how can I get time off work for therapy?

Most people don’t hesitate to tell their boss they need time off for a medical appointment – but when that appointment is for therapy, they often get a lot more reluctant. And understandably so. Frustratingly, mental health can still carry a stigma at work, and people are often unsure how much they really need to share and how much would be TMI. Plus, because therapy is often weekly, there’s added pressure to say more than just “I have a doctor’s appointment.”

At Slate today, I wrote about how get the time you need to get yourself to a therapist, including:

  • How do I ask for time off to go to therapy?
  • If I have a standing weekly appointment, won’t everyone assume it’s for therapy?
  • What if I’d rather disclose it? Is there anything wrong with sharing with my boss or coworkers that I’m in therapy?
  • Is there any legal protection for me if I let my boss know I’m in therapy and then suffer discrimination as a result?
  • What if my boss resists giving me time off for therapy appointments?

You can read the piece here.

{ 112 comments… read them below }

  1. Essentially Cheesy*

    I would tell my supervisor(s) I have a medical appointment and leave. Done and done! No explanation needed. Therapy is part of medical care, is it not?

      1. Mel*

        Yes, this is so true. With daily require overtime , my company wants all hands on deck and weekly appointments would require fmla.

    1. Abogado Avocado*

      Exactly! It’s part of medical care and that’s how you do it. Just as no one would need to know you’re going to a physical therapy appointment, no one needs to know that you’re going to a [mental] therapy appointment.

      1. Ask a Manager* Post author

        Agreed, and that’s exactly what I say in the article! But a standing weekly appt often does require more discussion than one random one on March 15.

      2. Manic Pixie Dream Grad*

        I feel like that depends on the culture though! If people share details (e.g. physio/blood test/counselling), it would be odd not to. However, most people will just say medical appointment (unless you’re on closer terms), which is completely fine and means I don’t have to reciprocate.

        I’ll usually give more details if it’s something very minor though, to reassure people that I’m ok and healthy – e.g. (physio for the skiing injury), but not for anything more private/concerning.

        1. Elitist Semicolon*

          I was recently offered a job that I fully intended to take until I mentioned that I had a standing medical appointment every other Wednesday and the manager said, “We have our staff meetings on Wednesdays.” I responded, “okay, I’ll see whether I can change the appointment,” and the manager came back with, “I don’t don’t understand why you couldn’t just tell them you’re changing. What kind of appointment is it anyway??”

          Admittedly, my phrasing could have been better – I didn’t mean “I’ll have to ask permission and if they say no I can’t take your job.” I was only thinking out loud about what I’d need to do after I accepted. But the hostility of tone and the boldness of thinking they were entitled to know the details were a GIANT red flag.

    2. Anon for today*

      I think this really ignores reality for many people. It’s the same as people just pushing the “No means no” axiom. Taking this approach would put a lot of people at risk for losing their jobs.

      1. Metadata minion*

        And heck, my job is *great* about respecting people’s need to take time off for medical appointments and such. But because of that, it would be weirdly aggressive for me to just go “I’m leaving early every Thursday from now on; end of conversation”. Both I and my supervisor are reasonable people, so I can have a conversation about the best way to adjust my schedule.

    3. Pucci*

      It is possible to have weekly standing appointments for something other than therapy. I have one for allergy shots. For those, I get the shot then have to wait in the office for a half hour to make sure I don’t have a reaction.

      1. TeaCoziesRUs*

        I was hoping someone else would mention allergy shots. Between those weekly, physical therapy twice a week, and counseling every one to two weeks, taking care of my health is already a part time job!

      2. Mannequin*

        Yep, con confirm this for allergy shots, I did them as a toddler (can barely remember) and again in high school, where I had a standing appointment right after school every Friday.

  2. General von Klinkerhoffen*

    Very interesting, thank you.

    I’m also glad there’s going to be a regular MH slot.

  3. What's in a name?*

    If your company/boss is really overbearing, you can just open this article at work and wait for them to mention it.

  4. No Name Today*

    Regarding the stigma: I used FMLA to care for an ailing parent. Had coworker tell me she figured it was mental health treatment, so that’s what she said when people asked where I was.
    So that was fun to come back to.
    I just reminded myself that Jackasses are gonna jackass. After all, she and her partner in evil would also sit at their desks and comment on how the woman who used an electronic scooter obviously didn’t need it because she would walk the five feet from it to the bathroom stall.

    1. lilsheba*

      “After all, she and her partner in evil would also sit at their desks and comment on how the woman who used an electronic scooter obviously didn’t need it because she would walk the five feet from it to the bathroom stall.”

      OOOOHHHH I wish people would realize that use of a scooter or wheelchair doesn’t mean paralyzed, and doesn’t mean you can’t walk AT ALL. It means you can’t walk as much as you would need to to get around in a day. And it may be different on different days. Mobility aids are a good thing, and need to respected.

      In the past I had a standing mental health therapy appointment every two weeks, and just setup an FMLA claim for it, never got any grief about it. It did say it was for therapy but that’s it.

  5. fieldpoppy*

    Alison, my gf, who is a therapist, read this and said “Alison is always so REASONABLE” lol. She will pass it on to her clients.

  6. Trawna*

    Maybe if no one uses the work stigma in association with mental health care, the so-called stigma might just disappear. I say make the naysayers and discomfited look like dinosaurs.

