Professional Will for Therapists: Why "I'll Deal With It Later" Isn't Enough
We've been in this field for over twenty-five years, and there's a particular kind of phone call that stays with you when there has been something tragic that has happened to a colleague. If you've been in private practice long enough, you've either made one of those calls or you've gotten one. What happens in the days that follow (who calls the clients, who handles the records, who pays the lease, who logs into the EHR) depends almost entirely on whether the therapist who's gone, or temporarily out, had a plan.
In our work coaching private practice owners through Business School for Therapists, we've watched both sides of this. We've seen members lose colleagues and step in to clean up practices with no instructions, no passwords, no executor named, no continuity plan, all while grieving. We've also seen members get sick, get injured, get unexpectedly hospitalized, and have their clients gently held by a system they'd built in advance. So what we are talking about isn’t only an ethical issue, it's something deeply felt by the clients on the other end.
A professional will is infrastructure, the same kind of infrastructure we coach on in BST, alongside your fee structure, your contracts, your insurance, and your business entity. A practice that can survive a bad week, a bad diagnosis, or a bad accident is a practice you've actually built. One that can't is just high-functioning improvisation.
The reason most of us don't do this work isn't laziness. It's that the field doesn't really teach us to think of our practices as ongoing entities with responsibilities that outlast us. Grad school covered termination but it didn't cover what happens when termination isn't possible.
We've come to know Robyn Miller and the team at TheraClosure over the years because they offer something the field needed and didn't have: a professional executor service built specifically for therapists, by a therapist. They've also extended a discount to Business School for Therapists members, which we appreciate because it makes doing the right thing more accessible to the independent practitioners we serve.
We asked Robyn to share what she's learned from stepping into this role for colleagues, and what she wishes every therapist had in place before they need it. Her piece is below. If you've been putting this off (and statistically, most of you have), please read it. Then please do something about it.
What Happens When a Therapist Suddenly Can't Practice
Therapists are only human, too. Like anyone, we get sick, have accidents, are faced with the unexpected, and there is so much we cannot control in life despite our defenses and denials of mortality. But therapists have an important responsibility to confront what makes us uncomfortable. Our life’s work involves creating deep relationships with vulnerable individuals who often rely on us. What is our ethical duty to them, even in the face of our own emergencies? How do we ensure that we protect our clients from unintentional abandonment?
The ethics codes of all mental health disciplines recognize the obligation of therapists to proactively put in place plans for patient continuity of care and the confidentiality of medical records, in case of the therapists’ incapacitation or death. In addition, state-specific regulations govern the duty of record retention and ongoing accessibility of records to clients, beyond the therapist’s retirement, relocation, or death.
When my friend and fellow psychotherapist, Kim, a vibrant and seemingly healthy woman in her 40s, was suddenly diagnosed with a terminal illness and died a few weeks later, I stepped in as “Practice Executor.” Serving on her behalf, I notified all her patients in heartbreaking phone calls and supported them through the shock. I assisted them with referrals by working to identify unique, available, well-suited therapists and then facilitated that transition. I took custody of the medical records, issued billing invoices for the practice, sent notice of transfer of records to former patients, changed voicemails and social media, cancelled malpractice insurance, and a slew of other administrative tasks. While managing my own full-time practice and my significant family demands. While grieving the loss of my close friend and supervision partner of 17 years.
This was incredibly difficult, but essential and meaningful work, to protect the clients in their efforts to cope with the significant and sudden loss, and to honor the ethical practice my friend had operated with compassion and integrity. Based on this trial-by-fire experience, and by serving in this role a second time for another friend who faced a life-threatening emergency, I began to write and offer trainings on what happens when a therapist is suddenly unavailable, and how we must put a plan in place for the possibility, no matter how unlikely, that such a situation would befall any one of us and our own clients.
Lessons for Therapists
My experience underscores the importance of preparation. Here are some key takeaways for therapists:
Have a Professional Will: A professional will is considered instructional, though is likely not legally enforceable, and it is not your personal last will and testament. Clearly outline your wishes regarding fulfillment of your professional responsibilities, including name your practice executor, patient records management, and plans for notifying patients.
