“Sorry, I can’t be your therapist. Here’s a referral to another colleague I trust…”
Some people may take for granted that therapists can pick and choose who they see and under what conditions. Not all therapists will see every patient that walks through their office door. There are a variety of reasons a therapist won’t see you, and most of them have to do with professional ethics.
For instance, most therapists seek to avoid “dual relationships” with you or their other patients. A “dual relationship” is one where the therapist isn’t just your therapist, but may also be a friend, lover, business associate, or some other role in your life. Therapists seek to avoid dual relationships, so if they are already your friend, business associate, or whatnot, they will refuse to become your therapist as well (this also works in reverse — your therapist should never offer to become your friend, lover, business associate, etc).
Although this may feel like rejection, you shouldn’t take it personally. Therapists will often avoid seeing certain people for these reasons to ensure the patient is treated with proper respect and dignity. Here are five reasons why your therapist won’t see you now…
1. You’re not on an insurance panel they belong to.
As much as we don’t like to think about it, therapists need to make a living as well and they do so by charging for the psychotherapy they provide. Many therapists accept health insurance for reimbursement, but they don’t always accept all insurance. So if the health insurance you have isn’t health insurance your therapist takes, you’re out of luck. Or you can pay their full rate out of your own pocket — anywhere from $75 to $150 per hour.
A small minority of therapists will take patients on what’s called a “sliding scale” fee, too. This is where the therapist discounts his or her hourly rate based upon your annual income. It never hurts to ask.
2. Your therapist has an existing relationship with you, your family, or a shared mutual friend.
As mentioned in the introduction, a professional therapist will almost always seek to avoid dual relationships — especially where they have a pre-existing relationship with you in a nonprofessional capacity. While this may seem not to make sense (“Who better to listen to me than my best friend the therapist who already knows all my secrets?”), you have to imagine the worst-case scenario. What would happen if your best friend, who is now your therapist, tells you something you don’t want to hear or vehemently disagree with in therapy? Who then do you turn to? Dual relationships rarely end well, so that’s why therapists are taught to avoid them.
This is also a good time for a reminder that therapists nearly always seek to avoid entering into a relationship of any kind with a past client as well. Because therapists share a unique therapeutic bond with that person, it has the potential to harm the patient if a new type of relationship is transposed on top of it later on. While different professional ethics vary on this topic, most therapists seek to avoid any kind of relationship — whether it be a friendship, romantic interest or business partnership — with an ex-patient.
3. Your therapist is seeing someone else in your family, a close friend, or has a close relationship with one of those people.
Unless the therapist is specifically doing family, child or couples counseling, most therapists try to avoid seeing people who know one another in a close or intimate manner. Doing so can cause all sorts of troublesome problems for both the therapist and the patient, as the therapist will hold secrets about the two parties that they may have a hard time not inadvertently divulging.
This can be especially difficult if you were first seeing a therapist and recommended the therapist to a close friend or family member. The therapist ends therapy with you and starts with a new patient, who is your friend or family member. The therapist may not agree to see you again while they are seeing this other person. It may not seem fair, but therapists may do this in order to keep their boundaries well-defined and avoid conflicts of interest.
4. You have a personality trait, physical trait, or component of your history that the therapist chooses not to work with.
Therapists are human too, and while they are carefully trained to recognize their own foibles and “issues” while conducting psychotherapy, there are times where it simply isn’t going to work for them. Good therapists recognize that they can’t work with certain clients as early on as possible in the client’s therapy, and refer them to a colleague for continuing treatment. It could be as something as simple as body odor, or as complex as you remind them of their mother.
Therapists will probably not share with you the specific issue that prevents them from working with you. Some feel ineffective working with certain types of people or those with certain kinds of problems. I know therapists, for instance, who refuse to see anyone with a personality disorder, because of the complications it can bring to treatment. A therapist may just not feel safe around a certain type of client, or clients who have certain types of concerns.
5. They’ve worked with you in the past and feel they’ve done all they can for you, or don’t have room in their schedule now to take you on.
Sometimes therapists feel like they’ve already done all they can for a person after therapy has ended and don’t see the point in opening the door again. This may feel like they are not being fair to you, or that they should take on past clients no matter what. But therapists sometimes have to make a decision about who to see, and whether the person will benefit from additional psychotherapy.