    1. Me*

      As someone with bipolar, there is not “so-called” stigma, there IS stigma. Not using the word stigma won’t magically make it not exist. Lipstick on a pig an all that.

      In order for the stigma to get better (it will likely never go away), there are many things that can be done such as education and people speaking out on it.

      Pretending it’s not there isn’t it and not only isn’t helpful, it’s actively harmful.

    2. Dramatic Intent to Flounce*

      Sadly, ableism rarely works like that. (And yes, the stigma around mental health conditions, especially the less common and therefore less ‘relatable’ and acceptable ones, is very much ableism.)

      Saying ‘I’ve struggled with depression and anxiety for years’ might get you looks, or it might get dismissed because ‘everyone goes through that’. (Other pet peeves: ‘everyone’s a little ADHD/autistic/OCD/whatever.’) Saying ‘I have had periods where my anxiety was so bad I couldn’t leave my dorm room to eat’ or ‘I have been hospitalized for my psychiatric condition’ will INEVITABLY get you treated differently and negatively, even if your mental illness is well-managed, and probably even from some of the same people who downplayed your issues before because doesn’t EVERYONE get depressed sometimes?

      Acting like the stigma doesn’t exist doesn’t change people’s underlying attitudes about mental illness. It sucks that we have to decide whether or not to disclose for our own wellbeing, and humanizing these ‘scary’ conditions helps reduce stigma, but it doesn’t fall on people to be open about it at work any more than it should fall on queer people to be out even if they might be fired for it. (Or worse. Despite the stigma against people with, say, schizophrenia, they’re statistically far more likely to be VICTIMS of violence than perpetrators. And I don’t need to tell you that homophobic and transphobic hate crimes are still a thing.)

      1. batcat71*

        I am deep in this, thank you for saying it outloud, transphobia and homophobia are real, along with mental health and being neuro divergent are treated as something – other.
        I have been open at work I am ND, on the spectrum (ADHD and ASD) but, they still say i should ‘just try harder’ and ‘everyone struggles not just you’ and then they tell me my face looks wrong for the emotion i ‘should’ be expressing! and i am super low support needs.
        Never mind the rest of it. my coworker just told me (i do not consider myself cis gender and i am openly not straight) that if she was to date a man (she is straight) and found out he wasn’t, she would punch or otherwise assaults him, not because she is violent but because that is ‘so degusting’ she also encouraged me to NOT come out at work, as ‘no one will understand, they are just like that’.
        so, yeah, it is hard. these are not ‘bad people’ but they are all alike in a lot of ways. i am different and it is hard.
        they ALL pay lipservice, but, they seem to know little and care little to know more. i don’t know what to do.
        i am just tired of trying to fit in only to fail so often. i am discouraged to feel that cold shock to know my coworkers think i am ‘ gross’ or ‘lazy’ as that seems to be what they think.
        and, sure, it shouldn’t matter, just do my job.
        but it does hurt.

        1. Daisy Gamgee*

          I just wanted to say that I hear you, so much. It’s almost not so much the one horrible person who spews bigotry as the knowledge that millions agree with their asinine proclamations. (But of course it’s also the one horrible person whom you have to deal with day in and day out.) It does hurt. I send you strength.

        2. allathian*

          I’m always amazed at what crap people are willing to say to their coworkers’ faces. It hurts to be excluded and othered, and some people either never learned that, or else they get their kicks by hurting others intentionally.

      2. lilsheba*

        Add in DID and you have even more fun. Dissociative Identity Disorder not only has stigma (thanks to movies like Split) but it also isn’t believed to even be a real condition, that people are “faking” it.

        1. batcat71*

          oh you know it! I made the mistake of telling my coworker what my therapy was for – being tortured as a small child – she told me to remember that while she has not disclosed it previously, her parents got divorced when she was young, her mom feel so badly she TO THIS day, cleans her home for her weekly, she also bought her the home she lives in.. so yah, we are EXACTLY the same. I am so glad that now she can gossip about that about me.. I think that normies think that any kind of special accommodations, are a luxury they are denied.

          1. Mannequin*

            So f’ing clueless. I’m so sorry you had to deal with such an ignoramus. And NT people like her think that WE don’t have empathy?!

    3. Keymaster of Gozer (she/her)*

      It’s going to take more than just not using a word to overcome all the prejudices people have about mental health issues.

      I’ve only ever once admitted to an employer that my regular medical appointments were for my schizophrenia – thinking it might remove any stigma of this illness. How very, very, very wrong I was.

      Nowadays no employer knows what my appointments are for or any details of what mental illnesses I have. And it’s staying that way.

    4. Come On Eileen*

      But there IS a stigma around this kind of stuff – even if we wish there weren’t. It’s the same reason why I, as a sober alcoholic, don’t tell my boss that. Addiction has a similar stigma and I don’t want to be treated differently. I am open about it in my personal life and I’m thriving in recovery. Rightly or wrongly, the stigma means I stand to be treated differently and I don’t want that.

    5. SnappinTerrapin*

      I could tell several stories about gently pushing back against this stigma during my career as a peace officer.

      I was in a meeting with other senior staff of a large agency when our HR manager wanted to take an officer’s pistol away from her because he had heard she was taking psychotropic medications. I pushed back, with a few questions. No, he didn’t know what medications or what the diagnosis was.

