I lost a patient the other day. He didn’t die or anything; he just emailed to say he didn’t want to come any more. “No! Wait! Why?” I wanted to shout. “It was going so well! You told me all that horrific stuff you’ve never told anyone before. We haven’t even got going yet!” It was like being dumped by email after a few intense and moving dates. I wrote back saying that of course I understand how hard therapy can be; I know how important it is to feel a sense of autonomy, but I think we should meet to discuss his reasons for leaving or at least to say goodbye. No reply.

I remember the same thing happening to someone in my first supervision group. He’d waited longer than anyone to get a patient. Week after week he’d turn up to listen to our smug session notes and week after week he’d be told that nobody suitable had come up for him yet. I heard one supervisor say: “The patients getting referred for NHS psychotherapy are much iller nowadays. Not suitable for a trainee.” Psychiatric units are closing and the open ones are full, so patients who might once have qualified as in-patients are now coming for weekly therapy. Nobody is going to let a trainee loose on them.

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