For psychologists, the idea of taking an extended break from a therapy practice can be daunting. Regardless of whether you are working in a private practice or a hospital, college, or community clinic, you have patients who rely on you, and you have your own financial considerations as well.
But psychologists often need to step away from patient care for a while for a variety of reasons, including illness, said Blaine Lesnik, PsyD, a clinical psychologist in Chicago who stopped her private practice for around 5 years after her lungs became so deteriorated from pulmonary sarcoidosis, a rare autoimmune disease that causes small lumps of inflammatory cells to build up, that she needed a bilateral lung transplant to survive. “Psychologists are human, and we face illness at times. Our patients typically can accept the truth of that and thus want us to take care of ourselves.”
Along with physical health concerns, psychologists may need to take a break for mental health reasons—something that has become particularly prevalent during and since the COVID-19 pandemic. In 2022, 45% of U.S. licensed psychologists reported feeling burnt out, according to APA’s 2022 COVID-19 Practitioner Impact Survey.
Other reasons for pausing your practice may include taking parental leave, caring for a loved one, taking a sabbatical to travel or engage in a hobby, or pursuing related career interests, such as serving as an APA division president. Whatever the reason, this shift requires smart planning around notifying your colleagues, transitioning your patients to other psychologists, deciding how much to disclose to patients about why you are leaving, and taking the time to really separate yourself from your practice while you are away.
Lesnik and other psychologists shared their experiences and tips on how to pause a practice.
Prepare yourself and your patients ahead of time
First, recognize that you have the right to take care of yourself, said Stephanie Burcusa, PhD, a clinical psychologist in Great Falls, Montana. “We have to put on our own oxygen mask first,” said Burcusa, who went on maternity leave both in 2012 and earlier this year. “Being able to step away allows us to help others again when we come back.”
Then comes the logistics of telling your patients and colleagues. When Burcusa first went on maternity leave while working at an eating disorder clinic in Minnesota, she created a list of her patients and matched them with colleagues who had the proper clinical expertise and could take over the patients’ treatment while she was away. For example, if one of Burcusa’s patients with obsessive-compulsive disorder was in the middle of exposure and response prevention (ERP)—the practice of confronting the thoughts, images, objects, and situations that make the patient anxious or provoke their obsessions—she would match them with a therapist trained in ERP. Additionally, Burcusa considered the provider’s age, gender, overall therapeutic style, and availability.
A few months before her due date, Burcusa told each patient she would be leaving for a brief span and asked if they would like to have a trial session with the other therapist to make sure they were a good fit. It is important to clarify in advance if the patient should plan on transferring completely to this new therapist or if the other therapist will serve as a fill-in while you are gone.
“I tried to make it as seamless as possible and give the patients a voice in the transition,” Burcusa said. “I also made sure to mention that if they find it’s a better fit with the other therapist, that is totally fine, and they didn’t need to come back to me when I returned.”
Some patients may struggle with the news, so it is important to give them enough space to process it. In Burcusa’s case, her patients had eating disorders, so seeing their therapist’s body change could be triggering for them.
“For patients who I thought might have a hard time hearing the news, I would tell them at the beginning of a session so there would be plenty of time to process, if necessary,” Burcusa said. “Basically, I just tried to share the news directly and sensitively, and to give patients as much choice and autonomy as possible.”
To further help with the transition, Burcusa created a document with the clinic’s contact number, details about how long she was going to be out, and a written record of the patient’s coverage plan that she distributed to the patient and the colleague who would be stepping in.
Arizona-licensed psychologist Paula McCall, PhD, was open with her patients about her situation when she took 5 weeks off in 2021 to care for an ailing parent during her mother’s final days, take care of affairs, and grieve after her mother died. Luckily, her patients’ treatment was not significantly impacted by her short break.
“They were very supportive,” McCall said. “I tend to be more transparent as a therapist anyway. I work with children, teens, and young adults, so a lot of my patients include parents. I would already tell them when I needed to take a day off for my daughter’s birthday, or something like that. I aim to be transparent as a mom and a human being.”
Lesnik, who reluctantly closed her therapy practice of 15 years for health reasons, took the time to call each patient and tell them it would likely be years before she could practice again. She also set a clear end date with her patients. “Planned termination, if you can, is a better termination. It provides the patient with less unknown and more control,” Lesnik said.
Like Burcusa, Lesnik considered her patients’ needs and what type of therapist they would work with best before sending out referrals. She checked in with her colleagues to make sure they were able to take on new patients and, with each patient’s permission, scheduled consults with the new therapist to share some patient background. For many patients, Lesnik also had one or two final sessions after they met the new therapist to finalize and process the transition. However, she did not send over any patient notes.
“The patient and their new therapist have to make their own therapeutic alliance that doesn’t involve me, because they’ll be working together from that point on given that it wasn’t clear when, or if, I would be able to return to work,” said Lesnik.
