Ghosting: Why you are being ghosted and how to stop being ghosted in your psychology or therapy practice

The Business of Psychology

Ghosting: Why you are being ghosted and how to stop being ghosted in your psychology or therapy practice

This episode of the Business of Psychology is a response to a painful question that comes up in Psychology Business School and the Do More Than Therapy membership regularly in our weekly coaching calls, and that is; why do clients ghost us?

I have plenty of personal experience on this subject matter. In the first year of my practice, I would say I was ghosted at least on a monthly basis. What I mean by that is a client that comes for a few sessions, engages with you, you think it's going really well, you've got more sessions booked in, and then they just never show, never respond to your emails, don't respond to your phone calls, and you never hear from them again. It is a horrible feeling, and it is very likely that if you've been through that, or you're going through it at the moment, your mind says a lot of very unkind things to you about the reasons for it. I remember sobbing in my car after a day where I was ghosted twice, and I just thought, what kind of therapist am I that people don't come back, but not only do they not come back, they can't even tell me that they're not going to come back? That's my worst nightmare. That's my personal worst nightmare to be the kind of therapist that somebody can't say, ‘I don't like this I'm leaving’ to. I always want to try and create a safe space where people feel able to say, ‘this isn't working for me, can you help me find somebody else?’

What I have learned from that experience, and from the fact that actually it doesn't happen to me very often anymore, is that there are a few things that we can do that make it a lot less likely that people are going to ghost us. But before we can implement any of that stuff (and don't worry, I will give you those strategies at the end of this episode) we have to get it sorted in our minds first. And the best way of doing that is a good old fashioned Locus of Control exercise. So let's think that through for this issue, why has somebody ghosted you?

What you can’t control

First let's think about all the stuff that you can't control that might lead to ghosting.

We've got the obvious ones; we've got commitments, things like their kids, caring responsibilities, life events that might have come up outside of the therapy room that have made it difficult for them to prioritise coming along to your session. We've got the big hitters; we've got work stress, physical illness, all of these things that you've probably thought of. We've got the overall state of their nervous system. Let's not forget, people come to therapy because they are at the edge, usually. They're usually aware that they are on breaking point, and that their nervous system is jangling and frazzled. And when we're in that state, we know that we don't make the best decisions, and that sometimes we might prioritise short term gain over long term gain. So it might be that we've got the money for our therapy session, but actually it would feel better in the short term to spend that money on a takeaway and a bottle of wine than it would to come along to therapy and spend it that way. We all know that we think like that when we're overwhelmed, and we're dealing with overwhelmed people. So that's another thing that we can't control, but that might be going on for our potential clients.

But here are some interesting things that you might not have thought of if, like me, you're crying in your car over being ghosted.

• Public perception of psychologist and therapist income: The first one is public perception of our income as therapists. I only became aware of this when I stepped into the small business community and started talking to people who run completely different businesses to ours. But believe me, there is a public perception that psychologists and therapists are wealthy people. There is a public perception that we don't need the money that we make from our private practices, that most of us come from wealthy backgrounds and have wealthy partners that support us. Now, I'm sorry, that might be a bit controversial to say, but I promise you that the public who don't know any psychologists or therapists tend to see us in that way. If they don't see us in that way, then they see us as part of the intelligentsia elite class who just make tons of money out of our businesses. So that is pretty unhelpful and may explain why some people think it's okay to either not pay for sessions that they've had, or not turn up for sessions that you've booked in. They literally may not realise that it has a financial impact on you, and very likely don't realise the significance of that impact.