      I looked around the room. From private conversations, I knew several people in the room were taking medications for anxiety and/or depression. It’s kind of an occupational hazard. I pointed out that he was asking us to take action without collaborating with the employee because of his perception that she was disabled.

      I never did hear of any evidence that her condition (if it existed) presented a danger to herself or others.

      Pointing out his bias about the stigma struck me as more constructive than ignoring the stigma. And given his biases, I wasn’t going to enlighten him about anyone else’s undisclosed health condition.

  7. cookie monster*

    I put a calendar hold for “Appt” for my early morning weekly appt and no one has ever said anything to me about it. Definitely easier with WFH.

    If I did have to explain something I would say “I will need to have weekly medical appointments to manage an ongoing condition” but not say what its for. Honestly if I was really pressed I’d suggest that it was somehow womens-health related which I’ve found gets people to back off really quickly. Or at least understand that its none of their business.

    1. Smithy*

      To be fair, I think that “regular women’s health” can have its own stigma risks, but more so associated with pregnancy and fertility.

      What I like the most about the article overall is just saying that you have a weekly medical appointment and therefore need to arrive late/leave early/take a long lunch. And that if you do need to divulge more, really looking to address it with HR/ADA as opposed to getting pushed into an increasing boundary pushing, unprofessional or unreasonable conversation. Because when you work somewhere and that has those issues, it can be easy to fall into the trap that there’s a magic sentence or excuse that will stop their behavior when the reality is that they’re inappropriate and unreasonable.

      I worked somewhere when I had melanoma surgery on my shoulder and genuinely didn’t mind talking about it. As it was also an inappropriate, unreasonable and unprofessional workplace, it didn’t stop the CEO from asking me to show her my wound the day after the surgery. Not to prove I needed a sick day, but she was curious – and again see inappropriate/unreasonable and unprofessional.

      The excuses and workarounds most often work best with people where if we just said “standing medical appointment”, they’d also understand. And reinforcing boundaries will have to happen in more challenging work places or with more challenging people regardless.

      1. cookie monster*

        I do agree, I really don’t think you need to say anything! And people will just continue to be nosey. Just in the vein of detailing your stomach bug symptoms if your boss is asking why you need a sick day, give people TMI (in some awy) if they ask for TMI

    2. Snarktini*

      It does help a lot if one is lucky enough to get a regular appointment is at the very beginning/end of the day because people don’t notice that as much, especially if you WFH. It’s much harder to consistently defend a time slot in the middle of core hours. In ye olden days, I had 2pm therapy that took me away from my desk for two and a half hours including travel! There was nothing else available. I’ll never go back to in-person therapy, the time savings is too important to me. Now my appointment is basically invisible to my coworkers.

    3. PT*

      The dentist can be a helpful lie, in limited circumstances. I’ve had work that dragged out the full six months from my exam to my next exam, once.

  8. autumnal*

    Thanks for addressing this, Alison. The more we put forward information about reasonably managing mental health, the more we’ll be able to build systems that support reasonably managing mental health.

  9. DecorativeCacti*

    If you are eligible for FMLA, you can use that to cover mental health care as well.

    I had to take an extended leave a few years ago and my doctor included that I would need time off for ongoing care when we did my paperwork. I was able to leave an hour early every two weeks and use FMLA to take a whole day every once in a while when I just couldn’t do it.

    My job wasn’t a safe environment to disclose what was going on, so I would just say something along the lines of, “Nothing to worry about, but I’d rather not talk about it at work. Did you see my email about changing the topic?”

  10. QuinleyThorne*

    (To preface, I have been very lucky)

    I started going to therapy weekly when I was between jobs. When I started my current one, I decided to just disclose it to get it out of the way ahead of time. It was a risk since I had just started, but I figured it would be a good way to gauge how this was going to be dealt with going forward. My position is public-facing as well, so I knew coverage was going to play into that, so I framed the conversation around that: “I have weekly therapy appointments that are usually on X day at Y time, but I want to ensure there’s coverage so I’m not leaving anyone in a lurch; what’s the best way to go about that?” And we just went from there.

    Being matter-of-fact about it worked out for me in the long run, as it allowed me to talk about it without it feeling like I was hiding something when I didn’t need to. When I changed supervisors a couple years ago and had to fill the new one in on the arrangement, he understood immediately, and said “been there, done that, totally understand, just tell me what you need”. I never thought of therapy as an icebreaker, much less one for work, and even less one with the supervisor, but I’m glad it happened that way. Going to therapy is typically a result of regrettable circumstances, but but knowing we’d both been through them was a relief I didn’t even know I needed; that I was known and understood, and in a way where I wouldn’t have to over-explain or justify myself.

    1. QuinleyThorne*

      In the conversation with my current supervisor I also made him laugh by saying “Hey, same hat!”

  11. Aggresuko*

    I use my lunch time to go. I have my lunch time moved up an hour one day a week and nobody objects to it. I used to have people scheduling meetings for me (happened recently actually) during that time or having a meeting before that run late and then I felt obligated to cancel, but that stuff hasn’t happened recently.

    I’m pretty open about it because everyone knows I’m nuts.

