How do I manage a therapy break, when my therapist is ill?

The 'Dear Karin' Advice Column

How to cope with a therapy break when the therapist is ill (c)

In my advice column #DearKarin I offer to help with some questions and dilemma’s. Today’s question is about how to manage a therapy break, when your therapist is ill.

<strong>Dear Karin,</strong>

You may have discussed elements of this in some of your previous writings, but, if possible would you be able to give some advice regarding managing a break during long term therapy.

My therapist has been instrumental and wonderful helping me to open up and explore emotions, whilst at the same time supporting me face to face and with emails when going through difficulties and change.

Unfortunately she had to undergo major surgery and had offered for me to see one of her colleagues, which I didn’t want to do.

I feel very worried for her and then also very sad about when and if there will be any more sessions in the future.

Whenever I start getting upset about this situation I try and think about positive wishes for her and on occasions I have sent a text, card and flowers without wanting to intrude or overstep boundaries.

All the same, this is very unsettling and I try and focus on the here and now and those nearest and dearest around me.

Many thanks and kind regards,


(25th July 2019)


Dear M.P.,

Thanks for writing in and explaining a bit about what’s happening for you, and how you are coping with your break from therapy due to your therapist’s illness.

From my writing you may know that I have experienced both sides of the same coin – as a client when my therapist was suddenly taken ill, and as a therapist when I had to stop working twice due to illness. You can find all the pieces I have written HERE

In my response I will use the general term ‘therapist’ to also include counsellor, coach, mentor, confidante.

Five general points to consider

I believe there are at least 5 important factors that will affect how such a situation may impact us. You have referred to some. In no particular order:

1. Have we established a good rapport with the therapist?

In therapy terminology this fits into the area of “therapeutic relationship, working alliance”. The better the rapport, liking, empathy, trust etc the more likely it is, that the break will affect us.

2. Where are we at in therapy, when the break occurs?

What topics, level of processing may have been reached and opened up? Sometimes we can be left feeling extra sensitive when we have reached a new level of self awareness, change or feeling. Then therapy is needed to continue working things through, until they and we have settled down. If therapy is interrupted at that point, then we may feel extra vulnerable and disturbed.

3. Where are we at in our life, when the break occurs?

We may be going through a trying and testing time on our life. Our support network may not be sufficient to assist us and we rely on the external support our therapist has provided.

4. How do we cope with raptures, abandonment and uncertainty?

Depending on our past experiences, such unexpected breaks in therapy can trigger old wounds and fear, even though the situation itself does not justify it. Your therapist has not abandoned you, but it may feel like it. How well equipped are we to cope with uncertainty and the anxiety it can bring?

5. How has the break been communicated and how is it being managed?

How much do we know about the circumstances, if / when therapy will resume, how we may receive updates (if any)? What has been agreed regards contacting the therapist during this time?

Depending on the circumstances there is not always time or opportunity to provide all the information we would like to receive and make neat and transparent agreements.

How to cope

There is no blue print for coping. Based on the 5 points above (and others) everybody affected by a sudden break in therapy may have different needs and circumstances. We all have to work out, what is best for us.

Here is some general guidance:

1. Notice how the break affects you.

Become aware of your feelings, name them, understand them.  Don’t deny them, but don’t indulge them either. That helps manage anxiety.

2. Be aware of any negative self talk, catastrophizing etc.

It is what it is. You cannot do anything to help your therapist right now. It is their life, their responsibility.

3. It is your responsibility to cope with this break as best as you can and to look after yourself.

This may involve working out what other support you may need to cope with life in general and with the break in particular.

It is not easy, under such circumstances, to work with another therapist. I, too, declined the offer – initially. But after a while I realised I needed help to cope with the cancer treatment I was just undergoing and with the unexpected absence of my therapist. Working with someone else was not to replace my therapist, but a temporary support solution. And I am glad I followed my intuition.

You, too, may decide on additional support (or not) – individual therapy, group therapy, a course, learning a new skill, something fun … Reaching out to me and asking your question has already been a move in this direction!

4. View this break from therapy as part of your therapy.

Even (and especially) the hard times can be key moments of personal development and growth. It might help you to look at the break as a challenge and continuation of your therapy. But for now, on your own – where you can rely on everything you may have learnt sofar.

In that way you give the break a positive meaning and purpose.

