Protecting patients after a therapist’s illness or death

Lisa Harris, PhD, was worried when her therapist’s health steadily deteriorated each month, with symptoms of a worsening cough and noticeable weight loss. Harris shared her concerns, and the therapist—who was experiencing a recurrence of breast cancer—told Harris she was confident she would beat the disease. Soon, the therapist started bringing an oxygen tank to sessions and occasionally would not show up.

“She kept telling me she was fine,” said Harris, who was in her 20s at the time and hadn’t earned her doctorate yet. “For months, I struggled with confusion and hurt—and guilt for having these feelings.” She felt ashamed for wanting to find a new therapist, but eventually she did. Six months later, she heard that her previous therapist had died.

When Harris launched her own private practice in New York City years later, she promised herself she would never subject patients to the same experience. She created a professional will, which outlines a practitioner’s wishes for closing a practice in the event of illness or death. This document can include instructions for who will contact patients and how to protect patient confidentiality, passwords to access records, suggested referrals, and other details. A will also names a practice executor who will carry out these instructions.

While most states do not require therapists to draft a professional will, APA’s Ethics Code states that “psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement,” and having a professional will is one way to achieve this objective. This type of will—which provides a road map for managing all the practical and legal aspects of closing a practice—protects patients from perceived abandonment and the psychologist’s family members who may unexpectedly be responsible for closing the practice. It also offers psychologists some peace of mind that these details have been taken care of.

Despite the ethical imperative to create a plan, 68% of therapists in a recent survey reported that they did not have a professional will (Miller, R. B., Independent Practitioner, Vol. 45, No. 1, 2025opens in new window). The primary reasons given were procrastination, anxiety, and lack of guidance. Forty percent reported feeling dread when thinking about creating a professional will. Finding a practice executor was another significant barrier, with 46% reporting that they did not want to burden anyone with this responsibility, and 27% feeling they were not close enough to any colleague to ask.

The survey was conducted by Robyn Miller, PhD, a psychologist in private practice in Bethesda, Maryland, who stepped up as practice executor when a friend and colleague was diagnosed with stage IV cancer several years ago. As the practice executor, Miller had the responsibility to sensitively deliver the news to more than 30 patients and manage referrals to other providers, but those conversations and duties took an emotional toll (Psychoanalytic Perspectives, Vol. 18, No. 1, 2021opens in new window).

“One of the common misconceptions is that [serving as practice executor] is simply an administrative task that will take a couple of hours, but it was incredibly stressful and draining,” said Miller, who estimates that she spent 60 hours fulfilling this role.

The experience with her friend motivated Miller to found TheraClosureopens in new window in 2024, a company that helps therapists create a professional will and serves as the practice executor in the event the therapist dies. Patients should be informed and provide consent to having a practice executor involved in the unlikely event that their therapist becomes ill or incapacitated. Attorneys can also assist psychologists with preparing a professional will, but they are not able to execute the clinical aspects of the will. Some psychologists form groups of colleagues who agree to share the duties of covering for one another. Miller recognized that mental health providers, who pride themselves on navigating difficult emotions, often fear or avoid this task. Sidestepping this ethical obligation can have unintended mental health consequences. “Patients are vulnerable people, and they have formed a therapeutic bond,” she said. “By creating a plan, we can help these bereft people get the support they need if we are incapacitated.”

Miller’s experience in this role for her friend and colleague helped her learn the considerations for clinicians when drafting a plan. Initially, the two friends grappled with the devastating diagnosis, but the grieving process was cut short because of the immediate implications for a caseload of patients. The friend gave Miller her schedule, patient contact information, and details about each patient’s history, progress in therapy, transference and attachment, and future goals for treatment. Her friend also found a colleague who would be a good fit for a referral for each patient.

Miller agreed to call each patient directly with the news. She let them know that her colleague’s disease was terminal, and she did not have any hope of returning to practice. In some cases, Miller’s colleague provided specific guidance about how to share the information, such as putting off explaining the full situation to a pregnant patient until she was safely in her second trimester.

For those first 2 weeks, Miller called her friend’s patients in the evening after she finished seeing her own patients. She explained that her colleague wished she could speak to them herself, but she was sick and unable to do so. “I wanted them to leave with a feeling of being cared for despite the tremendous loss, and I would often hang up and cry after these calls,” said Miller.