  12. JH*

    This feels so timely! I was just asking someone how to handle this yesterday. I have a standing weekly therapy appt. that my former boss (still with the organization) knows about but my reporting line changed this week and I’ve been trying to decide the best way to address it. Thanks for being so open and providing advice on things like this!

  13. Chc34*

    At my last job, my boss was very open about the fact that he came in a little late on Wednesdays because of his therapy appointments. When I started therapy, it was much easier because of that to ask to leave a little early on Thursdays, which he totally supported. So if you manage people and are comfortable with it, I really encourage being open about it: it made it much easier for me to even consider going to (much-needed) therapy in the first place.

  14. HelloFromNY*

    I recently started attending therapy twice a month. As odd as it sounds, the pandemic has been helpful for this. Many therapists are now utilizing virtual appointments. I also work from home most days. I take my lunch break to log off my work computer and onto my personal computer for my sessions. On days that I’m physically in the office, I take my lunch and run out to my car and use my cell phone for a video session. I realize that not everyone has this flexibility, but it’s been incredibly beneficial for me. I know at some point my team will likely return to the office full time. I’ll have to cross that bridge with my appointments when I get there.

  15. Rage*

    I’m lucky that I work for an organization that takes employee’s mental healthcare seriously. For staff who are on the company insurance, we get 24 copay-free therapy sessions. For those who do not take our insurance, we have therapists in town that we’ll pay for 24 sessions for those employees.

  16. MechanicalPencil*

    When I was in therapy, I was lucky enough to either be able to schedule it after work (but I had to leave on time to make it) or to use my lunch break for appointments (lunch was “long” at maybe 85 minutes). I kept a standing blank meeting on my calendar so people didn’t schedule over it. That worked maybe 97% of the time. Possibly important to note that I did this while both working in office and remotely.

  17. Magenta Sky*

    This has been a reminder of how living in southern California is like being in an alternate dimension. Anybody who is even at the fringes of Hollyweird tends to see “having a therapist” as a mark of higher social status and financial success.

    1. California Dreamin’*

      Yes. SoCal native here and have been reading this thread thinking huh, I honestly did not realize that this was a thing because I’m pretty certain no one here would bat an eye. My teenaged daughter is in therapy and she has felt no need to keep it private amongst her cohort either.

  18. UpwardSpiral*

    Thanks for this! I recently changed jobs and am also trying to get on a regular schedule for therapy. While my previous boss would’ve been very supportive and totally accepted “I need to leave at 3 every Tuesday, I’ll start early on Wednesday”, I’m not so sure about new boss. He’s said things that read to me as suspicious of the severity of the pandemic, which make me more cautious about how I phrase requests for any medical time off. The advice here helped me remember that I just have work through it and handle problems if they come up.

    I’ve also noticed a trend in the comments so far: the word “lucky” has come up in quite a few posts. That’s a reminder to that getting into therapy and working with job schedules is not as easy as it should be for everyone.

  19. just a random teacher*

    Any thoughts about how to handle this when it’s a coverage issue and your hours cannot be flexed? I’m thinking particularly of teachers, here, since for a lot of us there are no whole hours without students within our workday where we could even go to a virtual appointment. (Lunch is often 30-ish minutes, assuming you can free it of other responsibilities, and prep time is also often in chunks of less than an hour. The logistics of finding time to pee can be a challenge, let alone have a confidential personal conversation at length.)

    I can’t take sick leave in less than half day blocks, and right now we’re in such a sub shortage that it’s extremely unlikely I could get a specific, consistent sub to agree to cover a half day in my class every week or every two weeks so it’d cause a lot of stress and chaos with whatever random warm body ended up watching my class that week as well as eating sick leave. Parents would start complaining if a teacher missed 1/5 of their kid’s class period on a consistent basis, particularly with the current sub circus meaning almost no chance of the kids getting reasonable lessons from a sub each week.

    1. Aggresuko*

      I don’t think there is any help for you there unless you can find someone who works after work hours :( It sounds like there’s absolutely no way to get help from work on this one, and if they won’t help you and you literally don’t have the time, what else is there?

      1. just a random teacher*

        Quitting in droves? Because that’s kind of where teachers are at right now, and this is part of why.

        1. pancakes*

          I keep seeing headlines about the NEA survey out this week. 55% of their members said “they are more likely to leave or retire from education sooner than planned because of the pandemic.”

        1. Kippy*

          My therapist works Tuesday through Saturday. Her earliest appointment is at 11:00 am and I think her latest is at 7:00 or 8:00 pm. Almost all her patients are virtual. She’s pretty flexible about re-scheduling appointments too. I’ve had to send her a text the morning of my standing appointment asking if we can reschedule for later in the week because I’ve had an urgent meeting come up at work that I absolutely could not miss.
          Flexible therapists do exist and they’ve become more common place in recent years.

    2. 3232*

      Sounds like you’d need a therapist who works evenings (and you can schedule things on all those school holidays). Yes, that will make it harder to find a therapist, but it’s possible.

    3. Can't Sit Still*

      Some suggestions:
      1. A therapist with early, late, or weekend hours. Many therapists do have an early or late day or work one weekend day, etc.
      2. A therapist in another time zone, so you can meet before/after your work hours.
      3. Asynchronous therapy through an app. I used Talkspace until my therapist retired, then moved to BetterHelp. I have weekly 30 minute text based appointments (but they could be voice or video, my preference is for text) with asynchronous support the rest of the time. The text sessions are not saved anywhere.

