AI therapy apps pose serious risks to users, which is why the American Psychological Association recently called for a federal investigation. Recent cases include teen suicides linked to chatbot guidance. With 987 million chatbot users worldwide, understanding these dangers is critical before trusting AI with your mental health.

Why AI Therapy Is Dangerous:

Artificial intelligence has crept into nearly every corner of our lives, from the algorithm that curates your morning playlist to the chatbot that handles your customer service complaints. Now, it’s knocking on the door of one of our most intimate spaces: the therapist’s office. And the conversation around AI therapy has gotten complicated quickly.

While tech companies promise revolutionary mental health solutions at your fingertips, mental health professionals and advocates are raising red flags that are impossible to ignore. The question isn’t whether AI can mimic therapeutic conversation: it’s whether it should, and what happens when it inevitably gets things wrong.

The Rise of AI Therapy and Why It’s Under Scrutiny

Let’s be real: AI’s takeover of healthcare was probably inevitable. The technology has proven useful for everything from diagnosing medical images to streamlining administrative tasks. But can AI be your therapist? That’s where things get complicated.

The explosion of AI chatbots and therapy apps between 2023 and 2025 has been nothing short of dramatic. We’re talking about 987 million people who have used chatbots, with 88% having interacted with one in the past year alone. These aren’t just casual users: many are turning to AI for mental health support, often without fully understanding what they’re getting into.

The regulatory landscape is scrambling to catch up. It’s a small step, but it signals that lawmakers are finally paying attention to what’s happening in this largely unregulated space.

Meanwhile, GoodTherapy professionals remain committed to what AI simply cannot replicate: accredited, expert care that’s genuinely personalized and grounded in ethical practice. Therapy isn’t just about having someone (or something) to talk to: It’s about the nuanced, deeply human work of healing.

Read More: Why AI Can’t Be Your Therapist

The Human Cost: When AI Gets Mental Health Wrong

The consequences of AI therapy-gone-wrong can be devastating, which is why the conversation about AI’s ethics is so meaningful. When we’re talking about mental health, the stakes aren’t abstract: they’re life and death.

There have been alarming reports of kids using AI chatbots to plan self-harm or suicide. Even more devastating was the recent case of a teen suicide that was reportedly linked to AI guidance. These aren’t isolated incidents or statistical outliers: they’re real people whose lives were affected by technology that simply wasn’t equipped to handle the complexity of human crisis.

But perhaps most troubling is how AI therapy might actually reinforce the very isolation that drives people to seek help in the first place. When someone is struggling with feelings of disconnection and loneliness, does it really make sense to offer them a relationship with a machine? AI therapy can feel like a polite mirror that reflects back what you say without the genuine human connection that makes therapy transformative.

AI therapy’s fundamental limitations are glaring: no crisis intervention capabilities when someone is in immediate danger, no ability to pick up on emotional nuance that might signal deeper issues, and zero accountability when things go wrong. These aren’t bugs that better programming can fix. They’re features of what it means to be human that simply can’t be replicated.

Watchdogs Step In: APA and Advocates Push for Oversight

The concerns have reached such a fever pitch that federal officials are finally taking notice. The American Psychological Association (APA) recently made an unprecedented move, requesting a federal investigation into AI therapy platforms. This move puts AI therapy’s risks of misrepresentation, failure to protect minors, and the absence of ethical guardrails on full display.

The APA’s concerns center on platforms that may be misleading users about the nature of the service they’re receiving, inadequate protections for vulnerable populations (especially children and teenagers), and the lack of professional oversight that would exist in traditional therapeutic relationships.

This regulatory push represents something crucial: recognition that the mental health space requires different standards than other AI applications. When a restaurant recommendation algorithm gets it wrong, you might have a mediocre meal. When a mental health AI gets it wrong, the consequences can be irreversible.

This is exactly why GoodTherapy remains committed to connecting people with real, qualified professionals who can provide the quality care and ethical oversight that human mental health requires. The role of ethics in therapy isn’t just about following rules: it’s about protecting people when they’re at their most vulnerable.