While most therapists will gladly open their doors to see an ex-patient again, not all will. It may be due to a conscious decision on their part, or simply that their schedule is full up and they have no room for “new” patients (even if you’re not really new).
This entry was inspired by Dr. Kolmes’ March 2010 blog entry, When a Therapist Says It Isn’t a Good Fit.
36 comments
A couple of reactions.
You wrote…
“3. Your therapist is seeing someone else in your family, a close friend, or has a close relationship with one of those people.”
I saw this in action once in an almost-soap-opera fashion, where a therapist had a long-standing psychodynamic therapy underway with client X, much of which had had to do client X’s search for a life-partner. Client X met person Y, and fell deeply in love with him. Person Y, unbeknownst to client X, was a close personal friend of the therapist.
What a mess. All three of them are still sorting it out. All I can say about it is that life happens.
What would you do in that sitch?
As for your last point, #5, it reads like a bundle of rationalizations wrapped in a collection of excuses surrounded by a plethora of justifications. After a gap in time, how can the therapist possibly deduce that s/he can nothing more for the patient without having the patient in his/her office for a good number of new sessions? Life changes, people change. This reason feels presumptive in the strictest sense of the word.
The scheduling thing? Puh-leeze. There are always cancellations and slots that open up at the last minute. You know this, and I know this. It is a reality of the business, even for the analysts. As a practical matter, if the patient is willing to be flexible for a while, the therapist can always fit them in at the last minute. And if the patient can only be flexible in the medium term, waiting a month, six weeks, or eight weeks will almost always result in an opening.
I agree. And the excuses kind of make it a whole lot worse. The therapist suddenly becomes just another person that is rejecting you but trying to be nice about it. That’s generally how adults reject one another.
I had this happen and it was so very painful that I’ve ceased therapy all together. I just can’t trust therapists anymore.
Excuses are easy to spot and turn a business relationship into a personal rejection.
I really think reason #5 is a terrible excuse for not seeing someone. It seems more like, the therapist just doesn’t like the client.
There are always openings eventually. The therapist can be honest and say, “I don’t have many openings, I think it would be best if you see someone else, or you may not get in to see me for a few weeks”, but private therapists always have people canceling and/or dropping out of therapy.
Also, unless the client has an issue that the therapist isn’t trained to deal with or is refusing to do the therapy homework or be engaged in therapy, I think it’s irresponsible for a therapist to just abandon the client. And even then, it should really be the client’s decision if they want to see someone else.
Most people in therapy are very vulnerable and many are suicidal (about 1/4 have suicidal ideation). I think it’s very damaging for a therapist to say “sorry, I don’t want to see you anymore.” Most people will see that as a personal rejection. Plus, if the client already has an established relationship with the therapist, it’ll be easier to keep seeing the same therapist, instead of having to start over with with another therapist.
Honestly, if #5 really is a paraphrase for “the therapist just doesn’t like the client,” that’s a fine reason by me, and phrasing it as a schedule conflict or a professional limitation is a kind way to do it. As the article says, therapists are only human. If any strong personal feeling–positive or negative–is likely to prevent them from maintaining their professional objectivity, especially if it comes up at a point in the therapy where some progress has been made and there’s a natural pause or plateau where a referral for another approach might be helpful, letting go is just the reasonable thing to do. They’re therapists, not life partners.
And seriously, if you honestly feel that a particular therapist would terminate therapy with you (or not make room in their schedule for you to resume therapy with them after a break) for trivial reasons that aren’t in your best interest, why would you want to work with that therapist anyway? Even if they capitulated and “took you back,” if you’re in an emotional state that leaves you vulnerable to taking that kind of professional decision personally, wouldn’t you end up so worried about the possibility of further rejection that you wouldn’t be focusing on your own progress anyway?
You are correct. That doesn’t take the trauma of bring dumped by a therapist away. Making excuses is not kind. It likely triggers many bad feelings where others have given you the same “kindness”
I was surprised to read such an unsubstantiated, outdated and inaccurate statement of “a professional therapist will almost always seek to avoid dual relationships — especially where they have a pre-existing relationship with you in a nonprofessional capacity.” Dual relationships are unavoidable in rural and many small communities across the country. They are mandated in the military and forensic settings and unavoidable on college campuses. As my book and many articles at http://www.zurinstitute.com/articles.html#boundaries clearly described, some dual relationships can enhance the therapeutic relationships between therapists and clients, which is the best predictor of positive therapeutic outcome. APA, ACA and many other professional organization have changed their view of dual relationships, which is also reflected in their codes of ethics.