Choose Your Executor Wisely: Consider a clinician who is reliable and prepared for the emotional and logistical challenges. Who will have the availability and resources to handle the urgent aspects of your practice in the face of their ongoing demands? Recognize that you are depending on someone who may not have the skills or experience to dismantle a practice.
Provide Detailed Instructions: Leave information about your caseload, referral recommendations, and access to practice systems like billing and scheduling. Consider how the executor will get access to your passwords, even when they change over time, and even with two-factor-authentication procedures. What about payments due, or paperwork clients may need for reimbursement? Be very clear and specific on how all the details will be accessed so that the executor can administer your will.
Think About Boundaries: Decide in advance how much your patients should know about your medical condition or ongoing status, as well as whether they’ll be welcome at memorial services.
Know the State Regulations pertaining to retention of medical records and duty to notify. If you practice across states, you should follow the most conservative requirements.
What are the obstacles?
In a recent survey I conducted, 68% of therapists said they do not have a Professional Will or Executor. The primary reasons are:
Denial of Mortality: We do not want to think about it so we procrastinate and avoid.
Who to rely on to accept this heavy duty of Practice Executor? Many therapists shared that they don’t want to burden a colleague, friend, or loved one. Many shared that they do not know anyone to ask. Also, a one-to-one arrangement with a colleague has risks: Will they be available? Will your estate need to compensate them? This is often much more costly than anticipated because the job is a very time-consuming one. Joining a group of colleagues who agree to cover for one another is a better plan, but it also has risks, as who will supervise and be sure none of the clients or responsibilities fall through the cracks?
Overwhelmed by how to arrange this complicated agreement: The legal and logistical processes can be quite complicated. You can hire a lawyer at significant cost or find a template of a will on the internet and hope it suites your situation. Either way, you are back at obstacle #2: who will serve your practice and fulfill your instructions to help your clients cope if faced with such a tragedy, and who will handle the mess of your practice so that your grieving family won’t have to?
A Solution
In the face of these obstacles, I decided to create a solution. I thought about how to unburden therapists who want to do the right thing but are so stressed out by the prospect of making a Professional Will that they feel stuck. To make it easier for therapists to be compassionate and ethically compliant without anxiety and overwhelm, I decided to professionalize fulfilling the duty to plan by creating is the first therapist professional executor service, TheraClosure.
Now therapists have the option of outsourcing this dilemma to experts in grief and practice closure. Designed to be a modern and comprehensive answer to all the enumerated challenges, an executor service provides therapists with:
A tailored legally reviewed Professional Will
Compassionate clinicians on retainer to serve as your Practice Executor
In the event of an incapacitation or death, we follow your plan and provide:
Immediate sensitive notification of current clients
Available tailored referrals matched to client need
Record retention and access for clients needing record transfer
Billing completion with funds transferred to your estate
Resolution of business aspects of practice such as lease and autopays
Fixed costs so that your estate is not saddled with unexpected bills
Therapists, too, are vulnerable to life’s uncertainties. Painful experiences can be a catalyst for innovation. I hope offering this resource can assist therapists in pushing through denial and procrastination to get it done so that they can practice without guilt and instead know they’ve truly done all they can do for the people who trust them. Preparing for the unexpected ensures that, even in the face of loss, the work of healing can continue.
Bio
Robyn Miller, Ph.D. is a clinical psychologist practicing in Maryland since 2002, and she is the founder of TheraClosure, LLC, the first psychotherapist professional executor service. Dr. Miller trained at the Massachusetts Mental Health Center/Harvard Medical School and at Harvard University Counseling Center. She earned a Ph.D. from University of Rochester, and a B.A. from Tufts University. Psychotherapy interests include menopause transitions, eating and mood disorders, and trauma. Dr. Miller writes and trains clinicians on professional wills and the role of practice executor and has been featured in The New York Times.