Read More: Explore the Importance of Ethical Therapy

What Stories Like This Reveal About Human Connection

When done right, your therapist should be a healing, safe, and encouraging part of your life that helps you navigate how to be human, which is something AI platforms can’t offer. Recently, a young woman, Savannah Dutton, got engaged and reported being so excited to quickly tell her longtime therapist. As one of the first people she told, her therapist of almost four years was crucial to helping Dutton feel safe, not judged, supported, and confident in her future.

Therapy works because it’s human. It’s about the subtle dance of empathy, the ability to sit with someone in their pain, the intuitive responses that come from years of training and human experience. When we replace that with algorithmic responses, we lose something essential: not just the warmth of human connection but also the clinical expertise that comes from understanding how complex trauma, relationships, and healing actually work.

GoodTherapy knows that the therapeutic relationship is the foundation of effective treatment. Our network includes professionals who do what AI can’t:

• provide the human connection
• set appropriate boundaries
• apply clinical intuition that make real healing possible 
• take accountability for their role

Whether you’re looking for culturally responsive care or simply want to find a therapist you can trust, the human element isn’t optional: it’s everything.

The Future of Ethical AI Therapy: What Needs to Change

AI isn’t going anywhere. The technology will continue to evolve, and mental health professionals need to figure out how to work with it rather than against it. But the key to a future of AI and effective therapy is clear guardrails and safety measures that keep patients safe. 

The future of ethical AI in mental health will likely involve hybrid models with robust human oversight, transparent regulation that protects consumers, and clear boundaries about what AI can and cannot do. Maybe AI can help with scheduling, treatment tracking, or providing psychoeducational resources between sessions. But replacing the human relationship entirely is not innovation: it’s a fundamental misunderstanding of how care works.

For consumers, the message is clear: research your providers, look for licensed oversight, and use major caution when considering AI-only mental health services. There are eight key ways that AI is not therapy, and understanding these differences could prevent serious harm.

If you are thinking about or actively looking for a mental health therapist, start by seeking safe, evidence-based care from qualified professionals. Real therapy, with real humans, is still the gold standard for mental health treatment. At GoodTherapy, that’s exactly what we’re here to help you find: genuine care, clinical expertise, and the irreplaceable power of human connection with no algorithm required.

Read More: Ready to Find a Therapist? 

Resources:

American Psychological Association: APA Calls for Guardrails, Education, to Protect Adolescent AI Users

Futurism: American Psychological Association Urges FTC to Investigate AI Chatbots Claiming to Offer Therapy

National Library of Medicine: AI as the Therapist: Student Insights on the Challenges of Using Generative AI for School Mental Health Frameworks

The New York Times: A Teen Was Suicidal. ChatGPT Was the First Friend He Confided In

Exploding Topics: 40+ Chatbot Statistics (2025)

CNN: Your AI Therapist Might Be Illegal Soon. Here’s Why

People: Woman Shocks Therapist When She Calls to Tell Her Big News (Exclusive)

First responders and physicians run toward danger when most of us run away. Yet at the end of the shift, many carry invisible wounds, intrusive memories, disturbing images, flashbacks, weights too heavy to carry alone. Preventive trauma treatment for first responders has become more critical than ever as research reveals alarming rates of PTSD among healthcare heroes.

The Culture of Silence and Why It’s Harmful

In high-stakes professions, showing vulnerability has long been seen as a liability. For physicians, there’s a persistent myth that trauma somehow “doesn’t happen” to them. This couldn’t be further from the truth. The fear of professional repercussions, perfectionism, and cultural stigma often pushes doctors and first responders to keep their struggles hidden.

But research paints a different picture. A recent systematic review found that nearly 15% of physicians experience PTSD symptoms, compared to only about 3–4% in the general population. Other studies have found ranges from 4% up to 28%, depending on specialty and trauma exposure. Emergency physicians, in particular, show high rates, about one in six meet criteria for PTSD.

These numbers make one thing clear: trauma doesn’t skip over people with medical degrees or uniforms. It just hides more easily under the weight of stigma.

Why Trauma Symptoms Don’t Just “Go Away”

Flashbacks, nightmares, and intrusive thoughts aren’t signs of weakness. They’re the brain’s way of saying: something needs attention. Left alone, these symptoms rarely fade. In fact, they often intensify, interfering with work performance, relationships, and physical health.