Ofer Zur, Ph.D.
Director, Zur Institute
http://www.zurinstitute.com
My only reaction, and I thank Dr. Grohol for his candor, is that contrary to current popular belief, therapy is not a cure-all. In fact, in my case, I found it to be worthless. Whatever progress I have made has been the result of self-help and hard work, and I didn’t have to pay $150 an hour for it.
Perfectly stated
I totally agreee with you Athirson. Not by choice, though. I went to counseling for appprox. 6 months. b/c of PTSD from rape, Major anxiety &depressive disorder,and was forced to have a new LISW every 3-4 weeks w/out notice after out-patient then voluntary in-stay in hospital for 5 days. Never completed CBT program in hospital b/c I was not in the hospital ong enough. Just got the booklet and a bunch of handouts. The hospital put me on the floor with suicidal and severely emotionly disturbed people. They should have been there. They neeeded help. Not me. I was not suicidal I just wanted talk therapy and tools to learn how to deal with all the fear, anger, anxiety, etc. The Dr.’s put me on so many anti-depressants that made me feel empty and diagnosed me with bi-polar disorder (ignoring the fact that I was raped and had PTDS. I just ignored what I had to deal, quit counseling,(I obviously got tired of the rotating counselors) took the meds. for 5 years.
Now I’m a mess. I’m off the meds., joined a gym, called a new PhD., she said I had to go back to the hospital!! I said no way. So I guess I’m on my own. I’ll continue to talk to my husband and deal with the denial of my family, try to forgive myself , & starve my fear /anxiety ALL BY MYSELF!
No thanks to the help of the Professionals!
Mouse
Wow, mouse, I feel for you and think your choice is good. The best therapists I ever found were not even therapists, but human. Also much better able to listen, and much more accepting and tolerating of the type of stuff that freaks professionals out. it seems to me that most professional therapists, even here, are unable/unwilling to handle anything, and feel that totally normal issues and feelings can only be handled in a professional, paid for $50 minute hour. They shake, and outright reject anyone who asks them for or about anything over the internet, immediately suggesting someone like ‘you’ needs to be handled in a hospital/office and is otherwise too dangerous to be talked to normally.
etc, etc,…Oh, and in a psychiatric hospital, or on a psychiatric floor, I think the only ones who are really helpful are either the aids, or the other patients.
PS: And social worker? my sincerest condolences!
Just venting here … I have been trying to find a therapist for the past year to help me get past a divorce … they either talk ONLY about money, are too busy or aren’t even licensed and go by the title “life coach”
One was very clear that she intended on billing my insurance BEFORE I met with her, and would not schedule an appointment unless I provided her with my insurance and financial information.
I have come to the conclusion that theripist have all become greedy and I give up … I read a book or something, but clearly there is no one who want to help … they just want to get paid ..
Oh and I have insurance that pays for this, and I have money … paying is not a problem for the right help. But the entire initial conversation being all about paying … fuck that …
So you so called therepist .. fuck you greedy bastards
I am so sorry for this bad experience my dear “why”. However, my experience is
very different. In Greece, Thessaloniki,therapists are ready to provide their help with lower prices and even without money if necessary. One of them is myself.
This is not new because of the economic crisis. It has been since ages.
I do not want to overgeneralise, but there are a lot of them.
By the way, there is no insurance that covers counselling fees, in Greece.
The client has to pay from their own pocket.
A doctor’s office does the same thing, why. People don’t complain about that. I can’t make an appointment at my doctor or any doctor without them asking about my insurance. A therapist is no different. They are in the business for money not charity.
Agree
I have had severe depression for many years now, but I also have social anxiety disorder. I have attempted to seek help 3 times in the past 7 years. Each time all therapists in my area say they do not have room to take me on as a client. I am to the point where the thought of death honestly makes me happy. I know I need help, but where am I supposed to go when the people who are supposed to help refuse to??? I just don’t k ow what to do anymore.
Hi Lost, I’m sorry to hear of your difficulty locating a therapist. Not sure where you live, but in my area, on the New Jersey Coast, a lot of therapists have only part-time practices to supplement the low wages they earn working full-time at behavioral health centers and agencies. This could at least partly explain why the five you called had no available appointments for you.
