There is a particular flavor of guilt that only solo therapists know. You are scrolling through flights for a week in July, your cursor hovering over the "book" button, and a little voice says: but what about my clients?

When your practice is just you, taking time off feels less like a holiday and more like temporarily abandoning a dozen people who are counting on you. There is no colleague to quietly pick up the slack. If you switch off, the whole thing switches off. So a lot of solo clinicians simply don't take real breaks — or they take them while secretly checking email from a beach chair, which is not a break at all.

It does not have to be this way. With a bit of planning, you can disappear properly, your clients stay safely supported, and you come back rested instead of frazzled. Here is how to do it without dropping the ball — and without accidentally tripping over HIPAA on your way out the door.

Start by telling people early

The single biggest favor you can do for your clients is notice. Therapy runs on continuity, and an unexpected gap can feel destabilizing, especially for clients working through anxiety, attachment, or abandonment themes.

For a standard one or two week holiday, two to four weeks of notice is plenty for most clients. For longer absences — a month or more, parental leave, a sabbatical — give as much runway as you reasonably can, ideally a couple of months.

Bring it up in session, not just in an email. A simple "I want to let you know I'll be away the week of the 14th, so we won't meet that week — let's talk about how you'd like to handle it" gives clients space to react and plan. Some will be fine. Some will want to schedule an extra session before you go. A few may need a safety plan in place. Better to learn that three weeks out than the day before you leave.

Decide whether you actually need coverage

Not every holiday requires a covering clinician. Be honest about your caseload.

If most of your clients are stable and low-acuity, a clear "I'll be unreachable from this date to that date, here is who to contact in a crisis" may be entirely sufficient. People manage a week without their therapist all the time.

You probably do want formal coverage if:

You have clients at meaningful risk who could need support during the gap.
You will be away long enough that a crisis becomes statistically likely.
Your professional ethics code or licensing board expects continuity arrangements for absences — many do, so check yours.

Coverage doesn't always mean someone seeing your clients. Often it just means a trusted colleague who is willing to field genuine emergencies and knows how to reach you only if something truly cannot wait.

Setting up a covering therapist — and where HIPAA quietly enters

Here is the part most people don't think about until they are halfway through arranging it.

When you bring in a colleague to cover, the HIPAA relationship you have with them depends entirely on what you are asking them to do — and the distinction genuinely matters.

Scenario one: they are providing treatment. If your covering therapist will actually see your clients and provide care, they are acting as a healthcare provider in their own right — another covered entity. HIPAA explicitly permits providers to share protected health information with one another for treatment purposes without a business associate agreement and without separate client authorization. Covering a colleague's clients is a textbook treatment activity. So if Dr. Okafor is genuinely treating your clients while you are away, you do not need a BAA with her.

Scenario two: they are doing something administrative for you. If, instead, the colleague is performing a function on your behalf that involves your clients' information — say, monitoring your secure inbox, triaging messages, or managing your records while you are gone, rather than treating people themselves — that can tip into business associate territory. A business associate is someone who handles protected health information to perform a service for you. In that situation, a signed business associate agreement is the right move before you hand over any access.

The quick test: Are they treating my clients, or are they working for me? Treatment relationships between providers are fine without a BAA. Administrative access on your behalf generally needs one. When it is genuinely unclear, the safe default is to get the BAA — it costs you nothing but a signature and removes the ambiguity entirely.

Either way, only share the minimum necessary. Your covering colleague needs enough to keep clients safe — current risk concerns, key context, how to reach you in a real emergency — not your entire chart for every client you have ever seen.

Can your covering therapist get into your EHR?

Sometimes coverage requires real access to your electronic records, and that is fine — but do it deliberately, not by sharing your password.

A few principles to keep you on the right side of the Security Rule:

Give them their own login. Almost every HIPAA-compliant EHR supports adding a user with their own credentials. Sharing your own username and password defeats the entire point of access controls and audit logs, and it is exactly the kind of thing that turns a small incident into a reportable one.
Limit access to what they need. If your EHR supports role-based or client-specific permissions, use them. The minimum necessary standard applies even to your trusted colleague.
Turn it off when you are back. Disable or downgrade their access once your holiday ends. Access that lingers indefinitely is a quiet liability.
Make sure the access fits the relationship. If they are treating your clients, EHR access supports that treatment. If they are doing administrative work for you, that BAA we talked about should be in place first.

This sounds like a lot, but it is a fifteen-minute task in most modern systems. The effort is small; the peace of mind is large.

What you can — and absolutely cannot — say in your out-of-office

This is the trap that catches well-meaning therapists, so read this part twice.

Your voicemail and email auto-reply are public. Anyone can call your number or email your address — a wrong number, a spam bot, a curious ex, a journalist. That means your out-of-office message must reveal nothing about who your clients are or that any specific person is a client.

The mere fact that someone is your client is protected health information. So is acknowledging it, even implicitly.

Do not set up an auto-reply that says anything like "Thanks for your message — I'll respond to our session scheduling when I return." That confirms the sender is a client. Do not record a voicemail that references appointments, treatment, or anything that would only make sense to someone in your care.

Do keep it generic and safe. Something like:

"You've reached the practice of Jordan Lee. I am out of the office and unreachable from July 14th through July 21st. If this is a mental health emergency, please call 988 or go to your nearest emergency room. For non-urgent matters, I will respond after I return. If you need to reach a covering clinician during this time, please call this number."

Notice what that message does not do: it never confirms that the caller is a client, never references anyone's treatment, and never discloses any individual's information. It is helpful and completely PHI-free. That balance is exactly what you are aiming for.

Have an actual emergency plan

"Call 988 or go to the ER" should be your baseline, but for higher-acuity clients, do a little more before you go.

Make sure at-risk clients have an up-to-date safety plan and know how to use it.
Give clients the crisis resources in writing — the 988 Suicide and Crisis Lifeline, local crisis lines, and your covering clinician's contact if you have arranged one.
Brief your covering colleague on anyone you are genuinely worried about, sharing only what is necessary.
Decide in advance, and tell your colleague, what counts as "interrupt my holiday" versus what can wait until you are back.

A little structure here is what lets you actually relax. You are not hoping nothing goes wrong; you have built a net for if it does.

And finally — actually switch off

This is the hardest part, and it has nothing to do with HIPAA.

When your practice is your identity, stepping away can feel like losing a limb. But you are not useful to anyone burned out, and modeling healthy boundaries is part of the work. Set your auto-reply, brief your colleague, close the laptop, and trust the systems you built.

Your clients can survive a week without you. The version of you that comes back rested will serve them far better than the version that never truly left. Book the flight.

Get your compliance sorted early

Setting up a practice is overwhelming enough without worrying about federal regulations. Yundra's free HIPAA risk assessment takes 25 minutes and tells you exactly where you stand — so you can tick the compliance box and get back to the work that matters.

Start your free assessment →

Going on Holiday? How Solo Therapists Handle Time Off Without Dropping the Ball