Too often, the advice in medical and first responder circles is to “tough it out” or to “just talk about it.” While talking can help reduce isolation, untreated trauma symptoms don’t fully resolve without an evidence-based approach. This is where preventive trauma treatment for first responders becomes essential.

Prevention Is Not Optional; It’s Professional

Just as helmets and protective gear are standard in high-risk work environments, preventive trauma treatment for first responders should be treated as preventive maintenance. Early treatment prevents small cracks from developing into fractures.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is one such approach. Unlike general talk therapy, EMDR specifically targets and reprocesses disturbing memory networks. This helps symptoms like flashbacks and intrusive images quiet down.

But treatment isn’t just about methods, it’s about people. A trusting relationship with a therapist is the foundation of healing. Without rapport and safety, no evidence-based model will work. With it, even the most painful experiences can begin to shift.

Physicians: A Group at Special Risk

Physicians often hold themselves to impossible standards. Add to that the fear of losing licensure or professional standing, and many suffer in silence. Yet studies show the cost of ignoring mental health is high.

For example, nearly one in three medical residents experience depressive symptoms, and suicide rates among physicians are significantly higher than in the general population. The data on PTSD only adds to this urgent picture. Trauma symptoms are present, measurable, and real.

During the COVID-19 pandemic, research found that 18.3% of physicians reported symptoms consistent with PTSD, with higher risks among female physicians and trainees. This underscores the critical need for preventive trauma treatment for first responders and healthcare workers.

Changing the Culture: From Stigma to Support

Healing begins when stigma loses its power. Hospitals, fire halls, EMS bases, and clinics can create cultures of prevention by:

• Protecting confidentiality around mental health treatment
• Encouraging peer and leadership support
• Making time for routine mental health check-ins
• Implementing preventive trauma treatment for first responders programs

These changes send a powerful message: seeking help isn’t just tolerated, it’s expected.

Understanding compassion fatigue and burnout in healthcare professionals is also crucial for developing comprehensive support systems.

A Call to Action

Caring for trauma symptoms is not a sign of weakness, it’s a mark of professional integrity. It shows that first responders and physicians value themselves as much as they value the lives they protect.

Preventive trauma treatment for first responders isn’t a luxury. It’s a necessity. And when professionals heal, the benefits ripple outward, to their patients, their colleagues, and their families.

It’s time to normalize trauma care in medicine and emergency services. No one should have to choose between their badge, their license, or their life.

Frequently Asked Questions

Q: What makes preventive trauma treatment different from regular therapy? A: Preventive trauma treatment focuses on addressing trauma symptoms before they develop into full PTSD. It uses evidence-based approaches like EMDR therapy to reprocess traumatic memories and prevent long-term psychological damage.

Q: How common is PTSD among first responders and physicians? A: Research shows that physicians experience PTSD at rates of 15-28%, significantly higher than the 3-4% rate in the general population. Emergency department personnel show particularly high rates, with about 18.6% meeting PTSD criteria.

Q: What are the signs that a first responder needs trauma treatment? A: Warning signs include flashbacks, nightmares, intrusive thoughts, avoidance behaviors, hypervigilance, sleep problems, and difficulty concentrating. Physical symptoms like headaches and muscle tension may also indicate trauma-related stress.

Q: Is EMDR therapy effective for first responder trauma? A: Yes, EMDR has shown significant effectiveness in treating trauma symptoms. Studies show that 77.7% of veterans experienced elimination of PTSD symptoms after 12 sessions of EMDR.

Q: How can organizations support preventive trauma treatment for their first responders? A: Organizations can create supportive cultures by protecting confidentiality, normalizing mental health treatment, providing access to specialized trauma therapists, and implementing routine mental health screenings.

Take Action: Find Support Today

If you’re a first responder or physician experiencing trauma symptoms, don’t wait for them to worsen. Preventive trauma treatment for first responders is most effective when implemented early.

Ready to find specialized trauma therapy? Search our therapist directory to connect with qualified professionals who understand the unique challenges facing first responders and healthcare workers. Many therapists specialize in PTSD treatment and can provide the evidence-based care you need.

Remember: seeking help is a sign of strength, not weakness. Your well-being matters, not just to you, but to everyone you serve.