My suggestion (if you haven’t already done so) is to check out the therapist directories at: (a) psychologytoday.com; (b) goodtherapy.com; (c) the American Counseling Association (counseling.org), National Association of Social Workers (nasw.org), and American Psychological Associations (apa.org) online therapist directories; and, lastly, (d) your health insurance company’s provider directory. Most of these search tools even allow you to specify a particular specialization in depression.
Hope this helps. Godspeed to you.
Another time when a therapist should not see a client came to mind for me.
Social workers, counselors, psychologists, and Marriage and Family Therapists all contain a mandate in their ethical guidelines that they only administer treatment in areas in which they are competent. In other words, therapists have the ethical obligation to refer a client to another therapist if they lack the skills required to help a client.
For example, while I have experience working with clients struggling with substance abuse, I have never been trained to work with children on the autism spectrum. I lack the training to diagnose, and treat individuals on the spectrum. As a result, I would first explain to the client’s parents my lack of training and suggest other therapists with more specialized training. If I felt that I could help the client in other ways–for example help the parents learn to manage stress, process grief, learn to work together as a team, I would offer those services.
Since therapists are human too, many of them struggle to work with certain personality types or diagnoses. As a result, they sometimes offer subpar services when working with certain clients. During these times, therapists might choose to instead refer the client to another therapist.
Several months ago I was working with a mother and her parents during a therapy session. An issue came up that mirrored a family issue in my life. The clients asked me for my opinion regarding a matter, and I disclosed to them that I was biased regarding the matter. Luckily I was at a clinic, and with the permission of the clients, we were able to have another therapist join us for the rest of the session.
Dr. Grohol,
I’m glad you listed Reason #4, because that sometimes becomes misconstrued as discrimination. I’m thinking of the case last year in which a graduate counseling student (I don’t recall where) who was completing Practicum in her school’s counseling center, was expelled from the program because she referred a LGBT client to another therapist due to a conflict with her religious beliefs.
Professional counselors are ethically bound to either seek supervision or transfer a case to another provider, whenever they feel they will be unable to render objective professional care.
As a Licensed Professional Counselor ( I am also a Christian and personally have no moral conflict helping LGBT clients), my understanding is that it’s in the client’s best interest to refer her or him to another therapist who can provide objective care, than to attempt treatment myself and risk my religious beliefs compromising that treatment.
I was just told that is is unethical for a clinical psychologist to see you if you are seeing somebody else for therapy. Is that true.
During my first visit and evaluation, the psychologist decided he could not see me due to the fact that he already sees my mother. Once this was established he stopped the evaluation and ended the session. I then asked for a refund which was refused. How can he charge my insurance for an incomplete evaluation which is of no benefit to me? I understand that some time was taken in which he could have seen another patient, but in the end its a business and thats the cost of doing business. There are situations like this which are probably generally rare but are of no value to either party. I was told I could have my copay but they still wanted to charge my insurance. It seems fraudulent.
could you think of it like this? that person booked the time to do the evaluation, and write up the report. Regardless of when the appointment ended, he or she could not use those working hours to provide an evaluation or session for another client. When you have a regular salary job, if you show up for work and there isn’t much work that day, you might clean out your desk or catch up on stuff, but you would still get paid.
I was wondering if it is ethical to block a former client who will not stop calling? I have given her many referrals as well as a emergency hotline number and explained why O am not able to see her any more ( the reason was #4). So can I block her phone number?
Fascinating. I’ve never seen a therapist outright admit they want to dump.a.client by any means.
May you receive the karma your create. Only you know if that is good or bad.
Honestly sounds like a lot of excuses to stop helping someone or not to help someone whenever the therapist chooses. That’s an awful lot of power for one person of a therapeutic relationship to have. The therapist can say ‘hey open up to me with your private pain. Oh and by the way at any moment I have a number of excuses to pull the plug and leave you more vulnerable to perhaps further rejection and pain.’ Oh and all this from a profession that is there to help you and improve your life? Justification for just pulling out whenever?
Exactly. And being dumped by a therapist is profoundly damaging. PROFOUNDLY SO.
But they keep saying therapists are human too. Many people justify and reason away guilt from doing something cruel.
Yes. I had a suicidal attempt 2 weeks ago. Depression Bpd. My psycologist is disappointed. I wish it had of worked, maybe next time
..
