Why Therapists Leave


Any beginning predicts an ending. Permanent relationships can become impermanent with time’s passage. That knowledge unsettles those in long-term treatment. Abandoned before, they wonder not “if,” but “When?”

Why do therapists leave?

An example: the man and woman had been married for six years. In mid-life, however, he was afflicted with a rapid and permanent hearing loss. In the midst of the crisis, his mother-in-law was diagnosed with cancer. She lived 1000 miles away. What was the wife to do? She chose to spend the last six weeks of her mother’s life with mom. She’d have done the same thing if she’d been your therapist.

Granted the departure was temporary, but such disruptions happen and are sometimes more lasting. A lovely psychologist of my acquaintance, a being so calming as to make quiet moments with her almost holy, fought illness off and on for years. Her resilience seemed infinite. In her ninth decade she banged against infinity’s wall and retired abruptly, having met physical problems even she could not shake off.

The choice is usually not so harrowing. My own retirement was the consequence of the increasing depletion I felt from doing my work. The weight of the problems of others pressed heavily, even though my clients were less troubled as a group than they’d been earlier in my career. Then too, books called out to be read, courses of study beckoned, and new wonders of the world awaited.

Therapists are notorious for burning out, though not all do. Unfamiliar places trigger our wanderlust. Everyone seems to believe California or some warm spot would be nicer, at least if you live in the Midwest. Grandchildren need attention while they are small. You cannot place their youth in a safe deposit box for later use any more than you can your own.

Life intervenes in unexpected ways. I do not mean to minimize the pain when a therapist departs before a patient expects the end of the relationship. I helped clients grieve such losses when they came to me afterwards. I also caused unhappiness myself by deciding to leave practice. Unexpected finishes, however, cannot be allowed to finish us off.

When I was about to embark on the capstone or giant-killer to a graduate education, the dissertation, my advisor disappeared, vanished. I found out he was going through a messy divorce. Fair enough, but to another state? Without telling me? I adjusted. I lined up a new dissertation committee chairman and was ready to proceed when my initial advisor returned, as unexpectedly as he departed. Granted, he was not my therapist, but still …

Therapists also, on occasion, change as people. Funny, one wants a transformative counselor, not a transforming one. The patient expects to be the only person to make substantial self-alterations, setting aside any desire for a reduction in boundaries allowing more intimacy with the doctor.

A young therapist/colleague became a carpenter in his ’30s. I met a lawyer with a towering income who opted out of his partnership to opt into a seminary. Charles Krauthammer, a syndicated conservative columnist, was a psychiatrist. Granted, not many established counselors change careers, but an occasional dropout happens.


Close to the end of my career I’d hear the question from a patient, “Do you expect to retire soon.” I think I answered, “I have no plans.” Until, of course, I eventually did and then announced my future unprompted.

We (and by “we” I mean you and me) have no crystal ball, no bewitched mirror on the wall. We don’t expect to divorce when we marry, don’t enter careers anticipating they will end soon, don’t fall into friendship with a vision of its erosion or collapse. I can only tell you — only tell myself — the things I know for sure. And sometimes what we think we know we don’t know. Fate’s hand spins the top of our lives in directions never imagined and, when the spinning stops, a new idea forms and informs us.

Therapists leave and it’s not personal, except it is. When you don’t think you are “enough,” a therapist’s departure (at least not one caused by a lightening-strike) says “You’re not enough to cause my staying at the job.” I get it and I also get the absence of an intention to harm.

So yes, your therapist might leave you, but your departure is more probable. The latter is best, for sure, if you’ve gotten what you came for. The good news is we have encouraging career-longevity data on doctoral level psychologists. The American Psychological Association’s Center for Workshop Studies reports that among those already “retired” in 2013, 42% were still working. The median age of retirement was 61, meaning half retired before 61 and half after. The sample included all doctoral level psychologists in the year of the study, not only clinical or counseling psychologists in practice.

Therapists, like most of the rest of us, are living longer and need to make a living. They have multiple incentives to continue. The satisfaction of meaningful work, the intimate contact with good people, and the words of thanks are enriching. The work is interesting and research offers us new tools. It’s an exciting time to be in the field, in the lab, and in the office.

We cannot guarantee our lives, any of us. The retirement or side-lining of a therapist probably won’t happen while you are in treatment. The answer to the “What will I do if it does?” question is that you will do what is required. In the meantime, avoid living the infinite variety of doom-laden scenarios available to imagination: a “thought-error” called catastrophization which can be treated with cognitive-behavior therapy (CBT).

Good advice comes from John Steinbeck’s The Grapes of Wrath and his character “Ma” Joad, the rock of a migrant family almost out of chances. She is the lady responsible for their emotional and physical sustenance, including cooking the salt-pork packed for the clan’s trip to an uncertain life in California. Her 16-year-old son Al asks:

Ain’t you thinkin’ what it’s gonna be like when we get there? Ain’t you scared it won’t be nice like we thought?

No. No I ain’t. You can’t do that. I can’t do that. It’s too much — livin’ too many lives. Up ahead they’s a thousan’ lives we might live, but when it comes, it’ll ony’ be one. If I go ahead on all of ’em it’s too much. … An’ (what I concentrate on is) jus’ how soon (the family) gonna wanta eat some more pork bones. That’s all I can do. I can’t do no more. All the rest’d get upset if I done any more’n that. They all depen’ on me jus’ thinkin’ about that.

