We’ve all heard of “ghosting” in the context of dating: You’re having a great time together, things seem to be going well, and then you never hear from them again. Ghosting can also occur in the therapy realm. In my experience, most people who drop out of therapy leave without warning or providing any explanation. It kills me when people “ghost” therapy, because usually they continue to need services, and now they’re just not receiving care. According to Swift & Greenberg (2012), one in five people drop out of therapy, so this is a common problem.
I do understand the urge to ghost, because it can be awkward to have a tough conversation with your therapist. One thing to remember, though, is that therapists are literally trained to have difficult conversations. We talk about unusual things all day, and you’d be surprised by the things that do not offend us.
People drop out of therapy for many reasons. Although the therapists themselves often don’t find out, research provides some answers (Mojtabai et al., 2012), and I can guess as to why many people leave.
Here are some of the most common reasons people “ghost” therapy. This guide is meant for both adults in therapy and parents of kids/teens in therapy to learn how to navigate barriers to treatment and have difficult discussions with their therapist in order to continue to receive care.
I’m sure financial situations are the #1 reason for early dropout from therapy. Therapy has many costs associated, such as the fee itself (which may or may not be covered by insurance), gas mileage, and lost time from work. Maybe therapy is costing more than you expected, you lost your job, or your insurance changed. Although unfortunate, please do not ghost therapy for these reasons!
First of all, with the recent passage of the No Surprises Act, hopefully your therapist has explained their fee structure well, so that you are at least well-aware of all the potential costs of therapy.
Secondly, although it can be awkward to talk money, therapists are open to having discussions about finances. Your current therapist may be able to go on a sliding scale fee until your financial situation improves. If not, they can help guide you in finding more affordable therapy options, instead of you having to navigate the mental health care system on your own.
Lastly, sometimes finances are wrapped up in the reasons that people are attending therapy. Whether it’s someone with ADHD impulsively spending on unnecessary items or someone with anxiety worrying they can’t afford therapy (when they can), you and your therapist may find that you actually do have the financial resources to continue treatment.
You Think You Don’t Need it Anymore
Sometimes people just decide, “eh, that seems like enough therapy.” Or they just have no idea how long therapy is supposed to last. They think they should be “cured” after 1-2 sessions. These are the kind of things you’re allowed to ask your therapist!
My advice is to please finish the “course” of treatment, even if you feel like you’re better. I can’t tell you how many times working with kids and teens, families have dropped out too early, and then months later they are dealing with a much bigger issue than before. You may end up essentially wasting those initial few sessions if you drop out and then return later.
Most evidence-based therapy is more short-term, but depending on your presenting problem, it may be a longer time period. Your therapist will explain when you’re supposed to be finished. If you “feel” done, please have an open discussion with them rather than just stopping making appointments.
Maybe your school, work, or extracurricular schedule changed and now you can’t attend treatment at the same time as before. Instead of dropping out of therapy before it’s complete, please discuss the issue with your therapist. Maybe they have ideas for how you can still fit in treatment. Or, you might be able to be flexible with your schedule for a short time, if you understand the expected time frame of continued therapy.
You Don’t Like Your Therapist or They Offended You
It’s really nice to be able to find a therapist who matches variables that are important to you: ethnicity, gender, age, sexual orientation, etc. Sometimes, though, that is just not possible. Or, they met your criteria, and you’re just not a huge fan of their personality.
When I work with teens, I usually say that it’s a problem if they 100% hate me, but they don’t have to 100% love me. I’m not here to be their BFF, I’m here to help treat a disorder. If your therapist is using evidence-based treatment and helping you feel better, but you don’t completely click, therapy could still work. But, at the end of the day, if you just don’t think you can connect with them, this can be an open discussion with them. Either they can actually be more personable, which would help you get along better, or they can help you find a better fit with someone else, rather than you having to search again on your own.
If your therapist actually offended you, you have to ask yourself whether it was intentional or not. If it was an accident, please bring it up to them! Although it could be uncomfortable to discuss, the conversation might really improve your relationship. (If they intentionally offended you or don’t understand how they offended you... skip to the bottom!)
You’re Afraid to Open Up or Tell Them a Specific Problem
Maybe you’re very new to sharing your feelings and it’s tough. Or maybe you’re worried about telling them something very specific, such as your suicidal thoughts or current abuse, because you’re unsure of what happens next if you disclose something like that. Try asking your therapist a hypothetical question. They may provide more information that helps you feel more comfortable disclosing something major to them.
You’re Unsure if Your Therapist is Credible
Maybe your therapist is in training, and you don’t know if they have enough experience to help you. Or they have 30+ years of expertise, but you’re still not sure if this whole approach is right for you. This is another time to have an open discussion with your therapist. It can be scary to risk offending them, but as long as you’re respectful, they are used to answering these kinds of questions. If a good therapist realizes they are not competent to treat you, they will refer you to someone who is a better fit.
You’re Unsure if You’re Getting Better
Although this factor seems like an “unknown,” it really is not at all! You and your therapist should be tracking your treatment progress to ensure that your symptoms and overall life are improving. If you have no idea if you’re better or not, this is a good question to ask your therapist.
If you are in a depressive episode, just getting out of bed or showering can seem like too much. Attending a weekly therapy appointment and having to talk... out of the question! Now, obviously, when you’re currently depressed is the best time to attend therapy. This is another time to share with your therapist. They may be able to help you problem solve so that you can attend therapy in a way that works for you. And, along the way, hopefully your mood will improve!
Maybe you’re coming in to treat an anxiety disorder, but the treatment seems terrifying! Or you already have social anxiety, so talking to someone you don’t know well is extra challenging. This gets down to defining your personal goals for treatment. Working on your anxiety will mean opening yourself up to discomfort. Why would you do that? Because you have a goal of becoming a singer, or you want to travel to Australia solo, or you want to just be able to say “hi” to someone in class. These are the reasons that can motivate you to keep coming to therapy, even though it’s hard.
Another challenge I have found is that often parents of anxious children are also anxious. They get a bit freaked out when they see that the therapist is pushing their child (and them as parents) to face their fears. In this case, as a parent, you may need to do some anxiety work to be able to handle participating in your child’s treatment. Your child’s therapist can usually help you find an adult provider.
Reasons to Ghost Your Therapist
There are some scenarios in which it would be most appropriate to ghost your therapist. If your therapist violates ethical codes or laws, you should leave their care. Here are some examples of scenarios that would warrant ghosting:
-Trying to engage in a sexual relationship with you or committing sexual assault/harassment.
-Trying to be your friend outside of session.
-Asking you for money (outside of their fee), gifts, or to offer them services.
-Using a treatment modality that has been discredited by experts (e.g., conversion therapy).
In these cases, you should report the therapist to their state licensing board (or local authorities, if needed).
In conclusion, most problems in therapy can be resolved through a simple, but uncomfortable, discussion with your therapist. Even if you decide they are not the best fit for you, they can help you find another provider or resource to continue your treatment. Your mental health is so important, and it should not be neglected because of very common obstacles to continuing therapy.
Mojtabai, R., Olfson, M., Sampson, N.A., Jin, R., Druss, B., Wang, P.S. ... Kessler, R. C. (2012).
Barriers to mental health treatment: Results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 41(8), 1751-1761. doi:10.1017/S0033291710002291
Swift, J. K. & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A
meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547-559. doi:10.1037/a0028226