• Public perception of the value of mental health: The second thing, and this thing makes me even more sad, related to public perception is the public perception of the value of mental health. And this is particularly pertinent with some client groups and it certainly is in the space that I predominantly work in, which is perinatal. People often don't think that their mental health is very valuable. It may be that when they sit down and they review their family finances, even though they technically can afford therapy, they don't think that is a worthwhile way of spending their family income. They might think that it's more valuable to spend that money on something that provides a more obvious or tangible benefit to the family. Obviously we would massively dispute that, and I would hope that somebody that's been coming to therapy for a while has started to see things in a different way, but we have an overwhelming culture of prioritising physical health and material benefit over mental health. The connection in most of the public's mind between mental health and physical health, and success and productivity, and a calm and fulfilling life has not been made for most people. So if you find that a client that you were looking forward to working with doesn't come back, it could be that cultural narrative is playing a part, and you didn't control that you didn't choose that, and it is a big piece of work to start unpicking that with somebody. It may be that that is what you would have done in therapy and that's what makes it so frustrating, but I think taking personal responsibility for the fact that our culture doesn't yet prioritise mental health is bonkers. So it's worth reminding yourself of that, if you're really beating yourself up.
• Change in financial situation: There is also a possibility that their financial situation really has changed, and that they literally cannot afford therapy sessions with you. You might say that doesn't explain why they wouldn't talk to me about it, but think about the way that our culture is around money and admitting when you can't afford something. That is still something which is infused with a huge amount of shame in our society, and again, you didn't create that stigma, but it exists. Acknowledging that that is something outside of you that may be playing a role in this ghosting that you're going through at the moment is really important.

What you can control

That brings me onto the things that you can control, but you might not have thought about in your practice.

• Be firm about your boundaries: The first one, speaking to that public perception of our income, and potentially public perception that it doesn't have very much impact on us if they don't show up to a session is your boundaries. Being firm about your boundaries and making sure that if somebody needs to reschedule a session you don't break your boundaries in order to allow that, I think is really important. One of the mistakes I used to make a lot in my practice was if somebody phoned me up to reschedule the session, I would fit them in even when it was really difficult for me, even if that meant missing my lunch break, even if it meant working later than I normally work, I would do that because I wanted to help them. But if you do that it gives the perception that you've got unlimited time and resource, and that feeds this perception that it doesn't really have a very big impact on us if they don't come, or if they reschedule a session. So being firm on those boundaries (and if that means that somebody rescheduling has to go into your normal clinic the next week, rather than being fitted in at an odd time) I think that is an important message to send to people. They need to understand that you are a busy clinician providing a valuable service, and sometimes being too accommodating can undermine that sense for people.

• Is friction preventing people engaging? Secondly, how much friction is there for people to engage with you when they have a difficulty coming to a session? How easy could you make it for people to have that conversation with you? There's two things I'm thinking about here. There is common sense friction; do you have a system where people can reschedule their appointments online? Do you have a system where people can email you rather than having to pick up the phone if they want to reschedule? Do you have a system where they can phone you if they're a little bit technophobic and not very good with their email? Depending on your client group, you'll know where the friction is likely to be. Are you making it super, super easy for people to get in touch with you? Because like I said, if they're feeling overwhelmed, then they need the path of least resistance, they need it to be super easy to get in touch with you. Or it might just become something that is too challenging and they just ignore it, because that's easier. Also, though, do you have a third party dealing with your finances and should you consider it? Because of that issue we talked about a minute ago, because of that shame that comes around not being able to pay, I have found that having a third party deal with my invoicing has basically eradicated instances of ghosting because they don't have to email me anymore. If they can't afford to come to their next session, or they can't afford to pay for one they've had, they don't have to tell me, they can tell Anna, my lovely assistant, who will compassionately help them figure out either a payment plan, or will pass the message on to me, so they don't have that embarrassment of having to talk to their therapist about money. I wish our clients didn't feel that way, because if they do come to me to talk about money, I hope that they would get the most compassionate response possible, and I will always figure out a way to make it work, but the fact is, people are funny about it, and they worry about it, and it causes a hell of a lot of shame for people, so talking to you might be too difficult. If you possibly can have a VA handle it for you, or some kind of assistant or secretary, that is much easier for our clients, and it really will have a big impact on ghosting. If you can't do that, then it doesn't hurt to set up an email account that maybe is [e-mail] and to kind of pretend that there's someone else staffing that account. I know that feels a little bit icky, because it is a bit deceptive, but it does really help people in this regard. When I couldn't afford a VA, my accountant advised me to do this. Mahmoud, who's been on a previous episode, he advised me to set up an account that just said admin, and to send messages from that account with a different name. I can't remember I called her now, I think I've mentioned it previously on the podcast, but it's gone out of my head, but I invented a person and I sent email responses from that person. So if somebody was late paying, I would send an email from, let's call her Mary, saying, ‘we've noticed that you haven't paid for your session, are you having any difficulties? Please do get in touch and we'll figure out a way to settle your bill’ and it was exactly the same email that I would have sent; I templated it exactly as I normally would have, but I just signed it off as from someone else. And I noticed that people were much more open and transparent with me if they were having difficulties paying, and ghosting kind of went out the window. Now it's even better than that because Anna is really good at handling these things. Again, I've templated the emails that she sends out to people, so it's exactly what I want to be said, but because it's being handled by somebody different, people just feel a lot more confident and comfortable to be open.