References

• García-Izquierdo, M., et al. (2016). Prevalence of posttraumatic stress disorder in health workers: A systematic review and meta-analysis. International Journal of Clinical and Health Psychology, 16(2), 143–151.
• Mata, D. A., et al. (2015). Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA, 314(22), 2373–2383.
• Olabarriaga, A., et al. (2024). Prevalence of PTSD among physicians: A systematic review and meta-analysis. BMC Psychiatry, 24(1), 50.
• Rodríguez-Rey, R., et al. (2020). PTSD in emergency staff: A systematic review and meta-analysis examining prevalence and risk factors. Humanities and Social Sciences Communications, 7, 21.

We’re living in a time when you can ask an algorithm for advice about anything, your marriage, your trauma, your loneliness at 2 a.m., and get an instant response. AI/ChatGPT therapy has become increasingly popular as people seek immediate mental health support. In some ways, that’s extraordinary. It can also be profoundly misleading.

While ChatGPT offer 24/7 accessibility as a therapy tool, they lack the nuanced understanding and therapeutic relationship that licensed therapists provide. More and more people are using large language models like ChatGPT as a stand-in for real therapy or meaningful connection. And while AI can offer information, or even momentary comfort, it also has a shadow side: reinforcing your biases, confirming distorted thinking with too much positive reflection, and leaving you lonelier than before.

It’s not that AI is inherently bad. It’s that it was never designed to replace the irreplaceable: human relationship, accountability, and the deep attunement that comes from being witnessed by someone who can see what you can’t. Understanding these AI therapy limitations is crucial for anyone considering ChatGPT therapy as a mental health solution.

The False Sense of Connection in AI Therapy

One of the most seductive qualities of AI is that it “feels” like you’re having a conversation with something that knows you. It’s programmed to mirror your tone and offer validation.

But unlike a therapist, a trusted friend, or a community, AI can’t perceive your nonverbal cues, notice your subtle contradictions, or check in about whether its reflection resonates. It can’t ask, “Are you sure?” or gently challenge you when you’re about to repeat the same patterns that keep you stuck.

Validation without reality-testing isn’t therapy, it’s an echo chamber. Research from Stanford University demonstrates that AI chatbots often provide generic responses to complex emotional situations, missing critical nuances that human therapists would catch.

Over time, the experience of being “heard” without being known can deepen the ache of loneliness rather than soothe it. This is particularly concerning given the rise in mental health stigma that already prevents people from seeking professional help.

Loneliness and Emotional Avoidance

For many people, turning to ChatGPT or other AI tools feels safer than the vulnerability of human connection. If you grew up believing your feelings were too much, or not enough, you might prefer something that always responds predictably and never has needs of its own.

AI can ease discomfort in the moment, but it doesn’t meet deeper longings for belonging and real connection. Using it repeatedly can become a way to avoid the risk, and reward, of genuine relationships.

A comprehensive study in Nature reported that people who relied heavily on AI for emotional support showed less motivation to seek human connection. Over time, their social anxiety increased. Easy access to AI interactions can unintentionally reinforce isolation.

Why ChatGPT Therapy Lacks Challenge and Reinforces Bias

AI is built to be agreeable. Its primary goal is to be helpful and inoffensive. This means that it often repeats back what you want to hear or what aligns with dominant cultural narratives, rather than offering nuance or challenge.

If you’re stuck in black-and-white thinking, shame spirals, or grandiose beliefs, AI is unlikely to question your assumptions. It doesn’t have a felt sense of you, so it can’t say, “I’m noticing this comes up a lot. What do you think it means?”

And that’s where therapy shines, someone who cares enough to help you see the patterns you can’t see alone. Licensed therapists are trained to recognize cognitive distortions, challenge unhelpful thought patterns, and provide evidence-based interventions that AI simply cannot replicate.

How ChatGPT Therapy Impairs Ownership and Creativity

The concern goes beyond mental health. Even in creative work, over-reliance on AI can reduce your sense of ownership and engagement.

A recent study exploring how people use large language models found something striking: “Participants who first worked without AI and then used AI tools to revise (‘Brain-to-LLM’) showed higher neural connectivity across multiple brain networks, alpha, beta, theta, and delta bands. They were more engaged, more integrated. In contrast, participants who relied on AI from the start (‘LLM-to-Brain’) demonstrated reduced neural effort and impaired perceived ownership of their ideas.”

