My first therapy appointment was almost 10 years ago, when I was in a particularly bad cycle of my depression and trying to self-medicate with drinking. I was lower than I’d ever been, so I made an appointment with a licensed clinical social worker, ready to get started on the work I needed to do to get better.
Over the course of my hour with the social worker, I told her everything I could about what was going on with me. I felt unburdened and confident that I’d made the right choice—this therapy thing was going to be just what I needed. High on a wave of optimism, I scheduled a second visit.
Days passed, and that good feeling wavered, then faded. I convinced myself of all kinds of things about how the appointment had really gone: I wasn’t as bad as some people; she didn’t like me because I’d been too forthcoming; my problems weren’t real enough and I was just amplifying problems that weren’t actually problems. That was that. I canceled my appointment and never went back. My depression and drinking spiraled.
A few years later, after a traumatic late-term pregnancy loss, I was guilt-ridden and barely functioning. My obstetrician recommended a therapist and I went, more out of a sense of obligation than any hope of actually dealing with my grief. That’s what people do when they lose someone, right? Go to therapy. The first appointment seemed pretty routine: Here’s my deal, here’s what happened, here’s how I’m doing. Again, I never went back.
I’ve had three more first appointments since, but never a second. I tried therapists in different cities, with different approaches to treatment, but I couldn't commit, or even return once. I thought this weird pattern of ghosting therapists made me an outlier—that something specific to my pathology kept me from accepting help when someone could offer it.
But I’m not unique in this. Although research on one-time visitors isn't readily available, it’s estimated that around 20 percent of people who begin therapy don’t complete their course of treatment. Cost, distance, and scheduling conflicts are the usual suspects for ghosting on therapy—but sometimes it’s deeper. Patients may feel uncomfortable with the therapist they see, others may not be ready to do the work and become overwhelmed with the process, or, like me, they may feel guilty about having shared intimate details of their lives. Whatever their motivation, people who ghost after one appointment are part of business as usual for therapists, and there are some fairly straightforward reasons why it happens.
Feeling Remorse After Seeing a Therapist
Telling a stranger things that you've never said aloud, or that are embarrassing or traumatic, can understandably be difficult. It can leave you feeling vulnerable, exposed, or guilty.
You might have the tendency to say as many intimate things as possible if a therapy session is the first chance they’ve had to actually put voice to troubling or personal thoughts. When this is the case, New York–based clinical social worker Eileen Moran explained that first-time patients may feel remorseful after their first session. “If this is a lifetime of going through this problem, spitting it all out on the first day can be very intimidating afterward.If you’re teaching someone how to ride a bike, you don’t tell them to pedal as fast as they can on a main road with their eyes closed. The counselor needs to help the client to pedal slowly," she said. In a first session, if she picks up on a client's rushing into intimate or sensitive parts of their experience, she interjects to slow them down without shaming them or making the patient feel as though they’ve made a mistake.
Moran said that feelings of remorse may linger, but that they will most likely abate as a person becomes more accustomed to the process—but that a person should anticipate flare-ups from time to time: "They should expect that it isn’t easy to ride the bike, but they’ll get better at it and will occasionally fall...even after riding it for a while.”
Not a Good Personality Fit
If you aren’t comfortable with your therapist, the likelihood of a successful therapeutic process drops. An introverted patient may not connect with a therapist who is extroverted or “in your face”—while some people like direct answers and advice, others may prefer a gentler, more nurturing program.“While [some] therapists think that we can connect with everyone, some clients may not be a good clinical fit, depending on their reason for coming to therapy, their background, your expertise, their socioeconomic status, or just personality differences,” said Los Angeles–based therapist Kiaundra Jackson.
Jackson suggested that prospective clients do research before choosing a therapist. Information about many therapists' approach, background, and area of expertise, and cost are usually accessible online. Narrowing down your pool of prospective therapists might be a little tricky if you’re not familiar with the different types of therapy available. Having a basic understanding of what the most popular approaches to therapy entail can aid in your search. Some of the most common approaches include cognitive-behavioral therapy (CBT), psychodynamic therapy, dialectical behavior therapy (DBT), eye movement desensitization and reprocessing therapy (EMDR), and interpersonal therapy. There are many less common forms of therapy available, including mindfulness approaches and more existential or spiritual approaches.
During initial visits with clients, Jackson discusses the importance of a good personality fit and lets them know they’re in charge of who they see. “I tell my clients in my first session that they are not bound to me forever. They have the capacity to change therapists if they do not feel like we are a good fit.” If, after a first appointment, a person doesn’t feel comfortable with a therapist, the client can let the therapist know, and they may be able to suggest other therapists who may work better.
Not Ready to Commit to a Difficult Therapeutic Process
Doing the work to get better can be intense and emotional, and you may not feel ready to take that on. “Change can be uncomfortable, because one has to be willing to take a risk by trying new ways of thinking, coping, and behaving," Virginia-based clinical social worker Nidhi Tewari explained. "In most cases, previous patterns served a purpose, often for survival, but they are now having negative consequences, so they need to be altered.”
“Sometimes clients come to the realization in the first session that it is too daunting a task at that point in time,” Tewari said. " Clients may not be in a place to truly engage in the therapeutic process, but that doesn’t mean that clients can’t retry therapy down the line when they feel more ready.”
Tewari explained that many clients may be more inclined to make the leap into therapy when they see the impact their struggles on work, relationships, family, and other aspects of life. “At that point, the pros of therapy outweigh the cons, and the idea of being vulnerable and honest is less scary than life continuing on in the current direction.”
It’s important that a person feels comfortable with the therapist they choose, but it’s also important to understand that therapy itself isn’t comfortable. Understanding that discomfort is part of the process may help a person stick with it. If a potential client has a pattern with therapists like mine, Jackson suggests they tell let their therapist in their initial appointment. Acknowledging the pattern with a therapist can be integrated into the therapeutic process and help someone understand why they're ghosting in the first place—and find them actually coming back. I realized that my ghosting habit has been perpetuated by guilt about being too open in my five first sessions, then not wanting to face the therapists I spoke to about them. Knowing that this is a normal response for people like me makes me a little more willing to try again.
For help in locating a therapist in your area, visit the National Alliance on Mental Illness.
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