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Is a Leave of Absence from Private Practice in Your Future?

Updated: Jan 14



Managing an Extended Leave of Absence from Your Private Practice



Written by Leslie S. Tsukroff, MSW, LCSW

Founder and Executive Director of Leslie S. Tsukroff, Inc.


Are you planning on taking a temporary leave of absence from private practice to recover from a medical procedure, for other medical or mental health reasons or to care for a loved one who is ill? Or are you an expectant parent and preparing for parental leave?   If so, read on to learn from my experiences and gain helpful strategies.


When taking any time off from your practice- whether short or long term- mental health professionals are ethically and legally obligated to have a pre-determined plan in place to ensure all clients receive the care they need while their clinicians are unavailable.  In my 24 + years in private practice, I’ve experienced several situations in which I needed to take extended time away from the business and each one presented unique challenges.  I don’t want to bore you, so I’ll highlight the most complicated experience.


One of my leaves was somewhat planned; I say “somewhat planned” because I didn’t know when I’d need to take time off, but I knew that at some point in the future, I would be out of the office for several weeks or months.  At the time, I didn’t know if I would have advanced warning of a few days or weeks, or if I would have to temporarily close the practice at a moment’s notice.  At first, I panicked.  I couldn’t just leave my clients in the lurch, but due to the nature of the leave and potential complications, I wasn’t sure if it was fair to forewarn them about something that would occur “sometime” in the near or far future.  The whole situation was overwhelming and I felt paralyzed.  So, I sought formal consultation, talked it through with trusted colleagues, and with the help of “my team” we constructed a blueprint of what actions needed to be taken beforehand, what needed to be done when the time came and who would do it.   We also explored several “what if” scenarios, such as requests for records/medical information, paperwork or letters and developed a plan for how to handle them. Together, we identified other competent colleagues who understood my predicament and agreed to serve as designees --those willing and able to contact my clients when/if needed. Many of these wonderful colleagues (you know who you are and I still feel blessed by your support, generosity and friendship) even agreed to provide temporary or permanent services to my clients.


In planning ahead:

1.      I determined it was best to stop accepting any new referrals. This was unbelievably anxiety-producing  because I didn’t know how long I’d be in this holding pattern and I was worried how a decreased caseload would affect the business’s finances long-term.

2.      With the objective input and guidance from colleagues, I assessed my current caseload. We reviewed each client’s overall progress, goals, current mental status and level of functioning to determine which clients would likely need to be referred, which were ready to reduce sessions and which were ready to terminate. I took into consideration the length of current stability any historical patterns that might help to inform my perspective. Reflecting upon current clients’ progress and objectively noting those who had met or were close to meeting their treatment goals, was both extremely helpful and empowering during a time filled with uncertainty.   It was also useful as I began to pare down my practice in preparation for the changes to come. See #3

3.      I had to face reality. Upon my return from leave,  I would not have the time, physical or emotional capacity to provide exceptional care to clients who required more or had significant needs. Clients who consistently or periodically needed an increase in the frequency of sessions, those with acute medical conditions, those with limited coping skills and tenuous supports and school-aged clients that required additional outreach to parents, teachers and school-based systems might need to be referred out.  All of my clients, but especially these clients, deserved to have a therapist who would be able to provide the same services as before. I just wasn’t going to be able to do it.  

4.      Once decisions were made- I took action. As hard as it was, I knew I needed to reduce the number of weekly clients and once I identified those ready to launch and those who required transfer to another qualified clinician, I broached the subject.  As I recall, of those clients who seemed ready to fly, most agreed that it was time, but they were scared.  

With clients whom I felt would need more than I would be able to give during this waiting period and upon my return, I made the well-thought out and conscious decision to inform them that an extended leave was imminent.  They had concerns.  I was careful to hold firm boundaries and not share the reasons, but reassured them I was okay and would be okay and shifted the focus back onto them.  During this intense and draining process, we concentrated on identifying, examining and processing their thoughts, feelings (they had BIG ones) and needs and I listened, validated, supported, encouraged, reframed, and reality tested. For some clients, their termination and/or transfer process occurred over several weeks, for some, several months. 

