Psychotherapy dose, clinical outcome, and academic withdrawal at university counseling centers

Academic withdrawal from colleges and universities is a common occurrence, particularly among students with mental health concerns. Receiving a successful course of psychotherapy may reduce students' risk of academic withdrawal, but outcomes in university counseling centers (UCCs) could be hindered by strategies used to meet high service demands with limited resources, such as offering a low number or frequency of sessions. The present study examined associations among psychotherapy dose, clinical outcome, and academic withdrawal among students (N = 16,197) in short-term individual psychotherapy at 85 UCCs in the United States. Structural equation modeling results indicated that after controlling for baseline psychological distress, the number of psychotherapy sessions attended positively predicted, and the average number of days between sessions negatively predicted, clients' self-reported reductions in psychological distress. In turn, after controlling for pretreatment characteristics associated with academic withdrawal (prior psychiatric hospitalization, gender, academic distress) reductions in psychological distress negatively predicted therapists' report of clients voluntarily withdrawing from their academic institution during psychotherapy. This indicates that students who receive higher psychotherapy doses within a short-term context (i.e., 10 or fewer sessions) are less distressed by the end of treatment, which then predicts a lower likelihood of academic withdrawal during psychotherapy. UCC leadership and clinicians might enhance clinical and academic outcomes by providing flexibility in the number and frequency of psychotherapy sessions available to students. However, centers may need additional resources from their academic institutions to provide this flexibility. (PsycInfo Database Record (c) 2026 APA, all rights reserved).