Reflections on Making Professional Wills for Hundreds of Therapists

By Robyn B. Miller, Ph.D.

The views and opinions expressed in this article are solely those of the author. This coverage is strictly editorial and is not sponsored, funded, or advertised by the American Psychoanalytic Association.

As an unwitting expert in executing professional wills, I have spent the past several years helping psychotherapists plan for their own death or incapacitation. I began this work after more than 20 years in solo private practice, deeply engaged in rich psychodynamic work. Many therapists overlook the need to prepare for the unexpected, however, serving as a practice executor for colleagues in crisis exposed me to the many clinical and practical demands that arise when a therapist suddenly disappears. Only by understanding these demands can therapists create professional wills that are clear, actionable, and protective of those left behind.  I argue that we owe our patients the courage to account for our own mortality.

Our Responsibilities to Our Patients

The therapeutic relationship is a profound bond, and honoring it requires appreciating the impact of abrupt loss on patients. We cannot believe the therapeutic alliance is healing while failing to recognize the risks to patients when we neglect to plan for emergencies. Although loss may be inevitable, our responsibility is to prevent traumatic loss by planning for our absence.

The ethics codes of all major mental health disciplines mandate proactive planning for continuity of care and the confidentiality of records in the event of a therapist’s death or incapacitation. The American Psychoanalytic Association goes further, explicitly stating that members must create a professional will. While some states codify these obligations, most stop short of enforcement. Regardless of legal mandates, creating a professional will is, above all, an act of caring.

Pinsky articulates the professional dilemma with striking clarity: “The way our work works is by our becoming important to people, in whatever individual ways they will make us important: we aim to matter…..If our aim is to matter, and if we set out to court that condition, what is it for us to be lost?”[1]

She continues: “If we analysts accept that we are mortal, our patients, then, are vulnerable—at all times vulnerable—to losing us, whether we are thirty, or sixty or ninety. Do we hold any responsibility to provide for them in that event? If we don’t hold a responsibility- and maybe we don’t- why not? And if we do have a responsibility, what constitutes reasonable provision? Finally, if we think there should be provision yet tend to neglect it, why is that?”[2]

If we accept that we matter, we must also confront the vulnerability our absence creates.

Collective Avoidance of Mortality

Despite caring deeply for their patients, most psychotherapists turn a blind eye to mortality planning. I propose that the field colludes in this avoidance. Emergency planning is often framed as an administrative or risk-management task, which allows clinicians to dismiss it as unnecessary for an unlikely event. Avoidance becomes harder when the issue is viewed clinically. In a preliminary study I conducted, 69% of surveyed therapists reported not having a professional will. Respondents cited denial of mortality, overwhelm, lack of knowledge, minimization of impact, and concern about burdening others. At the same time, nearly all described themselves as deeply caring about their patients. Many reported guilt about procrastinating for years. Perhaps this guilt reflects an unspoken awareness that therapists will one day fail their patients by dying. Ironically, planning is what protects patients from this inevitable failure.

McWilliams writes: “it is a core part of our professional ego-ideal to get our minds around the implications of all disturbing human experience….So it is pretty evident that a central way that all of us, analysts and non-analysts alike, deal with death is by dissociating any self-state in which it is visible. Additional evidence for this avoidance may be seen in our reluctance, which I can see in myself and numerous colleagues who have admitted a similar procrastination, to make plans for our patients if we should die or become unable to work with them.”[3]

This normalization of the avoidance comforts as the sentiment is so relatable, however, it contributes to collective noncompliance.

Ignoring death is psychologically protective. Aktar in his 2011 book, Matters of Life and Death: Psychoanalytic Reflections wrote succinctly, “Death is the greatest narcissistic injury.”  Even as we age and we see it in the mirror, we feel it in our bodies, we often continue to look the other way. Many aging therapists tell me, “I’m healthy.  I don’t need to worry about this, yet.” As if they will somehow evade our mutual fate. It’s easier to understand the denial in the younger cohort, further away from the outward signs, but the unpredictability of life, accidents, illness, exist for all of us, no matter our age. It could be hubris or grandiosity not to create a professional will, if you believe you may live forever, even if you know that you will not.