    4. Chocoholic*

      A therapist that I used to see with my daughter had evening and weekend appointments, which was helpful when we always needed an after-school appointment. Maybe you can find someone who has availability one evening a week or on the weekend?

    5. Night owl*

      A lot of therapists maintain some evening hours (and/or early morning hours, but likely not early enough for a teacher) because so many people need to balance the timing with inflexible work schedules. Those evening slots are often especially coveted for that reason, but I know some teachers who have been able to leave for the day early enough to get an afternoon appointment that’s more likely to be open because it isn’t as desirable for 9-5 folks. Sending lots of empathy your way; I’m not a teacher but I’ve had jobs with very rigid schedules and similar coverage issues in the past, and it made it very complex to meet any personal health needs like therapy unless I was able to find a therapist with the right times open.

    6. drcambia*

      Therapist here — I have a number of patients who are teachers. Virtual care has been really helpful in opening up options for teachers for late afternoon options, so even if you can’t find evening/weekend hours, virtual might work (from classroom, car, or even home depending on your commute).

  20. H*

    Thanks for covering this Alison! it’s something I wondered about before. I have an additional question you don’t cover in the article. You mention flexing ones schedule in order to avoid taking off work time, but if I’m lucky enough to have generous sick time, can I use an hour of that a week? Would that be considered odd?

    1. Generic Name*

      This is how I handle it. I put in an hour of sick time if I wouldn’t otherwise hit my 40 hours. (I’m a consultant, so I track hours very closely)

    2. I Am Not a Lawyer*

      When I was seeing a therapist weekly, I told my boss I would flex my time when it made sense and use sick time when it made sense. She trusted me to use my judgement there, fortunately. During quiet periods when I didn’t have a heavy workload, or when I was just not feeling up to working late, I would use sick time. The rest of the time I flexed.

    3. BookMom*

      Different time zones could be tricky. I work for a mental health agency in a metro area that covers multiple states. When we started offering virtual appointments, the “location of service” became the client’s home. If the therapist was only licensed in the state where our office is, but not where the client lives, it was a problem. We need better reciprocity for professional licensing!

  21. Hellyeah227*

    Meeting virtually has made things a lot easier, since I don’t need extra time to drive to a therapist’s or psychiatrists’ office. I sign onto Zoom to meet with therapist right at 5 p.m. twice a month.

  22. Toys'R'Us Grown-Up*

    While I hate it’s advice that has to be given out, thank you for the advice! Especially with the pandemic fraying everyone’s nerves, it’s a great resource to have.

    Also, my two cents, from experience: if you need to get a busybody/gossip’s nose out of why you take off an hour every Wednesday, you can lie and say you have (physical) therapy for an old (mental) injury. A bad back is much less interesting than mental health issues to gossip about. I actually DO go to physical therapy as well, but it’s on the day of my short shift so busybody doesn’t know squat.

  23. Lurknomore*

    Just as it’s taken years for many folks to grow more comfortable with acceptable pronouns, transitioning, and other LGBTQ issues, it’s way past time for those who are brave enough to seek MH therapy to just be open about it with others. It makes it so much more acceptable and will help others.

    1. pancakes*

      Neither of these are nearly as much a bravery issue as a safety issue. LGBTQ people aren’t obliged to be out in situations where they can tell it isn’t safe to do so, and similarly, people who are in therapy or have diagnosed mental health issues aren’t obliged to be open about that at work if doing so seems likely to put their employment in jeopardy. Why not try to put pressure on people with regressive views to be braver about not clinging on to those views instead of trying to pressure the targets of their disdain to be more open with them?

      1. Wendy*

        I feel the same way too about that.

        I was diagnosed with anxiety and depression in 2011.

        I was also diagnosed as a highly sensitive person, HSP, at that time.

        My current employer does not know about any of this.

        My manager at that time was notified of my being an HSP.

        I felt I was treated differently after letting that manager know.

        Differently in a *not so good way*

        So, that is the main reason why no-one at work knows any of this.

        I prefer to keep it that way.

    2. Keymaster of Gozer (she/her)*

      This is incorrect in my experience. Also it’s not up to people in discriminated groups to be the voice of acceptance and reason – it’s putting the onus on the wrong side.

      1. Jackalope*

        Yes, agreed. The one situation where there might be a bit more of an onus on someone with MH issues is if they otherwise have power. For example, I had a supervisor once who was honest and open about MH treatment and it helped make it the norm for the rest of us if we needed it. Even then someone who is a lower level supervisor might not have that ability if it puts their job at risk. But yeah, saying it’s the responsibility of the people who could lose their jobs, be unable to get promotions, etc. because of MH issues being known should NOT be the ones who have to change this.

  24. Not a Dr*

    If you have a boss who won’t take vague this is also a case where you can lie. Say it is physiotherapy or something.

    When I had a boss who was overly involved, “this is a family” type I lied about the type of surgery I was having, and I have zero regrets.

  25. josee*

    When I started therapy, we were in-office, and I felt comfortable telling my boss why I needed to leave the office a little early on Wednesdays every week. I put it as Appt on my public calendar and added in transit time, but no one really asked about it. It’s also the kind of workplace where people are expected to get their work done, but not required to do it in a certain fashion (depending on your role), so it usually wasn’t a big deal to leave early for a dentist appointment or something.

