We’ve all seen it happen. Maybe some of us are even guilty of it ourselves. When you get an email from that pesky neighbor, a text message from the boring date you went out with last week, a voicemail from the lazy coworker who wants you to pick up the dessert for the potluck—sometimes it’s easier to simply ignore the person on the other end than respond. This disappearing act has entered our lexicon as “ghosting.” Some call ghosting a byproduct of diminishing face-to-face interaction. Others say it’s because we’re simply too busy to give priority to the small things. Unsurprisingly, many therapists now encounter clients who may even ghost therapy. Here, four therapists acknowledge that while getting ghosted by clients may shake your clinical confidence, it’s also an opportunity to become more empathic, more intuitive, and more effective.
1) Respect Hesitation and Leave the Door Open
Early in my career, I worked with a woman, Denise, who was in a very difficult marriage. There were a lot of reasons to stay in it, and a lot of reasons to leave. Several weeks into our work, it became clear that Denise would never be fulfilled if she remained with her husband. Then, suddenly, she didn’t show up for one of her sessions. I called her, but got no response. I waited a few days, then sent an email. A few days after again receiving no response, I decided to send her a handwritten letter. In it, I said I was writing to follow up about whether she planned to continue therapy. If she wasn’t, I asked if she’d tell me whether there was anything I’d said or done that made her uncomfortable, or whether she had concerns we might discuss. In the letter, I also invited Denise to have one last session with me so that we could at least talk about why the therapy was ending. I said that if I didn’t hear from her, I wished her all the best. For two years, I heard nothing.
Suddenly, one day, I got a call. Denise wanted to return to therapy. She’d ended her marriage and wanted to work through her grief, she told me. When we resumed treatment, she mentioned how much she’d appreciated the letter, especially that it was handwritten. She liked that it wasn’t intrusive, and was honest. It opened a door, she said, for returning to therapy when she was ready. I eventually learned that Denise hadn’t been ready to end her marriage during our first round of therapy. While I hadn’t been pushing her toward divorce, the more we’d talked, the clearer it became that the marriage was going to end. I hadn’t seen any overt discomfort from her, but I’d heard her reservations about divorce. She wasn’t ready to leave, and if someone’s not ready for change, it’s important that we as clinicians respect that.
I feel like the culture of dating apps, “swiping right,” and ghosting in romantic relationships has spilled over to other areas of our lives, with negative consequences. But clinicians have an opportunity to model something different. Ghosting is a largely undiscussed reality of psychotherapy, but it’s bound to happen sometimes. The useful questions are: How can we handle ghosting when it happens? How can we engage it in a way that’s not intrusive, but respectful? How can we create an ending to therapy that’s more real?
- Elizabeth LaMotte, psychotherapist, Washington DC
2) Ending Therapy is Awkward for Clients
Sean was a master avoider and very lonely. He was in his early 30s and had a lot of social anxiety. He was so anxious that he’d get nervous meeting the pizza delivery guy at the door. He couldn’t even look me in the eye during most of our sessions. But more than anything, Sean wanted to get into a relationship.
On several occasions, Sean didn’t show up for his scheduled sessions. When this happened, I knew it was because he was working through something he didn’t feel comfortable talking about. Luckily, he’d eventually come back and we’d continue working. He got better at being able to talk about his anxieties and how hard it was for him to say what he wanted to say. I saw him for several years, and eventually, he got into a relationship.
When Sean finally left therapy, he did it by cancelling an upcoming session and never rescheduling. I suspect he couldn’t tolerate ending therapy face to face. We never got the chance to talk about the work he’d done, or his successes and ongoing struggles. A few weeks later, I left him a voicemail. “I’m assuming since I haven’t heard back from you that you don’t want to make any further appointments,” I said. “I enjoyed working with you, and wish you all the best.” I also told Sean that if he ever wanted to return to therapy, I’d be happy to work with him in the future. When I mailed him a bill for our few last sessions, I included a little sticky note that read, “I hope you’re doing well. I enjoyed our work together.” I figure if clients wants to follow up, they will. They know how to reach me. A few weeks after sending the bill, Sean sent me a simple note back, thanking me for my help.
While it’s always healthier to have an in-person conversation about something that’s too tough to work on in therapy, if someone can’t do that, we have to be respectful of their decision. It’s an empathic failure to not listen to our clients’ behavior. Also, I think a lot of the time after clients ghost, they feel bad about having possibly hurt the therapist’s feelings or making them mad. I want them to know I’ve heard their message loud and clear, that I respect it, and that I have no hard feelings about it.
As you listen to clients talk, you can usually discern whether they’re avoidant or struggle to end relationships. In my experience, these are the people who are also going to have a hard time ending therapy in person. Saying “I don’t really feel like we’re on the right track and I think I need to find another therapist” would take a lot of guts. I don’t know that I could say something like that. The chance to repair relationships is a privilege. Sometimes we don’t always get that privilege.