• Are your comms handled in a welcoming and compassionate way? So that brings me on to another point. If you do have a VA or a secretary, how are they handling your comms? If you're really having a lot of problems with ghosting but you do have somebody in place that is not you, are they answering your phone in a welcoming and compassionate way? If somebody raises an issue like they need to reschedule or they can't afford to pay, how are they handling that? Is it the best way? Is it the compassionate way that you would want it to be handled? And I guess it's the same actually, if you're answering your phone, or if you're responding to your own emails, have a look back, are you giving people the kind of safety that they need to be honest with you? Because it could be that people are ghosting because they're feeling shamed by something in your processes. Now, I'm not saying that's the most likely, and there's a good chance it's not that, it's one of these other things that we've talked about, but if you've ticked all the rest of the boxes we've talked about, and you're still finding that people are ghosting you, it might be that there is something shame inducing somewhere along the line that is making it easier for them to scuttle away and never talk to you again than it is to say, ‘look, I'm having this issue, can you help me resolve it?’ So that's always something to watch out for.

Really, I guess the theme of this episode is that ghosting happens because of shame, generally, because it's easier to ghost you than it is to own up to either not being able to pay, or needing to reschedule for the 1,000th time, or maybe something has happened that they think as a therapist, you might judge them for. I know I've been ghosted before because somebody's had a relapse, for example, in substance misuse, and they thought that I would be really disappointed in them. Now of course, I wouldn't be. Of course, we all expect relapses and we view those as part of the journey that somebody goes on, but that is not usually where our clients head is at, and often, if they've got a really nasty, critical internalised voice, they imagine that coming from us. So there's a very good chance that ghosting is something to do with shame, whether it's financial, societal, or something that's happened in the client's life that they don't want to talk to us about. So everything that we can do to prevent ghosting is about alleviating that shame, or anticipating it, and trying to alleviate it where we can. There will always be some people who ghost us, and it will not be your fault. But I hope today I've given you some ideas of things that you can do, strategies that you can adopt, that are going to make it a lot less likely.

As ever I would love to hear your thoughts on this topic. Have you been ghosted? How did it make you feel? What did you do about it? Please do come and talk to me over on Instagram, I'm @RosieGilderthorp and I would love to hear from you.

Links

Instagram: @RosieGilderthorp

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Do you sometimes wake up at 2 am worried that you’ve made a terrible error that will bring professional ruin upon you and disgrace your family? I’m laughing now but when I first set up in private practice I was completely terrified that I had “missed” something big when setting up insurance or data protection. Even now, three years in, I sometimes catch myself wondering if I have really covered all the bases. It is hard, no impossible, to think creatively and have the impact you should be having in your practice if you aren’t confident that you have a secure business. BUT it can be overwhelming to figure out exactly what you need to prioritise before those clients start coming in. I’ve created a free checklist (plus resources list) to take the thinking out of it. Tick off every box and you can see your clients confident in the knowledge that you have everything in place for your security and theirs. Download it now - the link is in the show notes.

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