    Since going remote, the time of my appointment shifted slightly since it’s virtual, but it’s now even easier to log off for that hour, then log back on and check in on things. At some point, I became comfortable with labeling it as Therapy on my calendar, because I didn’t want to hide what I was doing.

    And, in fact, someone told me recently that they liked how I made public that I was going to therapy, and that when they were going through a hard time, they felt comfortable getting into therapy because I’d help to make it seem like a normal thing that you do sometimes. Obviously, every workplace is different, and this kind of environment wouldn’t fly everywhere, but it felt good to know that my comfort with owning my therapy appointments helped someone else get into therapy when they really needed it.

  26. M.C.*

    Thank you so much for addressing this! Just having a couple of sentences in this situation is a huge help.

  27. DivineMissL*

    I had a heart attack years ago and the cardiologists told me it was caused by stress. Ever since then, I’ve been seeing a cognitive behavioral therapist to work on my stress levels. I have always been very open to my coworkers about supporting both women’s heart health awareness and stress/mental health awareness. I just say, “I’m leaving for my stress therapist appointment, and boy, do I have a lot to tell her this week!” I’m lucky that I have plenty of time off banked and a flexible schedule; I know not everyone does. No one at my workplace has ever said a negative word to me (some say they wish they had a stress therapist too). If someone is saying it behind my back, I don’t care. I hope that my small efforts to make it a little more acceptable to take care of mental health and practice self-care.

  28. overcaffeinatedandqueer*

    I’m glad this is improving. In the late 2000s, I had therapy and high school. My mom taught at my school. She told me not to tell anyone, and to arrange appointments less often/not at the same time every week so people wouldn’t suspect. Much helpful. Very support. Especially as I was specifically struggling with self harm at the time; it also made me feel ashamed of that particular physical manifestation of my problems. I still rarely wear shorts even though things are much better as an adult.

    Now, with Telehealth it is easier to fit therapy in. But if asked I would lie. I help care for my grandmother (visit at her living facility, take to appointments, check on her care), so I would probably go with that or a continuing Ed class. I just don’t want to deal with that particular bias when I may already face another kind for being LGBT.

    I’m mostly okay with telling friends, but I usually wait for them to make the first “move” by mentioning mental health in at least not a negative light.

  29. hayling*

    I tell my direct reports when they start that I think mental health is really important, I do therapy myself, and that I want them to prioritize their mental health. If they need to see a therapist during the work day, that’s a-ok by me, they don’t need to clear it ahead of time. Since we’re all remote right now, they don’t even need to tell me they’re offline for an hour.

  30. Hanging by a thread*

    I’d love to get some mental help, but there’s not enough therapists and my old therapist cannot practice across state lines due to the US’s outdated and nonsensical policies. :/

    1. I'm just here for the cats*

      I’m sorry that you are struggling finding a therapist. I can’t say how expensive or how well they work but there are online apps where you can see a licensed therapist via tele-health.

      I hope you can find something that works.

  31. I'm just here for the cats*

    Question I’ve always had. ADA only covers if “your condition needs to “substantially limit one or more major life activities,” which include interacting with others, communicating, eating, sleeping, caring for yourself, and regulating your thoughts. (While the ADA doesn’t list specific conditions that it covers, depression, anxiety, post-traumatic stress disorder, and other common mental health disorders often do fall under its protection.) ” But at the same time “e ADA also protects you if you are perceived as having such an impairment, whether or not you actually do.”

    So lets say you’re going to therapy but it doesn’t limit major life activities but if you tell your boss that you are going to therapy without disclosing what’s going on doesn’t that mean you could be perceived as having that impairment and then covered under ADA?

    1. Tinker*

      The trick here isn’t so much whether or not you’re covered by the text of the ADA as whether it will do you enough good on a practical level if you are.

      Even a person who fully intends to avoid discrimination on the basis of disability can manage to make some big dang messes if they’re unconsciously incompetent at doing the avoiding, and “this person is inherently bad at doing any sort of work, but they’re implicitly threatening to sue if we fire them” (to name one potential pitfall) is not a fun hand to play in the corporate game.

    2. SnappinTerrapin*


      The perception of having a disability invokes the protections of the ADA. However, that might mean pursuing a remedy after the fact for invidious discrimination, rather than deterring the discrimination.

      That brings up an issue I confronted a few years ago, in a course on conducting pre-employment background investigations in law enforcement. There is a lot of scope for illegal discrimination based on the perception of disability, if an investigator or hiring authority isn’t adequately trained/educated to make prudent assessments of risks rather than reflexively treating all history of mental health treatment as a red flag.

      There were people in that course who reflexively assumed anyone who had ever been treated was “unstable” and “dangerous.” They were resistant to my suggestion that they approach personnel decisions with more nuance, in order to comply with the ADA.

  32. Tuckerman*

    Do employers need to accommodate appointments for mental health issues that don’t rise to the level of “disability” i.e., substantially limit you in one or more way? It sounds like based on the ADA wording, have mild depression and wanting to start therapy sooner rather than wait until later when it might become worse wouldn’t be protected.
    Of course, reasonable employers would still allow it.