- Alicia Clark, psychotherapist, Washington DC
3) Make Sure Your Clients Know They’re Worth Your Time
When Daniel first called, he said he was having trouble with his marriage—“the usual kind of trouble,” he cryptically explained. Daniel had been married 27 years and had two girls, both of whom he loved very much. We scheduled a session for the following week. When the day of our appointment came, Daniel called from his car to tell me he was running late. By the time he’d arrive, we’d only have 20 minutes left to talk. “We’re not going to have much time,” I told him, and asked if he’d be able to talk as he drove. “I can’t go into it right now,” Daniel replied. I was a bit annoyed, and suspect I didn’t hide it too well once he arrived.
Given the time restraint, I wanted to get started as quickly as possible. “Take a seat,” I told him in a way that probably came off as too assertive. “Now, tell me, what’s the purpose of our meeting?” It was a terrible choice of words, and an even worse delivery. Daniel blushed and glanced around the room nervously. Minutes passed. “Maybe we don’t have enough time,” he said. “We have enough,” I responded. Again, I was much too firm, and a labored silence fell between us. “I think I might be gay,” he said quietly. He crossed his arms, clearly feeling vulnerable. We had five minutes left in the session. “That’s something we can certainly talk about,” I told Daniel, to which he quietly nodded. At that moment, I knew it would be hard to recover from the damage I’d done. Daniel probably realized it too. Although I texted and left a voicemail, I never heard from him again.
Looking back, I know I damaged the therapeutic relationship by handling such a delicate matter with impatience. Today, I make a special point of taking time to let clients share their vulnerabilities without interrupting or letting my own feelings get in the way, even if it means my day runs a little longer. In the end, therapy isn’t about me. It’s about my clients, and being as present as possible for the full range of their humanness.
- Paul Hokemeyer, psychotherapist, New York
4) Ghosting Can Be an Opportunity to Repair the Therapeutic Alliance
I’d been seeing Mary in therapy for some time. In one session, we’d been working through a particularly difficult issue when she suddenly became frustrated. “Therapy feels like too much, too soon,” she said. We’d been doing good work, and I thought we were on the verge of a breakthrough. When Mary didn’t show up for her session the following week, I knew she’d become overwhelmed and had decided to end therapy.
When clients ghost, the therapist needs to think about how they might’ve been responsible. There could’ve been a breach of the therapeutic relationship that left the client feeling shame or anger. I thought back to the specific issues Mary had been working through before she ghosted to see if anything stuck out, and whether I could’ve handled things differently.
When a client ghosts, I like to give them a few days to follow up, so I don’t reach out immediately. At the same time, you don’t want to wait too long before reaching out, either. Otherwise, your client could interpret this as you abandoning them. When it comes to what you’re going to say, don’t be pushy. The point of reaching out is just to let the client know you’re available, not to scold them. Your message could be something as simple as “I noticed you missed our session a few days ago. You were working through some difficult things, and I want to let you know I’m in this with you and I very much hope to hear from you so we can continue our work.” I always encourage clients who’ve ghosted to try to come back to therapy for one last session. It helps to take the time to consolidate your gains and make a plan going forward, I tell them. Lastly, avoid talking too long when you leave your message. Otherwise, you might make clients feel more embarrassed about missing the session than they already are.
I knew not chasing Mary but respectfully reminding her that I was here for her was the best course of action. A few weeks after leaving her a voicemail, Mary called to express an interest in returning to therapy. “Maybe we went too quickly,” I told her over the phone. “Maybe all that stuff that came out was too difficult to face right now.”
This new honesty between Mary and me helped forge a relationship where we could discuss our dynamic and stop to assess how she was feeling during specific moments in our work. We decided that I had to learn to check in with her more, and she had to speak up more when something bothered her. It was especially beneficial because she even learned to do these check-ins outside therapy, becoming more conscious of her feelings in difficult situations.
I encourage therapists not to take ghosting too hard. We’re seeing a big pattern of cancellation in general in our society, in large part because technology allows us to ghost easily. The weight of cancelling doesn’t feel as heavy when we send an email instead of making a phone call or meeting face to face. Many of us also consider ourselves busier nowadays, so we sometimes give ourselves permission to cancel things without much thought. I think that most times when clients ghost, it’s probably because they have a difficult time deciding how to say goodbye, or think it’s going to be too awkward setting a date to end therapy.
- Andrea Bonior, psychotherapist, Washington DC
Did you enjoy this blog? You might also like "Five Things Seasoned Therapists Wish They'd Known: ...And the One Question You Should Always Ask Your Clients." or "The Mentor Who Changed My Therapy Practice: ...And How Two Little Words Changed Everything."
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Topic: Professional Development