Will Your Therapist Leave You? On Parting, Hints of Rejection, and the Dread of Abandonment

Koryusai_woodcut_parting

Saying goodbye occupies a different place in our lives than it has for most of history. It is the pain of parting I’m about to ponder, with a focus on counselor vacations and the fear of more permanent departures.

First a little perspective.

The average sixteenth-century man didn’t worry about therapist holidays. No therapists! Parting from others, however, was both a greater and smaller dilemma for a person of his time as compared to our own. This ancestor was probably a farmer. He worked the ground only a few miles from where he was born. Travel consisted of taking his crop to market. Hardly the sort of goodbye from his family we think of. Hardly the kind to break the heart.

With the improvement of transportation, the beginning of a time apart created more drama, as in an ocean voyage or a tour of duty at war. These emotional separations were not regular occurrences. At some point, however, long distance transportation — at first by rail, then automobile and plane — became commonplace. Thus, in 1927 the statesman and author, George Kennan, wrote “our arrivals and departures are no longer a matter of emotional debauches — they are too common.”

The world of relationship endings — dissolutions — is different.  Human reactions to them overlap with, but are not identical to temporary separations. For example, the aforementioned sixteenth-century farmer might never have heard of a friend’s divorce. Yet losing a wife to childbirth was well-known to him. Indeed, he could have lost children this way or in their early years. Familiarity with the death of adults was just as common. Those who died of illness usually expired at home. In effect, our predecessor of 500 years ago had less knowledge of temporary partings and far too much of permanent ones.

Consistent with this difference in present and past experience, being jilted by one admirer for another was rare in the short period of the farmer’s pre-marital life. Back then, cohabitation meant marriage, most likely at an early age.  In rural areas few competed for affection. The community enforced standards of faithfulness by its ability to shame an adulterer, thereby further reducing infidelity. The lovers of our day live together or marry with less assurance of relationship permanence than their ancestors. Much more fleshly opportunity and anonymity exist in the big city, easing the way to change partners. Nor do we experience the pressure to conform socially once imposed by religious institutions.

When this kind of particularized goodbye occurs in a romance, it includes the element of rejection not present in a long trip or a death. Placement on the discard pile is about you. You not measuring up. And if a few of these disappointments are strung together, they contribute to self-doubt. Should such a person then enter psychotherapy, he is sensitized to anything hinting of a perpetual break from the therapist, at least once a good connection with the counselor exists. The pattern of previous relationship disappointments, including those from childhood, can prime the expectation of more hurt to come.

Will he come back? Is he actually taking a vacation or just a break from me? What if he dies?

The fears pile up and lead to more.

He’ll decide to live somewhere else or give up doing therapy. What if he gets seriously ill? Might he retire? I seem to be too much for people, even strong people, even people who promise never to leave. I don’t care if he denies that, I know he will flee!

Therapists approach this by providing reassurance. Some permit email access during vacations, but, to me, no respite for the therapist is to be found in doing so. Nonetheless, the therapist’s holiday provides the potential for a learning experience: for the patient, over time, to obtain the answers to all those questions:

  • Yes, he’s always come back.
  • No, he didn’t take the vacation from me alone. (Choose your own way of making certain).
  • No, he didn’t die.
  • No, he is still doing therapy right here, in the same old place.
  • No, he hasn’t gotten sick so far and seems to be in good health (I hope).
  • No retirement yet (although he will, at some point).
  • No, I’m not “too much” for him.

And an answer to an unstated question also follows:

  • No, he isn’t like the others. He hasn’t abandoned me.

512px-The_Parting,_Roland_W._Reed

Then, if the rest of the treatment is working, the client gradually revisits other ingrained beliefs about himself:

  • I thought I was unlovable. Well, since he returns repeatedly and hasn’t referred me to someone else, perhaps I possess some value.
  • Maybe I’m not as worthless as the others made me think. They were wrong.
  • It’s possible I can survive my therapist’s absences. In fact, I’ve been surviving particularized rejections all my life.
  • I’m stronger and better than I thought!

The above outline of a hypothetical course of treatment ignores the possibility that the patient contributes to his rejection history by his actions or words. That issue might also require therapeutic focus. Once any necessary attention has been paid, however, there is still the matter of the shrink’s vacation to survive. Some time ago I offered direction in dealing with a therapist’s temporary absence here: Managing the Dread of a Therapist’s Vacation.

I’ll add one more method to calm and comfort you while the time seems to stand still — while you cross off dates on a calendar as if you were serving a prison term.

In 1809 Ludwig van Beethoven wrote a 15-minute sonata for piano, a solo piece in three short movements. Apart from its sheer loveliness and musical logic, he could have written it for you and about you. Here is how Beethoven biographer, Maynard Solomon, described this composition in his book, Beethoven:

The beautiful Piano Sonata in E-flat (Lebewohl or Farewell), Op. 81a, was composed for Archduke Rudolph following his departure from Vienna during the French bombardment of 1809, and its expressive movement titles — Farewell, Absence, The Return — may tell us something about the depth of Beethoven’s feeling for his young student … On the sketches Beethoven wrote, “The Farewell — on May 4th — dedicated to, and written from the heart for, His Imperial Highness.” A decade later, on the autograph score of the Missa Solemnis, Beethoven wrote a similar dedicatory message to Rudolph, for whom the Mass was composed: “From the heart — may it return to the heart!”

Beethoven knew separation. His attempt to achieve a permanent romance was a lifelong, futile struggle. When, finally, the progression of deafness closed access to the world outside, his music remained to give solace to himself and all of us.