Put more simply: when you let AI do the heavy lifting, your brain does less of the meaningful work. This shows up in therapy, too. If you outsource your reflection to a machine, the insights don’t feel like they belong to you. And when something doesn’t feel like it’s yours, you’re less likely to trust it, and less likely to change.

The Future of AI and ChatGPT Therapy

AI isn’t going away. It can be a helpful companion when used with intention, a spark to get unstuck or a tool to organize your thoughts. The key is understanding how technology in therapy can support, rather than replace, human connection.

But if you find yourself using AI as a stand-in for real connection or the brave work of therapy, it’s worth asking: “What am I protecting myself from (or avoiding)? And what might be possible if I reached for a living, breathing human being instead?”

We heal in relationship. No algorithm can replicate the magic of being known by someone who is committed to your growth and well-being. Human vs AI therapy isn’t even a fair comparison, they serve fundamentally different purposes.

Frequently Asked Questions

Q: Can ChatGPT diagnose mental health conditions?

A: No, ChatGPT cannot diagnose mental health conditions. Only licensed mental health professionals can provide accurate diagnoses based on clinical training and assessment tools.

Q: Is it safe to share personal information with AI?

A: While AI tools like ChatGPT don’t retain personal information between sessions, they lack the confidentiality protections and ethical guidelines that govern licensed therapy relationships.

Q: When might AI be helpful for mental health?

AI can help with journaling prompts, basic coping strategies, psychoeducation, and supplementing professional therapy. However, it shouldn’t replace real therapeutic support. The best way to use AI is as a tool within a broader mental health care plan.

Q: What are the biggest limitations of AI/ChatGPT therapy?

A: AI cannot provide genuine empathy, recognize non-verbal cues, adapt interventions to individual needs, or form therapeutic relationships. It also lacks the ability to handle crisis situations or provide specialized treatment for complex mental health conditions.

Ready to Experience Real Connection?

If you’re ready to move beyond AI assistance and explore authentic therapeutic relationship, finding the right therapist is your next step. Real therapy offers what AI cannot: genuine human connection, professional expertise, and personalized care tailored to your unique needs.

Understanding what to expect in therapy can help reduce anxiety about taking this important step. Many people find that the vulnerability required for therapy, the very thing that makes AI feel “safer”, is actually where the deepest healing happens.

Take Action Today:

• Browse qualified therapists in your area
• Learn about different therapy approaches and specialties
• Consider how a compassionate approach to mental health might transform your relationship with yourself

If you’re feeling lonely, disconnected, or unsure where to start, working with a therapist can be a powerful first step. You deserve support that honors your complexity, challenges your assumptions, and helps you build a life that feels more alive. Find a qualified therapist near you!

Reference

Kosmyna, N., Hauptmann, E., Yuan, Y. T., Situ, J., Liao, X.-H., Beresnitzky, A. V., Braunstein, I., & Maes, P. (2025). Your Brain on ChatGPT: Accumulation of Cognitive Debt when Using an AI Assistant for Essay Writing Task [Preprint]. arXiv. https://doi.org/10.48550/arXiv.2506.08872

Dear GoodTherapy,

I had been seeing my therapist for 28 years. Around March, she was unwell. This was a rare occurrence in our time together. But her viral infection persisted until about six weeks ago, when she texted me to say she would not be returning to her practice. I was and am devastated.

I asked if it would it be okay to email her. She said yes, but when I did, she said she was still ill. Initially, I drew on our relationship, which I had come to internalize. However, as the weeks have passed, I have felt angry at the way it ended. And as a recovering alcoholic (dry for 10 years), I am fearful of the future. I would value your views. —Hung Out to Dry

Dear Hung Out to Dry,

Thank you for asking this question, and I imagine other readers thank you as well. Few things can be more painful than the sudden end of a relationship, particularly one in which we felt a strong connection and entrusted with our vulnerabilities. I can hear the loss and confusion you feel and what I presume is a sense of abandonment. These are huge, potentially overwhelming emotions. Congratulations for reaching out for help.

