It’s not you — it’s them. Seriously.
When it comes to therapists, I’m something of a serial monogamist. Even though I’ve been in therapy since I was a pre-teen, I’ve only had four therapists, and one of those stints lasted for over a decade. I take my relationships with mental health professionals seriously, and for the most part, I’ve found therapists who do, too. But two years ago, after seeing a therapist for about five years, she just sort of stopped responding to my appointment requests. It felt wildly unprofessional and I felt abandoned. And even though I have a new therapist, I still wonder: Why did my therapist break up with me?
To set the record straight, ghosting is deeply unprofessional for a mental health specialist and generally doesn’t happen often. But breakups do happen. “There are three main reasons why a therapist might stop seeing a client,” explains Stefani Goerlich, a Detroit-based psychologist. The first is insurance, says Goerlich. Sometimes the policies of clients, insurers, or therapists change and therapists are no longer able to provide care. Sometimes a therapist may offer to let a client pay out of pocket for services, but depending on their policies, that may not be possible.
The second reason is about the professional’s capacity or breadth of experience. “A therapist will often realize that the challenges facing the client fall outside their scope of practice,” says Goerlich. “We have an ethical obligation to only treat clients who present with issues that we have the skill, knowledge, and training to treat.” Goerlich, for example, specializes in sex therapy, so when clients with, say, eating disorders, come to her, she refers them to a therapist better suited to meet their needs. We have a tendency to think that therapy is therapy, but many therapists have specialized fields of knowledge, just like doctors.
Unfortunately, sometimes the revelation that a therapist and client aren’t well matched happens after they’ve already started working together. “Sometimes something comes up after we’ve been working with someone for a while, and we realize that while we’ve been exactly what they’ve needed until then, they now require someone with a different set of skills or training,” says Goerlich. That can be harder to deal with because a relationship has already been established, but a therapist who’s been working with you also may be better able to refer you to the best possible therapist for your particular situation.
Finally, at the personal level, therapists sometimes experience life transitions that impact their work, Goerlich explains. This is where we have to remember that mental health professionals are people, too, with their own complicated lives. Therapists move, they get married, they suffer losses, and sometimes they just have problems of their own that impact their work. “Therapists are human beings, and also suffer from mental health conditions and can go through stages of career exhaustion and burnout,” says Christina Miller-Martinez, a family therapist in California. But, Miller-Martinez adds that it is up to the therapist to take the appropriate next steps of ending a client relationship.
All that being said, you shouldn’t fear that your therapist will break up with you out of the blue. There is a standardized professional process to ending therapeutic relationships. “A proper therapist break-up includes a conversation, an explanation, and either an acknowledgement of your success, or a referral to another provider,” says Goerlich. Miller-Martinez agrees. “Ideally, a therapeutic relationship should end with a termination session,” she says.
That end-of-relationship conversation can be crucial for clients. “We don't often have good experiences with closure in relationships, and having a termination session with a therapist is an opportunity to have a chance to reflect on what was learned about oneself, what worked well, and what could have been done differently,” says Miller-Martinez.
But no matter how professionally and carefully it happens, it is totally normal to have complicated feelings about a relationship with a therapist ending. “It’s okay to be hurt when a therapist ends the therapy relationship,” says Goerlich. “A huge part of our work happens because we build relationships with our clients, and any relationship ending is hard.”
Okay, so what about what happened to me? Well, it turns out that it’s not actually okay — professionally speaking — for a therapist to mysteriously cut off communication with a client. “What your therapist did to you was unethical,” says Goerlich. “ I would argue that your therapist didn’t break up with you — you were abandoned.” Ugh. Abandonment — which is the professional term for ending care without due process — is exactly what it feels like. Even years later, it still hurts at least as much — if not more — than some of my failed romances.
I’ll never know what happened between us, but the experts I spoke with agree that it’s not about me, actually. “It is up to the therapist to recognize that they are starting to feel burnt out and to take appropriate steps to take care of themselves before it starts to impact professional relationships,” says Miller-Martinez. So I mentioned before, therapists can’t just ghost you. It happens, but it’s not considered ethical professional behavior.
“No matter what the reason for the ‘breakup’ the therapist is still responsible for seeing that the client has access to care,” says Aimee Daramus, a Chicago-based clinical psychologist. That’s still true even if things with a client get messy. “Although it’s uncommon, a client might have become threatening or manipulative,” Daramus explains. And sometimes, as you might have heard, there is client-therapist sexual chemistry. “The client might have become sexually attracted to the client, or even the other way around, in which case it’s important for the therapy relationship to end,” she says.
No matter how uncomfortable it is, a therapist is responsible for terminating the relationship ethically. That doesn’t mean, though, that a therapist owes you a lengthy explanation when they end the relationship. As Goerlich points out, you might not want or need to hear one anyway. “It is sufficient — and sometimes the best therapeutic option — to simply say that they’ve realized they’re no longer the best person to help and they want to make sure the client is getting the best possible care,” says Goerlich.