About 20 years ago I was going through a trying time and sought out a psychologist to possibly help me work through some issues. I made an appoiment for my first evaluation. I went to the appointment filled out all the insurance information and paid for the visit. The psychologist spent a 1/2 hour with me going through my issues. Then she told me her office would be in touch about further care. I received a phone call a couple days later where her office manager commenced to inform me that the doctor was choosing not to take me on as a patient. No explanation for why only that she hoped I’d get help somewhere else. No referrals either. I was humiliated. I had trust issues to begin with and felt so rejected and hurt. I had trusted her with my pain and was rejected with no explanation for why by the office manager no less. I never went to another psychologist after that. I could no longer trust the process.
I want to gently point out that, by your comment, you need to see another therapist.
If you could open up enough in just 1/2 hour that you felt abandoned, and lost trust by that person not taking you on as a client, that’s something that needs serious looking into.
Also, that therapist didn’t refer you to anyone because they didn’t know you enough to make a good decision. Their choice would be as good as your guess.
I hope you give therapy another try. I know what it feels like to hold back decades of feelings, and wanting to dump off those emotions all at once. But, part of that first appointment is about getting a “vibe” with each other. If they had an opening in their schedule, they want to fill it. So don’t take it personally if they didn’t accept you. You could have been a splitting image of someone they know. Or, insurance problems.
Just know that they will take you unless there is immedeite countertransference, or they feel like they don’t offer the type of therapy/have the skills you need.
This. Exactly. When your trust is violated to this extent, you just can’t trust the process again. Thank you for helping me phrase my feelings correctly.
I am so very sorry that you had to go through that.
After 2 years with the same therapist she abandoned me for good when I was released from hospital. She had me forcefully admitted in NY because I told her of my desire to die. The day after I was released she took 11 minutes to say she was done with me. I’m hurt, feel rejected, worthless and stupid for ever saying anything in the first place. I have not returned to therapy with anyone because I no longer trust any provider. I struggle every single day and have no one to talk to. She was my lifeline and someone I believed was compassionate, honest and caring. She quit because it was too hard, and I wasn’t worth her effort. Add patients that are not worth the effort to your list, call it what it is and stop defending poor practice.
Psychotherapists have a duty of care to their patients. I believe that terminating therapy because you don’t like someone or choose not to work with their particular pathology, without referring them on to another therapist, breaches this duty of care. People who seek therapy are often deeply distressed and to experience rejection as the hands of the therapist does enormous damage and destroys trust, making it very difficult to receive psychological treatment. I do feel that psychotherapists frequently dodge their professional responsibilities while cynically using the patient’s illness as an excuse. This is why I am very reluctant to go to therapy again despite having significant mental health problems.
The entire field of therapy is a joke. My therapist left because I called him out for bringing someone into our session without my permission. Two weeks later he was no longer competent to treat me and referred me to another therapist. At the time I was grieving the recent death of my son. He did not care. This turned me off from therapy and decided to go to friends and clergy which is a much better fit. I can see why people who have mental difficulties don’t seek help. More mental help dollars is not what is needed to help those in need it is kind and caring people. Therapy only makes those hurting feel worse. All the excuses for abandoning these poor souls only makes the therapist feel better while the client goes on to feel worse or even commit suicide or murder. Grief counseling is available. You hear that after every tragedy where was it before the tragedy?
I don’t mind if it’s #4 or # 5, which for me it’s one of the two I believe. But I don’t understand why he didn’t refer me to anyone. Not another therapist. Not a hospital. Nobody. What can I do in this instance.
I am experiencing this now in my life.left feeling confused by the rejection.people seek help for a reason .your told if you have suicidal thoughts seek help just to have them say there is nothing more I can do for you.just being there just being supported and show empathy.thats what’s needed.dont tell people to seek help if your just going to reject them
I recently had a similar experience.After a sexual assault I was given the name of 3 therapists. The first therapist informed me she couldn’t see me due to a conflict of interests, she recommended the same 2 others I was given. In contacting them, the first would love to take me however she was retiring in a few months was not new patients .The third no longer excepting my insurance and only accept insurance clients. I currently am on a waiting list for a non-profit thats about a 1hr drive(and another state,I live in a very rural area) I’m also attempting to get my insurance to cover a doctor thats out of state but offers telemedicine.
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