There are various reasons a therapist might be unable to work with you, such as lacking expertise in a key area you need support with, what insurance they accept, or conflicts of interest.
There are various reasons a therapist may refuse treatment. Although it may feel like rejection, it’s typically not personal. Most reasons relate to professional ethics.
For instance, most therapists seek to avoid “dual relationships.” This is when you already have a friendship or business relationship with the therapist. This also works in reverse — your therapist should never offer to become your friend, lover, or business associate.
If a therapist is unable to treat you, they typically give you a referral to another professional who they believe can offer the care and support that you need
1. They would be practicing outside their scope of practice
A therapist may be unable to treat someone if the issue they need support with is outside the therapist’s scope of practice.
For example, if you need help recovering from an eating disorder but the therapist isn’t trained in how to treat eating disorders, they would need to refer you to a therapist trained in this area. This is a matter of professional ethics.
A therapist may refer you to someone else if they don’t have specific training or expertise in:
sexuality or gender issues, like gender dysphoria
therapy for trauma
If the therapist doesn’t have expertise in supporting people with those issues, the right thing for them to do is refer you to someone who can support you in the way you need to be supported.
2. Conflicts of interest
A conflict of interest is when your therapist has a relationship or personal situation that could affect their professional judgement or expertise when offering you treatment.
For example, they may realize they are friends with your family or your partner, which means they cannot be objective when you discuss these people during therapy.
If a therapist realizes they have a conflict of interest during your consultation or intake they should refer you to another professional who can be neutral. This allows them to maintain objectivity and protect the privacy of all people involved.
The therapist may be unable to disclose their conflict of interest to protect a client or a family’s confidentiality. They are bound by law and ethics to protect their clients’ confidentiality. As such, you may not know exactly why the therapist has refused to treat you.
3. Their method of delivery isn’t appropriate for your needs
A therapist who practices telehealth only may refer you for in-person therapy if they believe you would benefit more from in-person sessions, or if you don’t have the appropriate technology to meet through telehealth.
The rise of going to therapy online increased during the COVID-19 pandemic. Research from 2021 reports many benefits of online therapy, including:
improved access to care
not having to commute
While these benefits are great for many, telehealth may not work for everyone. You may have trouble with online therapy if you:
feel more comfortable with in-person sessions
have a poor or intermittent internet connection
persistently need emergency services or psychiatric hospitalization
feel uncomfortable with potential privacy or security issues that can impact teletherapy
4. Dual relationships
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 it might seem like a good idea for your friend (who already knows you well) to be your therapist, privacy and interpersonal issues would prevent the therapeutic relationship from being ethical.
Therapists also avoid entering relationships of any kind with past clients. Therapists and clients share a unique bond, and it can be harmful to the client if you transpose a new relationship on top of it later on.
While professional ethics vary on this topic, most therapists seek to avoid any relationship — whether friendship, romance, or business — with an ex-client.
5. Insurance or cost differences
A therapist may refer you to another professional if:
they don’t accept your insurance
you cannot pay or disagree with their full rate
they don’t have sliding scale options or spots to offer you
Many therapists offer some sliding scale options that are based on your income, so it’s worth asking a new therapist about this option.
If you can’t afford a therapist’s full price you might ask them about having shorter sessions that cost less, or meet less often, such as every other week or every month. You might also ask them to refer you to a colleague whose rates fall within your range.
What happens when a therapist ends therapy with a client?
If a therapist decides this therapeutic relationship is not the right fit, most have an ethical duty to provide an appropriate referral. You may seek another therapist on your own or use the therapist’s referral list.
While they can’t always tell you the nature of the problem, they can let you know that they have a conflict of interest — something like: “I’ve identified a conflict of interest and can’t see you, but I’d be happy to provide you with some referrals.”
A good therapist is transparent about what they can and cannot treat. They should be able to identify — and act on — potential conflicts that might influence their ability to be objective.