When therapy ends prematurely, especially when it is characterized by a deeply established relationship, it can feel like your world is being turned upside down. It is not uncommon to feel the way you feel. I imagine it is hard to understand what led your therapist to terminate her practice so abruptly and taper off communication. It is understandable to take this as a personal loss. In an ideal scenario, when a therapist plans to retire or end their practice, they communicate this plan with clients well in advance and they discuss and process the transition in session, perhaps even over time.

No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist.

Unfortunately, sometimes illness and/or other circumstances beyond a therapist’s control may necessitate a less-than-ideal end to the therapeutic relationship. In this case, it is up to clients to pick up the pieces and move forward, perhaps with the help of another therapist. (It is worth noting, though clearly not what is happening in your case, that when a client leaves therapy prematurely or without closure, this presents another challenge for recovery.)

You mentioned that you recognize how you have internalized this relationship. No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist. YOU have maintained your sobriety for the past decade. Your therapist was likely not with you during every one of your darkest moments, but YOU were. While you may have internalized the voice of your therapist when experiencing these dark moments, ultimately YOU have managed these circumstances. You made the decisions yourself.

It is understandable to fear what lies ahead for you. Hopefully, you are able to consider your future from a place of empowerment based on your past successes. Another important step is rebuilding your support network. This has been instrumental to you in the past and will likely continue to be instrumental in the future.

If you haven’t done so, you will want to explore options for therapy for yourself going forward. I see it as a positive indicator of success for your future that you formed such a strong alliance with your former therapist. You can do it again. The new relationship will not be the same because the therapist will not be the same. The new therapist will not always respond in the same ways, nor offer the same insights. This is okay, and arguably a real positive.

Change, though scary, can sometimes push us further into growth. You can explore options and consult with more than one therapist before starting anew. As you know, finding the right fit can make a world of difference.

I hope this feedback was useful, and I wish you luck as you move forward.

Marni Amsellem, PhD

Eating disorders, the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. “Best practice” treatment strategies for patients with anorexia nervosa, bulimia nervosa, and binge eating disorder all too frequently fall short of achieving timely and sustainable recovery outcomes. Beyond eating lifestyle dysfunction, eating disorders represent impairment of the patient’s Self, as seen in the loss of self-trust, self-control, self-regulation, self-care, and emotional resiliency, so necessary in coping with adversity and engaging in confidence-building life opportunities.

The development and recovery of the re-integrated Self in eating disorder treatment is best facilitated through the mindful and versatile use of the therapist’s self within a quality therapeutic relationship, the inclusion of parents and families in the treatment process where appropriate, and an appreciation of the fact that within the context of clinical treatment, healing changes in the patient’s behaviors and attitudes represent healing changes in the patient’s brain.

Eating Disorders and the Loss of Self

From infancy to adulthood, self-development occurs primarily within the context of human relationships, be they personal, familial, or professional. The loss of the connection with the eating disordered individual’s authentic Self becomes apparent cognitively, emotionally, physiologically, neurologically, and socially, typically rendering victims resistant to accepting diagnosis and engaging in treatment. Losses of connection can be seen in:

• A lack of neurobiological connectivity within brain domains and within the distributed connections between the cranial-based self and the embodied-self.
• The loss of the patient’s healthy relationship with food.
• The loss of connection to significant others due to social withdrawal.
• Attachment dysfunctions in eating disordered individuals, which often exacerbate challenges in treatment engagement and continuity of care.
• Experiencing disconnection from feelings and sensation; eating disordered individuals may not recognize eating disorder symptoms as signs of dysfunction, denying the existence of a problem.
• Withdrawal from significant others that may result in parents speaking of their eating disordered children as “strangers.” Where weight and behaviors typically reside on the continuum of normal, eating disorders ironically surface all too rarely in physician’s offices during medical examinations and in laboratory tests. Nondisclosure of dysfunctional behaviors is typical in psychotherapy offices as well, in light of the patient’s fear of stigma, rejection, or having to face the reality of the need to recover.

Self re-integration, a pivotal predictor in the achievement of positive mental health (Siegel, 2006) and a benchmark of full eating disorder recovery, becomes enhanced by treatment modalities that facilitate connections between people, mind-brain-and-body systems, and brain domains.

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship.

