Have you ever found yourself in a position where you quietly disengaged from your therapist or psychiatrist? Maybe you didn’t show up to an appointment and never followed up. Or perhaps you just stopped responding to communication. This is a surprisingly common phenomenon known as “ghosting”. Although it’s rarely addressed, we should talk about it!
First off – why does this happen? The client/provider relationship is a unique one. Your therapist or psychiatrist is often uniquely aware of your most personal concerns (i.e. trauma history, fears, intrusive thoughts, etc.). So why is it that it feels so hard to open a conversation about taking a pause from therapy, asking for a change in approach, or simply discussing an end to care?
Sometimes there can be shame associated with feeling like you’re not progressing with treatment or goals. A common cognitive bias is to personalize this feeling and make the assumption that it’s somehow your fault you’re not progressing how you’d like. However, feeling stagnant in therapy can be inevitable at times, and it doesn’t mean you’re doing something wrong. It usually just means something needs to be adjusted.
Another factor that can make the conversation difficult is the fear of somehow disappointing your therapist or psychiatrist. I want to emphasize how important it is to put this fear aside. Psychiatrists and therapists are trained and equipped to handle these conversations. As a psychiatric nurse practitioner myself, I have zero expectation that 100% of the patients I see will continue under my care indefinitely. It’s unreasonable to assume that every match is the right match. Furthermore, your provider may end up agreeing that a change is necessary. Sometimes that means staying in their care and changing the approach and sometimes it means referring to another provider. Therapy and psychiatry are not about loyalty, they’re about fit, timing and addressing needs as they evolve.
If you’re finding yourself in a position that feels stagnant or repetitive, let’s talk about ways to address it. First, if you feel comfortable enough bringing it into a session, this is totally appropriate. If that feels like too much, you can consider drafting an email or note to open the dialogue. Some good opening statements might be “I’m feeling a little stuck lately, can we talk about my goals?” Or “I’m finding myself wanting more out of my sessions but I’m not sure what that looks like”. Perhaps you have a specific type of therapy in mind, maybe something you read about that resonated with you. It’s okay to ask your therapist or psychiatrist about different modalities and mention why they appealed to you.
Sometimes simply circling back to your goals can be a good way to put a lens to your care. What is it that brought you to therapy? What are your needs and goals now? Needs and goals will change over time – this is all part of the process. Because of this, it’s often necessary to change approaches. For example, maybe you completed an intensive exposure and response prevention (ERP) program and made headway with OCD symptoms only to realize that past trauma was showing up in your day to day in different ways. Maybe it’s time to think about EMDR or a more trauma-specific approach. This is not a sign of failure, it is growth.
What if you bring up your concerns and then change the approach and you’re still feeling like something isn’t quite right? This is common too. If it truly feels like it’s time to move on, it’s still appropriate to let the provider know where you’re at. At this point, I’d recommend bringing up the concern either in a session or in between visits in a note/email. Again, there is no shame in discontinuing care. You can let the therapist/psychiatrist know that you’ve decided to move in a different direction and would like to cancel sessions moving forward. If you want to elaborate on the “why”, you certainly can, but you don’t always have to. If you feel that the therapist/provider might be able to offer some recommendations on other types of therapy or perhaps a colleague that they feel might be a good fit, then it’s also okay to inquire about that at the time you’re discontinuing care. Again, I want to emphasize that these conversations are not nearly as uncomfortable for your therapist or psychiatrist as you might expect.
So, if you’re finding yourself in a position where your mental health care is feeling stale or your gut is telling you something is off, don’t put it on the back burner. Choosing not to ghost your therapist or psychiatrist doesn’t mean having to sit in stagnant care. Advocate for yourself, speak honestly and make intentional steps toward your needs.