt, tension, or disconnection is forming
The therapist can observe
- Symptoms and functioning
- What happens during the session
- What the client chooses to communicate
- Attendance, cancellation, and eventual dropout
What Anesi adds
A structured, session-by-session view of the client's reported experience, available to the therapist before the next session.
Anesi is testing whether making the client perspective visible gives therapists useful information while therapy is just getting started.
Sources: Barrett et al. (2008), and related psychotherapy engagement and dropout research.
What Participation Would Look Like
What a participating clinic and its clients would actually do.
Clients complete a brief questionnaire before therapy and after each of the first few sessions. Their responses appear in a simple dashboard that therapists can review before the next session.
A walkthrough of what a participating clinic would use
What a participating therapist would see
Client Perspective
Clients share how they're experiencing therapy through brief questionnaires completed outside of session.
Session-by-Session Visibility
Therapists see how client responses change across early sessions.
A Brief Pre-Session Review
Responses, changes, and trends organized in one place, quick enough to review before the next session begins.
An example of how a therapist might use the dashboard
Pilot Partnership
See what's revealed by making the client's perspective visible.
A participating clinic receives early access to a new view of its clients' early therapy experience. Its therapists can use that information during the pilot, help determine what is genuinely useful, and directly shape how Anesi evolves.
The goal of this pilot phase is to evaluate, carefully and transparently, whether this additional perspective provides enough clinical value to justify further development.
- Small scope: A limited number of therapists and early-stage clients.
- Low time requirement: About a minute for the client to complete and about a minute for the therapist to review.
- Immediate access: Participating therapists can view and use the client-reported information throughout the pilot.
- Direct influence: The clinic helps determine what is useful, what is not, and how the system should change.