“Sorry, I can’t be your therapist. Here’s a referral to another colleague I trust…”

Some people may take for granted that therapists can pick and choose who they see and under what conditions. Not all therapists will see every patient that walks through their office door. There are a variety of reasons a therapist won’t see you, and most of them have to do with professional ethics.

For instance, most therapists seek to avoid “dual relationships” with you or their other patients. A “dual relationship” is one where the therapist isn’t just your therapist, but may also be a friend, lover, business associate, or some other role in your life. Therapists seek to avoid dual relationships, so if they are already your friend, business associate, or whatnot, they will refuse to become your therapist as well (this also works in reverse — your therapist should never offer to become your friend, lover, business associate, etc).

Although this may feel like rejection, you shouldn’t take it personally. Therapists will often avoid seeing certain people for these reasons to ensure the patient is treated with proper respect and dignity. Here are five reasons why your therapist won’t see you now…

1. You’re not on an insurance panel they belong to.

As much as we don’t like to think about it, therapists need to make a living as well and they do so by charging for the psychotherapy they provide. Many therapists accept health insurance for reimbursement, but they don’t always accept all insurance. So if the health insurance you have isn’t health insurance your therapist takes, you’re out of luck. Or you can pay their full rate out of your own pocket — anywhere from $75 to $150 per hour.

A small minority of therapists will take patients on what’s called a “sliding scale” fee, too. This is where the therapist discounts his or her hourly rate based upon your annual income. It never hurts to ask.

2. Your therapist has an existing relationship with you, your family, or a shared mutual friend.

As mentioned in the introduction, a professional therapist will almost always seek to avoid dual relationships — especially where they have a pre-existing relationship with you in a nonprofessional capacity. While this may seem not to make sense (“Who better to listen to me than my best friend the therapist who already knows all my secrets?”), you have to imagine the worst-case scenario. What would happen if your best friend, who is now your therapist, tells you something you don’t want to hear or vehemently disagree with in therapy? Who then do you turn to? Dual relationships rarely end well, so that’s why therapists are taught to avoid them.

This is also a good time for a reminder that therapists nearly always seek to avoid entering into a relationship of any kind with a past client as well. Because therapists share a unique therapeutic bond with that person, it has the potential to harm the patient if a new type of relationship is transposed on top of it later on. While different professional ethics vary on this topic, most therapists seek to avoid any kind of relationship — whether it be a friendship, romantic interest or business partnership — with an ex-patient.

3. Your therapist is seeing someone else in your family, a close friend, or has a close relationship with one of those people.

Unless the therapist is specifically doing family, child or couples counseling, most therapists try to avoid seeing people who know one another in a close or intimate manner. Doing so can cause all sorts of troublesome problems for both the therapist and the patient, as the therapist will hold secrets about the two parties that they may have a hard time not inadvertently divulging.

This can be especially difficult if you were first seeing a therapist and recommended the therapist to a close friend or family member. The therapist ends therapy with you and starts with a new patient, who is your friend or family member. The therapist may not agree to see you again while they are seeing this other person. It may not seem fair, but therapists may do this in order to keep their boundaries well-defined and avoid conflicts of interest.

4. You have a personality trait, physical trait, or component of your history that the therapist chooses not to work with.

Therapists are human too, and while they are carefully trained to recognize their own foibles and “issues” while conducting psychotherapy, there are times where it simply isn’t going to work for them. Good therapists recognize that they can’t work with certain clients as early on as possible in the client’s therapy, and refer them to a colleague for continuing treatment. It could be as something as simple as body odor, or as complex as you remind them of their mother.

Therapists will probably not share with you the specific issue that prevents them from working with you. Some feel ineffective working with certain types of people or those with certain kinds of problems. I know therapists, for instance, who refuse to see anyone with a personality disorder, because of the complications it can bring to treatment. A therapist may just not feel safe around a certain type of client, or clients who have certain types of concerns.

5. They’ve worked with you in the past and feel they’ve done all they can for you, or don’t have room in their schedule now to take you on.

Sometimes therapists feel like they’ve already done all they can for a person after therapy has ended and don’t see the point in opening the door again. This may feel like they are not being fair to you, or that they should take on past clients no matter what. But therapists sometimes have to make a decision about who to see, and whether the person will benefit from additional psychotherapy.

While most therapists will gladly open their doors to see an ex-patient again, not all will. It may be due to a conscious decision on their part, or simply that their schedule is full up and they have no room for “new” patients (even if you’re not really new).

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This entry was inspired by Dr. Kolmes’ March 2010 blog entry, When a Therapist Says It Isn’t a Good Fit.