Parents and Families As Recovery Advocates

Eating disorders insinuate themselves into relationships between family members. As family system disorders, eating disorders show up everywhere within the context of daily living, side by side with significant others, at kitchen tables, in restaurants, in family bathrooms, at school, and in places of employment. Though generally not responsible for causing eating disorders, which originate in genetic and temperament susceptibilities, parents who participate in their child’s treatment and engage in psychoeducation enjoy the potential to promote disease prevention and/or recovery. Becoming knowledgeable about eating disorders, the complex nature of their treatment and recovery, and their own role in their child’s recovery (particularly when the child remains in outpatient care while residing at home), parents can become ‘most valuable players’ in their child’s treatment team.

Recovering patients, faced with the demands and challenges of eating healthfully throughout each day, average no more than 50 minutes per week in face-to-face contact with helping professionals. Educated parents can become helpful in filling this void. With the understanding that the nature of parental support offered will need to change to align with their child’s changing needs as they progress, family participation in therapy gives both patient and family a voice, and an ear, in expressing and listening to feelings and in resolving conflicts and problems. By reconnecting with their child and learning how to understand, coach, and support their loved one, parents enhance their child’s emotional development and self-care.

The bonding and trust that develops in family treatment greases the path for the patient’s eventual separation and individuation, increasing the child’s capacity for autonomy and healthy self-regulation. Family sessions also diminish the potential for manipulative “splitting” and/or confidentiality breaches that could otherwise jeopardize a multi-disciplinary team treatment process. If not part of the solution, family members risk becoming part of the problem.

The Patient/Therapist Relationship in Research

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship. The trust that develops between therapist and patient within the treatment process ultimately re-ignites the patient’s trusting reconnection within their own exiled Self. The mindful therapeutic relationship ideally becomes the prototype for other healthful, quality relationships elsewhere in the patient’s life outside of the treatment system. Dr. Christopher Germer, in Mindfulness and Psychotherapy (Germer, 2005), considers mindfulness in therapeutic practice to be the pathway to establishing a healthy, healing treatment relationship. He speaks of the therapeutic relationship as “an intervention in itself” with empathy accounting for “as much, and probably more outcome variance than does the specific intervention.” He describes good therapeutic relationships as “the most potent of all the treatment interventions for healing within a mental health venue,” (Germer) providing the pathway out of an eating disorder.

According to Dr. Allan Schore, it is through the quality of the human relationship that “deficits in internal working models of the self and the world are gradually repaired” (Schore, 1996). Schore describes a phenomenon that exists between therapist and patient called “empathic resonance” (Schore & Schore, 2008), “which results in the patient’s right brain hemisphere becoming neurophysiologically altered in form and function in response to a mindful, quality connection to the functioning of the therapist’s right brain hemisphere. Right-brain to right-brain human attachments through mindful psychotherapeutic connectedness often result in the patient feeling ‘felt,’ creating a state of neural activation with coherence in the moment that has been shown to improve the patient’s capacity for self regulation” (Siegel, 2006).

A quality patient-therapist connection lays the foundation for the patient’s development of the Self, in addition to the foundation of a complete and lasting eating disorder recovery.

References:

1. Germer, C. K., Siegel, R .D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York, NY: Guilford Press.
2. National Eating Disorder Association. (n.d.). Retrieved from https://www.nationaleatingdisorders.org
3. Schore, J. R. & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9-20. doi: http://dx.doi.org/10.1007/s10615-007-0111-7
4. Siegel, D. J. (2006). An interpersonal neurobiology approach to psychotherapy; Awareness, mirror neurons, and neural plasticity in the development of well-being. Psychiatric Annals, 36(4), 248-256. Retrieved from https://www.researchgate.net/publication/241200655_An_Interpersonal_Neurobiology_Approach_to_Psychotherapy_Awareness_Mirror_Neurons_and_Neural_Plasticity_in_the_Development_of_Well-Being

We’ve all been there. We think therapy is going along swimmingly, and then all of a sudden, our client stops showing up. Sometimes we get a cancellation email or text that says they will call us to reschedule when we really know it’s code for, “I ain’t coming back.”