You may even decide to set aside the regular slot when you usually had therapy and do something special and of meaning for yourself.

5. Contacting your therapist

I don’t know what was agreed, if anything. And I hear what you say about respecting boundaries. I think you will be the best judge. As long as you don’t feed any abandonment wound or anxiety, if you don’t hear back. Because your therapist may not be well enough to receive or respond to messages.

6. What if?

And finally there is “what if” – what if our therapist cannot return to work or dies? What if we never find out? What if…?

Again, I don’t know what will happen. But it is important not to shy away from such potentially lingering fears. But it is equally important not to be overwhelmed by them.

Whatever may happen, one thing is for certain, you will cope. Trust in that.

It does not mean it won’t hurt, like you are hurting now. But you do demonstrate resourcefulness and self awareness, which should reassure yourself!

I hope these thoughts are of some assistance and I wish you well.

Very best.


(4th July 2019)

Photo by Abe B. Ryokan on Unsplash

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  1. As a therapist on a medical leave, I contacted my pts every few weeks by email to give them a sense of when I might rtn to practice . The objective was to provide a temporary holding environmental until I could rtn. Not every therapist on sick leave is up to doing so.I think this helped their anxiety.

    • Dear colleague, thank you for taking the time to read and share your own experience. It is much appreciated to hear from a fellow colleague on this topic. And you are right in pointing out that not every practioner will be able to keep in touch. It will depend on circumstances and levels of health and wellness, or indeed professional orientation or set up. I think working in private practice makes continued communication more possible than working through a therapy provider where direct client contact is limited or not possible. Wishing you well and a speedy recovery from your own medical leave. Karin

      • Comment:
        Thanks so much. Another element to the sick leave issue for therapists is to do with colleagues, who get in touch for collegial advice, despite one being on sick leave. I am a colleague and not a supervisor; so maintaining that boundary can be tricky, sick leave or not. Like patients / clients , I think colleagues can get anxious with the sick leave issue, if they are used to having a collegial exchange (while adhering to client confidentiality). Cheers from NYC.

        • Hello again, thanks so much for providing the therapist perspective of the therapy break. It can be a challenging time for both parties – clients and therapists. With best wishes. Karin

  2. I know this was a few years ago, but I just wanted to say thank you. As a primary care doctor, I’m always dealing with shutting off one side of me when someone in my life who is not my patient is ill. This is doubly complicated now that the person in my life is my therapist. I really appreciate your empathy about this situation and your suggestions.

  3. Thank you for publishing this. My therapist told me via email today that she is ill and will be out for at least 6 weeks, maybe longer. I had no warning, so this is tough. I am at a critical point in my therapy, and I am initially feeling abandoned and panicky. Reading this articles is helping.

    • Dear Gracie, thanks for reading and taking the time to share your own experience; it will help others. I am sorry to hear your therapist is unwell and the impact this unexpected news is having on you. It certainly is a challenge all around. As I say in the article, there are ways to reframe this and holding the space. It can be painful and frightening as it is a kind of loss. Trust yourself. With very best wishes for you and your therapist. Karin

      • Hi Karin,

        Thank you so much for responding and validating my feelings. You have reminded me to trust myself, and I am also reminded that I am strong. As you mentioned previously, it is helpful to reframe this break as part of my therapy.

  4. This article helps me a lot as I am undergoing this currently. It soothes me a lot. Thank you so much!
    Honestly I am still struggling with the absence of my therapist. She has been on sick leave for over 8 months…. hope she is well

    • Hello, thanks for reading my article and responding. I am glad it is of some assistance during this challenging time of uncertainty you are experiencing. With best wishes for you and your therapist. Karin

  5. This piece was really touching for me as well. My therapist is currently in hospital, and I haven’t heard from him for around 6 weeks. It has been very hard, but reading what was written here has helped a bit.

    • Hello George, Thanks for reading this piece and taking the time to send in some feedback. I am sorry to hear you (and your therapist) are going through a challenging time. I am glad my thoughts are of some assistance. With very best wishes. Karin

  6. This was great advise and comforting to read. I’m going through something very similar right now since the end of December. I am still in shock and have all the old abandonment traumas and attachment issues ? This is really difficult.
    I wonder how you are doing M P.

    • Hi, I am sorry to hear you are going through a similar experience. Good to know this piece is making a contribution towards you working things out. My very best wishes. Karin

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