Prepare financially
Working out your finances is another key step in the planning process. When Burcusa took maternity leave earlier this year, she received financial support through her hospital’s paid time off and family and medical leave services. For psychologists in private practice, however, coordinating the financial aspects of leave is far more complicated—so the best time to prepare is before you pause your practice.
“It’s hard to step away for a long period of time with no income,” said McCall. “Doing what you can to plan for that income gap ahead of time is crucial.” For example, everyone in private practice should purchase disability insurance in case they need to pause their work for physical health reasons or parental leave.
Taking a break means your savings will need to cover both your personal expenses and your professional ones, like office rent, insurance premiums, business licenses, and quarterly taxes, that will still need to be maintained while you are away. Therefore, it is critical to set up two budgets for your personal and business expenses before pausing your practice and to start saving as soon as possible. Ask yourself questions like: How much money do I currently have saved up? Are there business costs I can cut while I’m out of the office? Do I have a support system like a partner or family that can help during this period?
Additionally, you can check if your state has paid family leave policies (for example, California offers 6 weeks of pay at 60% to 70% of an individual’s average weekly salary).
Separate yourself
A vital part of going on leave is establishing boundaries. That can mean telling patients and staff ahead of time that you will be checking your email only at the end of each day, only responding to urgent calls and messages, or stepping away from emails and phone calls entirely. Setting up an automatic out-of-office email and voicemail reply telling patients you are currently unavailable, the date you plan to return to the office, and who to call in case of an emergency is also crucial.
“I had already set boundaries between work and home before my maternity leave,” said Burcusa. “I need the time at home for myself, and that boundary is a skill I already worked on developing. I also knew my patients were in good hands with my colleagues.”
McCall still checked her emails to make sure nothing urgent came up while she was away. One of the key things she has learned over her years as a therapist is how to gauge an email’s urgency without always responding. For example, an email from a patient about rescheduling a future appointment does not warrant an immediate reply, whereas one with threats of self-harm does.
“I’ve emphasized with my patients that if you ever need to email me or talk about something, that is fine, but I will never give therapy or advice over email,” McCall said. When she’s out of the office, she also reminds her patients of the 988 Suicide and Crisis Lifelineopens in new window, along with other crisis resources.
Pausing your practice can also benefit you in the long term. Research shows that taking an extended break from work brings positive changes to individuals’ work and life, including greater self-clarity, according to a 2022 study (Schabram, K., AOM Insights, 2022opens in new window). Leisure activities such as working out, reading, going to a museum or play, and volunteering in the community have also been associated with improved physical health, social functioning, and vitality (Elsden, E., et al., BMC Public Health, Vol. 22, No. 1275, 2022opens in new window).
Ease back in
Returning to your practice can be just as much of an adjustment as leaving. When McCall was about to start seeing patients again after 5 weeks away, she realized she had been burnt out and decided to revamp her practice. “I’ve completely changed my scheduling practice to make sure I have breaks built in,” McCall said. Now, she sees patients every other week and spends her off weeks writing reports and evaluations. “I’m very cognizant of not overscheduling myself now.”
When Lesnik started up her practice again in 2017 after 5 years away, she began with only 5 patient hours each week. Over time, she slowly expanded her practice, and now she has around 20 patient hours weekly. “I’d been through a lot of medical trauma,” Lesnik said. “It’s important to make certain that any choice you make doesn’t leave you in a position where you’ll overwork yourself with too many new patients at once. You need to be honest with yourself. The art of psychology takes a while to reengage in.”
Psychotherapist Charlie Davidson, PhD, stopped his practice 2 years ago when he decided to switch careers and work at a tech startup. He eventually wants to see patients again and is reaching out to colleagues who use similar therapy styles and may be able to advise him on how to rebuild a private practice. You can also connect with members of your APA division who are in the same field as you for help, Davidson said. “Take it one bite at a time.”
It’s important to be kind to yourself when you are coming back from a break, said Burcusa, because “it takes a while to get ramped back up again.” It is also smart to give your patients a chance to adjust by contacting them a few weeks ahead of time to remind them of your return date.
A lot can happen in a patient’s life in the weeks or months that you were gone, so you should go over any major updates with your colleagues. “I left my first day after coming back from maternity leave pretty open to check in with colleagues and review charts,” Burcusa said.
Furthermore, creating a back-to-work schedule to ease back into your practiceopens in new window is helpful. For example, if you are recovering from giving birth, you may plan to start seeing patients 12 weeks after your delivery date and begin with just 4 telehealth sessions per week. After a week or two, you may then move to 6 telehealth sessions and 4 in-person sessions each week, slowly adding more patient sessions until you eventually resume your full caseload.
Overall, one of the most important things to keep in mind is that breaks are a vital part of any therapy practice. “If you feel like you need a break, do it,” said McCall. “Give yourself the permission to step away.”
