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Participants included 141 therapists (\n                    <jats:italic>M<\/jats:italic>\n                    <jats:sub>age<\/jats:sub>\n                    \u2009=\u200946.1; 82.8% White; 80.7% female) and 12,988 adult clients (\n                    <jats:italic>M<\/jats:italic>\n                    <jats:sub>age<\/jats:sub>\n                    \u2009=\u200937.8; 41.9% White; 62.5% female) using a US\u2010based digital mental health network. Early dropout was operationalised as attending fewer than three sessions. Therapists completed self\u2010report measures of burnout and flourishing. Multilevel logistic regression examined therapist\u2010level 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\u2009=\u20090.90, 95% CI [0.814, 0.998]), while therapist burnout was not (OR\u2009=\u20091.01, 95% CI [0.758, 1.353]). More years in practice (OR\u2009=\u20091.02, 95% CI [1.013, 1.031]) and larger weekly caseloads (OR\u2009=\u20091.02, 95% CI [1.003, 1.033]) were both significantly linked to higher early dropout rates. Dropout was significantly lower for White clients (OR\u2009=\u20090.827, 95% CI [0.736, 0.929]) and White therapists (OR\u2009=\u20090.711, 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.\n                  <\/jats:p>","DOI":"10.1002\/cpp.70258","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T08:03:46Z","timestamp":1774080226000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinician Burnout and Flourishing: Predicting Client Dropout in a Practice\u2010Research Network"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4350-229X","authenticated-orcid":false,"given":"Seungbin","family":"Oh","sequence":"first","affiliation":[{"name":"Chobanian &amp; Avedisian School of Medicine Boston University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5640-0992","authenticated-orcid":false,"given":"Matteo","family":"Bugatti","sequence":"additional","affiliation":[{"name":"Oregon State University  Corvallis Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madalynn","family":"Hines","sequence":"additional","affiliation":[{"name":"Oregon State University  Corvallis Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven\u00a0J.","family":"Sandage","sequence":"additional","affiliation":[{"name":"Boston University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse","family":"Owen","sequence":"additional","affiliation":[{"name":"University of Denver  Denver Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"American Psychological Association.2024. \u201cBarriers to Care in a Changing Practice Environment: 2024 Practitioner Pulse Survey.\u201dhttps:\/\/www.apa.org\/pubs\/reports\/practitioner\/2024\/practitioner\u2010pulse\u20102024\u2010full\u2010report.pdf."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0015235"},{"key":"e_1_2_9_4_1","first-page":"258","volume-title":"Bergin and Garfield's Handbook of Psychotherapy and Behavior Change","author":"Baldwin S. 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