Ben Rutt, PhD, who runs a solo private practice in Baltimore, Maryland, did not have guidance from a professional will when his sister, a therapist, died unexpectedly in 2023. Years earlier she had informally asked him to step in if she was ever incapacitated. He knew where she kept the keys to her business mailbox, but getting information about her patients required him to retrieve paper charts she stored in her home. “I had to figure out which ones had more serious issues like suicidal ideation because they might need intervention sooner,” he said. He contacted a large local group practice, and they agreed to assign his sister’s patients to individual providers.

There were also challenges because his sister had been leading a group practice with eight employees. The employees did not receive paychecks for a few weeks because Rutt could not access her business bank account. His sister also did not have a personal will, which meant the probate court appointed an attorney who took responsibility for accessing her bank account and managing her records—which according to her state’s law needed to be kept for 7 years after a patient’s discharge date. “There came a point when I could not handle it anymore,” Rutt said. He took a leave of absence from his practice for 2 months after his sister’s death to focus on his grief and recovery.

Like Rutt, psychologist Dale Blunden, PhD, had to scramble when a colleague in her group practice died. The colleague, who had liver cancer, had been seeing patients in the office just days before she died. The group struggled to pinpoint who her patients were and how to reach them, so in most cases they resorted to asking people in the waiting room who they were scheduled to see. If they named the colleague who had died, a group member would take them aside to share the news. “We were grieving, angry, overwhelmed, and sad for the clients who were getting this shocking news,” Blunden said. After the experience, the group spent hours together researching professional wills, and each member of the group created one.

When Blunden started working on her professional will, the process of planning for the unexpected motivated her to transition from paper to electronic records. She realized that accessing electronic patient records would be far easier for a practice executor.

While contacting current patients is a pressing priority after a clinician’s death, executors also tackle the business aspects of closing the practice. States have different requirements dictating how long practitioners must maintain patient records, and patients who have been discharged within that time should be notified of who is in possession of their records. To protect patient confidentiality, records outside this time period should be destroyed, such as by shredding paper documents or deleting electronic health records on a personal computer. Electronic records maintained on a server, such as a Health Insurance Portability and Accountability Act (HIPAA)–compliant cloud service, should be deleted, and any backups, trash, or files in a “recently deleted” folder should be permanently deleted. A log should be kept of the records that were deleted, the deletion date, and the deletion method.

Information about the practice closure and who to contact with questions should be explained on the website and in outgoing voicemail messages. Executors should also notify the licensing board and malpractice insurance carrier about the practice closing, and automatic bill payments should be stopped. If someone is leasing a space, the executor informs the landlord and addresses the lease according to the terms of the agreement.

Richard Bloch, JD, general counsel for the Maryland Psychological Association, has helped many psychologists create a professional will. “For a solo practitioner, having this documentation is even more necessary than if others are in the practice who know the client base and have some sort of process available to manage an unexpected death,” he said. APA has also created a sample professional will (PDF, 254KB)opens in new window that can be accessed online.

Lisa Harris tackled the task when she was working with an attorney to draft her personal will and testament. The attorney helped her with the professional will as well, and Harris asked a colleague who was leading a group practice to manage the distribution of her patients.

Harris was relieved to have a plan in place when she had major surgery 10 years ago. Before the surgery, she let her patients know that she expected to recover but reassured them that if anything unexpected happened, someone would contact them. More recently, she had a cancer scare. Although testing revealed that the mass in her lung was benign, she was administratively prepared if the news had been different. “Professional wills are a form of insurance for the emotional safety and well-being of our patients,” said Harris.

The importance of this forethought was clear to Leilani Salvo Crane, PsyD, whose own therapist of 12 years died in 2022. A psychologist who was a friend and colleague of her therapist called Crane to tell her about the death. Crane appreciated the love and care she felt as the psychologist listened, offered to provide referrals, and invited Crane to touch base with her. “I felt that this was my therapist’s gift to me,” she said. “She had seen me through significant trauma, and this experience confirmed that she was exactly the sort of person I thought she was.”