It is all too easy to blame clients for dropping out of therapy. We say very clinical things like, “They weren’t ready to do the work,” or “We reached a climax in treatment and it was too much for them”. There may be some truth to those statements, but as therapists, are we doing a good enough job of educating clients about the termination process? Because it is a process.

It is a privilege to walk with a client from the beginning to the end of their counseling journey, but it is often a privilege we do not get. We lose clients when one of us goes on vacation. We lose clients when life gets extraordinarily full for them. We lose clients, and sometimes, we don’t even know why.

“Where Did I Go Wrong?”

If you are anything like me, you tend to eschew any tendency to fault a client for not following through with treatment. Instead, I wonder where I missed the mark or went wrong. What could I have done differently? Did that brilliant intervention I made fall flat? Was it not as well-timed and relevant as I thought? You can see how easy it is to go down the rabbit hole of self-condemnation.

We may never know why our clients do not return for our sessions, but a fully insightful and self-aware therapist must look at how we contribute to a client’s dropping out of treatment and what we can do about it. Below are some suggestions.

Address the End of Therapy During the Informed Consent Process

Yes—talk about the end of therapy at the beginning. By addressing termination at the start, clients can better understand that counseling does have a beginning, middle, and end. The informed consent process lets the client know what they can expect from working with us.

In the midst of talking about confidentiality, payment contracts, and consents, we would be wise to address how the client and therapist know when treatment should end.

In the midst of talking about confidentiality, payment contracts, and consents, we would be wise to address how the client and therapist know when treatment should end. Ask clients to imagine what life will look like when therapy is over. What would be different? What skills would they possess that they do not currently have? This lets them know you are looking at therapy with the end in mind and shooting for a mutually agreed upon goal.

As therapists, we keep the big picture in mind and hold a long-range view. Meanwhile, clients often only see immediate concerns. Of course, goals can change as therapy progresses, and they often do. When issues sprout up that the client didn’t even know were there, we revamp and incorporate new goals into our treatment planning. Once we share that terminating is a process and not an abrupt ending, we can continually check in about how the process of therapy is going.

Encourage Open and Honest Feedback About the Therapeutic Experience

This can be done during at least two points in therapy. The first is during the informed consent process, when we can educate clients about the collaborative nature of our relationship and any expectations of them as clients.

Let them know that at times, they may be asked to do homework, and any feedback about how beneficial it was will will be helpful. Tell them you may miss the mark. When they let us know the assigned homework wasn’t very useful or effective, that gives us information to steer sessions in another direction. I make sure to provide assurance that my feelings won’t be hurt.

Secondly, directly ask them for feedback throughout the process to model the two-way exchange mentioned during the first appointment. Inquire about how opening up in a session was for them, especially after a particularly vulnerable disclosure on their part. How did that affect rapport and trust? Ask about the pace. Is it too fast or too slow? Are they seeing the kind of progress they hoped? What is working in therapy, and what is not? These kinds of questions invite feedback in a safe atmosphere.

What to Do When a Client Stops Coming to Therapy

So what do we do when clients suddenly stop showing up? Here are a few ideas:

1. Address your own feelings. Are you irritated? Worried about the lack of income or a dwindling caseload? Recognize these are your own feelings and do not let them enter into the dialogue with the client.
2. Don’t take it too personally. Often, leaving therapy has more to do with what is going on with our client than about us or anything we said or didn’t say. Technology makes it much easier to cancel appointments, and it’s easier to send a text or email than to confront us about why they aren’t coming back.
3. Reach out empathically when clients no-show or cancel. The purpose is to let clients know you available to them, not to chastise them. You are leaving the door open for returning back to treatment. A phone call is more personal, but if you hear nothing back, follow up with an email a week or so later. After that, take a hint and know you have given a safe invitation to return to treatment on their terms.

This approach is no guarantee a client won’t drop out of treatment suddenly and without an explanation, but encouraging open communication along the way may help reduce attrition.

Some clients might feel sheepish about returning to a therapist once they no-show an appointment or have an outstanding balance. These are common issues therapists must address. While I might be annoyed that I have a hole in my schedule, my bigger concern is if my client is okay.

Most of all, I’d like my clients to know I care about them. Otherwise, I wonder what happened. Was therapy helpful for them? Sometimes we have to make peace with the fact we may never know.