    1. different seudonym*

      My experience is that the therapist will use an insurance code for your diagnosis, and those are not actually fine-grained enough for that sort of nitpicking to occur. If you’re on the books as “depression,” it’s assumed that you’re suffering a real limitation.

      I had similar worries, and on reflection in my own case such ideas demonstrate anxiety and self-hatred, not apprehension of a real issue.

      Best wishes.

  33. Leilah*

    So this is maybe going to sounds strange, but I think that people who disclose regular, especially weekly, therapy are going to have to keep in mind that it sometimes rubs people the wrong way for a different reason: class difference. At least where I’m from, the ability to go to therapy weekly is huge “red flag” that someone is extremely wealthy. I know that’s not necessarily true, because of insurance and all that, but I think it’s important to keep in mind that there may be people who perceive it as a signal of immense privilege. That absolutely should not stop anyone from getting healthcare, but it’s one of the more common things I hear in the Midwest about therapy. Especially if you are a manger or are regularly interacting with people at work who you know are paid significantly less than you, it may be relevant.

    1. Owlette*

      If the employer provides healthcare coverage, then how can anyone think that someone going to weekly therapy is wealthy? Wouldn’t someone going to weekly therapy be LESS wealthy than someone who doesn’t? Because you have to spend more money to go to therapy than someone who doesn’t have mental illnesses. I don’t think cancer patients are extremely wealthy or privileged because they can “afford” chemo…they just have to in order to stay alive.

      1. Leilah*

        Because it is far, far easier to get therapy if you aren’t using insurance. Last I saw the stats said only half or less of therapists take any insurance at all, and those that do take insurance are almost always have a wait time of months to get even one appointment. There are very few hospitals or oncologists working outside the insurance system….dermatologists, plastic surgeons and therapists however are extremely likely to do most of their business outside the insurance system.

        There is also the studies that have been done showing that even for therapists that *do* take insurance, they discriminate based on class and race quite heavily on which clients they will take and how often they will see them. I don’t think we can post links here, but some creative googling about wealth and therapy should yield soli results.

      2. Leilah*

        Also, it’s worth noting that just because an insurance plan covers “mental health services” doesn’t mean you will not being paying therapy out of pocket. Most plans you will still have to pay for each appointment, $100-$300 each, until you meet a deductible of several thousand dollars. They also often cover only a small number of sessions per year.

        1. Night owl*

          I know it still happens sometimes, and there are a small number of health insurance plans that aren’t subject to this regulation, but it’s largely illegal in the US for health insurance plans to place limits on the number of therapy sessions in a year. Thanks to mental health parity laws and the ACA, most plans can’t impose session limits for therapy if they don’t do it for physical health conditions. So an insurance plan that says you can see your allergist or your primary care provider as often as you need, but you can only see a psychotherapist 20 times in a calendar year… is often breaking the law.

        2. Owlette*

          I typically only have paid $50-$75 out of pocket for the 20 years I’ve been in therapy / treatment for mental health. While I recognize I might be lucky in that aspect, I literally don’t have a choice. Trust me, I would much rather spend that money elsewhere, and it just leaves a bad taste in my mouth that someone would think I’m wealthy for going to the doctor for my disability.

          1. Leilah*

            I definitely understand how critical it can be, but when most families in America say they couldn’t afford a surprise $400 expense, it’s easy to see why an extra $200+/month feels like a privilege to a lot of families (particularly if they know you make more than them).

        3. pancakes*

          This is a thing about high deductible plans in general, though – it’s why they cost less. They leave mental health care out of reach for many people but they’re not necessarily any better for physical health care, either. I don’t think the solution is for people to stop talking about therapy for fear of upsetting those who can’t afford it, but for all of us to talk more about healthcare as a basic human right.

      3. Parakeet*

        Yeah, I would be somewhat wealthier, by definition, if I hadn’t been spending a few thousand dollars a year on semi-weekly (not weekly, to save money) therapy for the last several years (the whole period of which I have made somewhat less than the average income in my area). Many, many people would not be able to afford that, and I am very fortunate to be able to. I’m not poor and I’m not claiming to be. But I’m not “extremely wealthy” on said below-average income from my non-managerial job, and anyone who thinks I am is looking for a reason to be dismissive about mental illness and its treatment. Though, unfortunately, that covers a lot of people.

      4. Something Something Whomp Whomp*

        Part of it is that having health care coverage doesn’t necessarily mean that someone’s comfortable navigating the health care system or comfortable dealing with money matters to seek out anything other than life-or-death health care. Some people don’t have a realistic idea of what out-of-pocket costs are involved and may not have the cash flow to pay a deductible or wait for reimbursement. Even people who might be eligible for sliding scale options, they may not know these exist or feel comfortable seeking them out.

        1. TeaCoziesRUs*

          This. I know far too many people in active duty who pay out-of-pocket, rather than go to mental health on base. Mostly because mental health ultimately has a responsibility to the command – and if they think you’re too dangerous to do your job (for instance a suicidal cop or munitions troop with access to a ridiculous amount of ammunition), if they think you’re going to harm your family, etc., then they MUST tell your command. For all that the US military says they value taking care of mental health, until they figure out this conflict of interest the mental health unit on base will continue to be primarily commander-directed. (Yes, in the military your boss can command you to go to the Mental Health unit for a psychiatric evaluation if they’re worried about your mental state.) Fun stuff.