 

What did I learn from this, as well as from other leaves?

 1.    Start getting your ducks in a row as soon as possible.  If you are anticipating a leave in the near future, it’s never too late to start planning.  As your leave date approaches, you will have a great deal to manage. A head start will result in a smoother experience in the days and weeks leading up to your leave. 

2.    Gather your team. I strongly recommend not facing this alone. Amass trusted and knowledgeable colleagues and other professionals to support you through the emotional, clinical, ethical, legal and practical matters you’ll face before, during and after your leave. Preparing for extended time off, even if only for a few weeks is emotionally and physically draining. It is natural to experience feeling of anxiety,  distress, guilt, worry and doubt (just to name a few).  In addition to stress related to the reason why you will be out of the office, you have to take in, integrate and apply the ethical, legal and clinical standards of the profession to ensure your clients’ needs will be met and the business you have worked hard to create can flourish upon your return.  Your documentation and record-keeping need to be up to date before your departure, including progress notes (outlining the care plan), treatment plans, and termination summaries. You are tasked with assessing each client’s current state, anticipating their needs and formulating a clinically sound plan for their care in your absence. Your team can help you navigate this daunting process and assist you in determining which clients are appropriate to “wait” for your return and which clients would be best served by continuing treatment with another provider in your absence. 

3.    Inform clients as early as possible about your impending leave.  Advanced notice allows for the opportunity to fully process what your absence means for the client and the therapeutic work and provides ample time to discuss and develop a care plan.  Most clients rely on the consistency of their sessions and your impending leave is likely to bring up a myriad of feelings about you, your well-being, the status of their treatment and any unresolved conflicts. It is not uncommon for clients to experience a range of emotions including fear, resentment, abandonment, sadness, worry, anger, disappointment and loss. They will want to know, and have a right to know what options they have during your absence-- termination and transfer to another clinician, termination, a temporary transfer to another clinician or temporarily pausing treatment until your return.

4.    Obtain clients’ informed consent to share information. Because continuity of care is the gold standard of practice, make sure clients sign a release of information so that your designee has their expressed permission to contact them if and when needed.  If you believe a client may seek interim services with another clinician in your absence, obtain an ROI before you suspend treatment. That way, if the client does engage in treatment with someone else, your designee already has permission to provide the interim clinician with the necessary clinical information for a smooth transfer.

5.    Provide all clients with written information pertaining to your leave (in addition to verbally). This letter/e-mail should outline: your last day of work; your anticipated date of return; the proposed care plan; who they can contact if they need something from your office; how they can contact this person; alternative options for support including referrals to qualified professionals, community resources and emergency/crisis services.

6.    Manage your digital presence. Activate out-of-office messages for text, email, and voicemail and add a notice on your website and any on-line profiles that notifies others of your absence, anticipated date of return, contact information for your designee, emergency instructions and information outlining how current and previous clients can access their medical records. 

7.    Don’t forget to develop a financial plan for when you will be unable to work. Taking time off will not only have an impact on your clients, but it will also affect your personal and business finances.    You will still have business expenses and will most likely need to continue to draw a salary during your leave of absence.  Speak with your accountant and/or financial planner to help you determine what will work best for you and your business; but do this early. If possible, begin putting money aside when you know a leave is imminent.

 

The final takeaway

Advanced planning will ensure a smoother, less stressful transition for you and a more supportive, collaborative,  informed and structured experience for your clients.   When a leave of absence is anticipated, no matter what your professional discipline, professional Codes of Ethics and most professional state licensure regulations emphasize the practitioner’s responsibility to implement clear and client-centered policies and procedures to ensure their clients’ well-being throughout the process. Anticipating a leave in your future? Enlist Leslie S. Tsukroff, Inc. to be a part of your collaborative team!

 


© Leslie S. Tsukroff, Inc. 2024 (All Rights Reserved)

This article originally appeared in Leslie’s January 2024 Newsletter



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