The top photo is entitled Goodbye Grenada, Goodbye Karabik by giggle. The cover art for the sheet music for Long Boy (I imagine this means “So Long, Boy”) was drawn by Gar Williams. Both images are sourced from Wikimedia Commons.

Why the Holidays “Bum You Out” and What to Do About It

We are about to enter one of the darkest times of the year — and ironically are expected to feel great about it. I’m talking about the period from just before Thanksgiving through January 1st, also known by therapists as “six weeks from hell” for a good part of their clientele. But while the therapeutic community knows it is a tough time, much of the rest of the world works hard to look upbeat despite suffering inside.

What’s going on?

1. Fall and Winter. Things are dying. Nature is cold and wet, not warm and bright. Driving takes longer and is more dangerous. Days grow shorter until December 21st.

2. If you are looking for work, you are entering the season of waiting for the New Year when, you hope, job openings and hiring will begin again. Waiting is rarely easy.

3. People have less time for you and you have less time for yourself. Holiday gifts must be chosen, crowds must be endured, parties must be planned, food must be purchased and prepared. Budgets get stretched. Planes are costlier; while airports, train stations, and roads are more crowded. Lines are longer.

4. You dread the fact that you will have to see Uncle Ralph and Aunt Matilda over the holidays. Your uncle will drink too much and make dirty jokes that aren’t funny and your aunt will criticize your homemaking, while you are expected to smile through it all and be a good host or hostess.

5. TV and the Internet shall offer inescapable images of other people having a wonderful time, a striking contrast to your own existence. You can begin to feel that you — you alone — are out of the mainstream; and that the world really doesn’t care. This will be particularly hard to endure if you are without someone who recently was important in your life or if your social options are limited.

6. Many therapists go on vacation at this time of year (“Those SOBs!”), leaving their patients feeling abandoned.

7. You might begin to ask yourself where the year went, reflecting on all the things you hoped to do that somehow didn’t get done. The media will remind you of New Year’s Resolutions that you failed to enact and encourage you to make more of them.

8. Much about the holidays involves shopping, surely one of the emptiest, most soul-slaying activities ever invented. Yes, it can give you a “sugar rush,” but it is one that usually leaves you emptier after the thrill of purchase is over than you were before.

9. New Year’s Day — especially if you failed to get a date for New Year’s Eve — offers the possibility of capping the season in a truly miserable state. You will have a full 24 hours with nothing to do but reflect on your existence, compare yourself to all those people in sunny California having a good time at the Rose Parade, and look in the mirror and realize (to quote Dan Greenburg and Marcia Jacobs in How to Make Yourself Miserable) that

…every year you get to look less and less like the little kid with the diaper and the banner across his chest and more and more like the old guy with the beard and the hourglass and the scythe.

What to do?

First, realize that there are tons of people like you who are suffering silently — who don’t want anyone to see them in their unhappiness at a time of the year when everyone is “supposed to be” happy, and when lots of people are faking it.

Second, remember that if you don’t have someone to spend the holidays with, many people will be welcoming if only they are informed that you would be open to an invitation. Yes, it can be embarrassing to admit your lack of holiday plans, but it could lead to having a nice time.

Third, find activities to fill your day, even if it is organizing your photo collection. Shelters and soup kitchens where you might volunteer will remind you that there are usually people who are worse off (and more cut-off from the world) than you are. And you could discover, as some psychologists suggest, that giving does actually feel better than receiving, and make you feel better at a difficult time of year.

Fourth, if you sense your mood dipping as you enter this period you might consider calling your MD and asking for antidepressant or anti-anxiety medication. Most general practitioners are comfortable with prescribing these if they know you well. Many of the antidepressants can take a few weeks to have a positive effect, but the anti-anxiety drugs generally have a more immediate impact.

Fifth, recognize that the holidays will pass and that you’ve probably endured them (and things that are worse) before.

Sixth, if your mood typically plummets during the dark months, you might be suffering from Seasonal Affective Disorder. The use of a “light box” to provide you with the full spectrum of light found out-of-doors can provide relief. Have this possibility evaluated.

Seventh, avoid relying on drugs or alcohol to deal with the holiday blues. Whatever immediate benefit they might provide, they can quickly make things worse. Take care too, that your nutritional intake not be thrown out of whack by too many parties and big dinners; perhaps also, your exercise schedule. Get back on the track in all senses.

Eighth, make a list of those things that you are grateful for. Things you take for granted — the health of your children, the roof over your head, a good book, and even a single friend — can help you reframe your current condition.

Ninth, take some time to plan activities for January and February. Once the “low-grade frenzy” of the holidays is over, there may be an anticlimactic let-down. Without preparation and a return to normal social contact, the weather-challenged months of the early part of the year can be much too quiet.

Finally, you might want to read a portion of a benediction by William Sloane Coffin. Take it as a holiday wish for you, whether or not you have religious faith:

May God give you grace never to sell yourself short.
Grace to risk something big for something good.
Grace to remember that the world is now too dangerous for
anything but truth, and too small for anything but love.
So may God take your minds, and think through them.
May God take your lips, and speak through them.
May God take your hearts, and set them on fire.
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The top image is The Grinch Who Stole Christmas. The second comes from a Wikimedia Commons post of a 1910 New Year’s Post Card by Frances Brundage.