    2. Night owl*

      That’s so interesting. Thank you for sharing this perspective, it’s really good to know! I currently pay a lot for therapy (though not nearly as much as it could be) but in the past I’ve paid $40, $25, or even $12 a session by seeing trainees, people with a sliding scale, or using insurance that had a relatively affordable copay, so it didn’t occur to me that someone might automatically assume it was a sign of wealth and privilege. At the time that I was paying it, $40, $25, and $12 per week were a stretch at times, but thankfully a stretch I was able to prioritize! But I’m also in a major coastal city, so while there’s still stigma, therapy isn’t really thought of as something that’s only for rich people. I sometimes manage people who are in other parts of the country, so this is useful to keep in mind.

      1. Leilah*

        In the research I was reading, some of the patients could only get a call back from 1 out of 80 therapists they called — the access issue is so tragic outside of a lot of metro areas.

    3. PT*

      I was thinking this too, I worked in a community-based nonprofit and something like a weekly therapy appointment, would get you told to “stop flaunting your privilege.” Even basic medical care could get that label, because not everyone has the privilege of having health insurance or dental insurance, so you would need to keep it discreet.

      1. Not So NewReader*

        Yep. I worked for an NPO where my peers qualified for food stamps. I went for grief counseling with a $125 per visit charge. They all knew that the only way I was able to swing this was because of being a two person income household.

        I ended up getting out of that for a number of reasons. One of the lower level reasons was because I was so worried about cost I could not concentrate on the therapy conversation. Worse yet, the therapist seem to have zero understanding of the concept of ROI. After about 8 sessions we were still navigating the basic storyline. I could see that it would be years of sessions at this snail’s pace.

      2. pancakes*

        That is a terrible mindset. Being “discreet” about receiving healthcare does nothing whatsoever to improve access to it for people who don’t have it.

  34. Pobody’s Nerfect*

    The last line of the article says “Shouldn’t be required to disclose a diagnosis” on ADA request forms, but I have found this is very often not the case. My employer and others I’ve worked for have always specifically asked both the doctor and the employee to specify/name the health issue/diagnosis for which they’re requesting accommodations. And then this information, especially if sent by email which employers can monitor, can become public knowledge. It’s an imperfect system which unfortunately doesn’t hold the employee’s confidentiality in high priority.

  35. Keymaster of Gozer (she/her)*

    Am in the UK so this will be a bit different but some is the same:

    I have regular appointments with a lot of different medical departments (it’s easier to list off what bits of me DO work) and some of those are therapy and psychiatric.

    All my employer knows is that I’m going to be e.g. at an appointment at 10:30am Tuesday, it’s trying to help with a long standing issue and it’s nothing fatal or contagious.

    There’s too much danger to my job if people found out that it’s because I’m schizophrenic.

  36. Night owl*

    Thank you for covering this topic, in the practical and straightforward way that you always do! I did just want to add that sometimes therapy can be more than once a week, which can make scheduling and disclosure at work even more complicated. It’s not the most common, and it’s unfortunately often inaccessible (both because of cost and because of the time off it can require, and the additional stigma if you need to tell people) but I wanted to put it out there in the interest of further normalizing people’s mental health needs and combating therapy stigma.

    I go to therapy three times a week, and it’s one of the best decisions I’ve ever made! And yes, I have a demanding full time job, and no, I’m not wealthy, and no, I’m not in a constant crisis or severely ill or extra-strength self-absorbed (all things people have said must be true if I have this many appointments). I’m just someone who’s been able to prioritize therapy, has found it to be a very good use of time and money, and who’s been lucky to find a great therapist who works this way. Earlier in my career it was often a huge struggle to afford weekly therapy or get time away from work. Several times I went to a session on a freezing cold day without a coat, using public transportation, because I was going on my lunch break and I knew that leaving my coat at my desk would make the time I was gone less conspicuous! I don’t miss that toxic work environment, where actually using my entire lunch break was heavily frowned upon. Now, I’m lucky to have a job where I have the authority and flexibility to manage my own time, and I’ve eventually been able to move things around so that only one, sometimes two sessions are during core work hours. I’m worried that if I changed jobs I’d need to negotiate this into my schedule from the beginning, but I’ll cross that bridge if and when I get to it. In the meantime, I’m making it work!

  37. JustAMillenial*

    I openly label my appointments – except gynecology, that one still makes me bashful. So far, no one’s commented on the 8am every 3 months psychiatrist appointment, or weekly 5pm therapy appointment.

  38. Cat*

    Very timely, I had the same situation come up earlier this week. The therapist I’m seeing is offering virtual appointments, which is great as I save myself a hour’s drive at least. Many of us lump our 15 min breaks with our lunch break and take an hour lunch. With work from home, I could take a late lunch and go to my appointment and no one was the wiser.
    Our work just announced the return of hybrid, and one of my hybrid days was on therapy day. There is a small storage closet I could use, but I didn’t want to have to explain disappearing for an hour. I told my manager I’d be ok with resuming my previous hybrid schedule, but that one of the optional days didn’t work, which of these 2 other days would work best. She’s very flexible with scheduling, but it was no muss no fuss.

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