I have also observed a collective fantasy—particularly among analysts—that institutes will take care of their practices. As Gabbard described in his 1999 book Boundary Violations and the Psychoanalytic Training System, institutes are often imbued with transference as idealized, nurturing parents. In practice, spouses of deceased therapists frequently report that colleagues who had agreed to help later become unavailable, leaving grieving families overwhelmed by distressed patients and uncertain how to manage records.

Leaders of psychoanalytic institutes have shared the difficulty of even initiating conversations about professional wills, reporting low attendance at talks and resistance to formal requirements. These patterns suggest that the profession overestimates its tolerance for confronting mortality.

 

For more on creating a professional will please read Margo P. Goldman’s piece, “Reckoning with Death,” published in the Spring/Summer 2023 newsletter. If you are an APsA member, we encourage you to log in to your member account to find a model professional will linked in the Resources and Quicklinks page. 

 

The Harm Caused by Failure to Plan

The failure to create a professional will causes real harm to patients. In the post-pandemic era of virtual practice, many therapists work in isolation without nearby colleagues or referral networks. Even informal arrangements made with good intent can fail when successors cannot locate schedules or patient contact information quickly.

Some bereaved patients report being notified of their therapist’s death by a spouse, child, or neighbor, complicating grief and raising concerns about professional judgment. Others learn through text messages or listservs. Many report never being contacted at all. One patient shared:

“One day I simply walked into her office for our usual appointment, and no one was there. A few weeks later, I saw her obituary. I went to her funeral, but seeing her traumatized family only made me feel more disoriented and sad. Seeking out a new, unfamiliar therapist to process this felt unthinkable.”

These experiences raise uncomfortable questions. How can we rely on the therapeutic dyad as our primary tool of change while believing our absence would not significantly affect patients? Do we fear accusations of grandiosity if we acknowledge how much we matter? Are we uneasy admitting patients’ dependence, even when it is clinically appropriate?

Practical failures also harm patients and the profession. Without a plan, patients may lose access to continuing care or records. Confidentiality can be severely compromised. In one reported case, a deceased therapist’s widow placed psychotherapy records in recycling bins, leading to professional complaints. Of 15 patients I interviewed who lost therapists suddenly, only one knew what had happened to their records.

Planning for Absence as an Act of Care

I now spend much of my time consulting with psychotherapists to help them plan for potential incapacitation or death. Together, we examine every aspect of practice that would be affected by sudden absence. Many therapists seek help after a personal brush with mortality; others expect the task to be purely intellectual and are surprised by their emotional responses.

We review details often taken for granted: where schedules and contact lists are stored; how passwords and two-factor authentication can be accessed; how voicemail, email, and websites should be handled; how billing and referrals are managed; and whether former patients should be notified. Many therapists have never imagined what it would be like for someone else to step into their practice.

Those who complete this work frequently describe relief and gratitude. Breaking a complex practice into manageable pieces makes planning possible and spares friends and colleagues an overwhelming burden during times of grief.

Call to Action

As a field, psychotherapy must make emergency practice planning an expected and achievable professional duty. If we stop colluding in avoidance and recognize professional wills as a clinical responsibility rather than an administrative chore, we can shift our cultural norms. By tolerating our own discomfort, we honor our patients, protect our colleagues and families, and practice at the highest ethical standard.

 

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 writes and trains clinicians on professional wills and the role of practice executor and she and TheraClosure were featured in the New York times in July 2025 in an article on the impact on clients of sudden therapist death.  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. 

Sources

[1] Ellen Pinsky, “When an analyst dies,” in Flirting with Death: Psychoanalysts Consider Mortality, ed. C. Masur (Routledge, 2018), 140.

[2] Pinsky, “When an analyst dies” 140.

[3] Nancy McWilliams, Psychoanalytic Reflections on limitation: Aging, dying, generativity and renewal”, in Flirting with Death: Psychoanalysts Consider Mortality, ed. C. Masur (Routledge, 2018), 28.