Accept his gift and listen to his heart rejoice at the moment of “The Return” (10’21”). Perhaps yours will too.

 

I shortly will write an essay on those conditions that can cause a therapist to refer you to someone else.

The first image above is an 18th century woodcut by Isoda Koryusai, photographed by Helena Roslavets. The next photo is by Roland Reed. Each one is called, The Parting, and are sourced from Wikimedia Commons.

26 thoughts on “Will Your Therapist Leave You? On Parting, Hints of Rejection, and the Dread of Abandonment

  1. Therapists were not a part of our lives in Guyana and Northeast Brazil. It’s a new reality for me here in the USA.

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    • I’d imagine the mindset of a society in which therapy has become a punchline in comedy routines must be quite different from the two communities in your background, Rosaliene. If you ever care to write about the differences, I think you’d have an audience.

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      • Guyana doesn’t have a good record on treating mental illness. According to the WHO Global Report on suicide prevention released in 2014, Guyana had the highest estimated suicide rate for 2012 globally.

        In Brazil, I observed that strong family support systems helped individuals to get through rough times. By reaching out to friends and neighbors, I was able to make it through my most difficult years. My experience will be the subject of my third novel.

        Liked by 1 person

      • A story I will look forward to!

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  2. Would it be okay if I sent you a book I wrote and have had published on Amazon called “Real Life – Real Pain – Real Love”- Insights into Therapy and Transference from a Patient’s Perspective”. From a patients perspective (mine) it shows the total pain created by a forced termination (I think I’ve told you before my therapist moved to a different state after I’d seen him for just over 7 years). It covers our relationship – connection – the loss – and his boundaries. I was (and still am) questioning if a therapist ever really does care about his/her patients, if patient’s are just considered as a fee, and that seeing a “perfect” therapist, who will do nothing to shatter that mystique by making himself “human”, makes patients feel even less equal and more inferior (or so it seems). It still is unfathomable that for over 7 years I could see a therapist who knew everything about me – more than any other person on earth – and then overnight there would no longer be any contact, any more appointments, no contact of any sort even though I drive by his new office in NH several times a year on our trips to Maine from Upstate NY. Not even a “let me know how you are doing” or “I know my leaving will hurt you and I’m sorry, but I know you will be okay. If you ever need me, I’ll be there”. I still can’t “wrap my mind around” that a therapist can inflict this pain and be able to walk away feeling nothing . Thanks. You know I love your columns … they make you a real person and they explain in a straight forward way what so many of us want and need to know.

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    • This is very delicate. First, thank you for your most kind offer. I would gladly receive your gift if I were not already knee deep in taking a couple of courses that require considerable and careful reading. The book sounds excellent and certainly is on a topic of interest to me. I simply don’t want to take advantage of your generosity when I can’t foresee a time this year when I’d get to read your book. Re: what you’ve said about your therapist, I can only note that when I retired from practice I made it clear to all my patients that I would be interested in knowing how they are doing and would be available to assist them if they needed therapy referrals, then or in the future. Finally, many thanks for your praise.

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    • I just came upon this “NY Times” column. I think it adds something to the question of therapeutic boundaries, termination, and the like: http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/#more-156706

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    • For those who would like to purchase the book Judy Sullivan mentioned, it can be found here: http://www.amazon.com/Real-Life-Insights-Transference-Perspective/dp/150068807X/ref=sr_1_3?s=books&ie=UTF8&qid=1430132076&sr=1-3&keywords=Judy+Sullivan/ Just so you know, I’m not on either her payroll or that of Amazon:)

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    • I realize I’m very late to the game here, but need an outlet to express and relate 😊 I am going through my own version of the pain of abandonment by my therapist, and I feel for you (or what you were experiencing last year) deeply.

      My therapist and I started our three years of intensive work with several clear discussions about my immediately preceding 8 year therapy experience. Of the 8 years, the final five were merely an experience of almost constant crisis focused solely on the fear of losing my therapist. My fear was driven, in large part, because he was frequently shifting our recurring appointment times, shortening sessions, etc. He simply announced these changes with no advance discussion to prepare or to process any emotional reaction on my pary. His shifting our weekly appointment time to an hour during my workday frequently required that I sneak out of the office, which was professionally irresposible and regressive rather than a growthful response to therapy.

      The bottom line is that my perceived need for him was so great that I simply felt unable to set appropriate boundaries, allow myself to recognize what was happening, and let go of him long enough to see if it might help, to see if I just might be strong enough keep going on my own for a while.

      When I moved out of state and started working at a new job with a new therapist (someone on “standby” because, after 5 years of crisis, I believed I had little to no coping skills. To the contrary, I naturally began to flourish! Outside of this well-intentioned but ultimately damaging anddysfunctional relationship dynamic with my former therapist, my apparent attachment disorder no longer seemed to be an issue. In addition, it seemed like suddenly there were no longer more and more negatives to add to my now lengthy list of mental health pathologies. Instead, suposed pathologies started to drop away as positives got added to the list!

      After three years of incredibly productive work with my current therapist, and then seeing some sort of accelerated growth start two months ago, we experienced a number of relationship challenges which set off my abandonment fears for two months plus. We both became extremely angry with each other, and I ultimately learned from him that the very personal/vulnerable/embarassing information I had shared with him two months earlier in an attempt to face a difficult truth caused him to lose respect for me. Despite my finally taking ownership and personal responsibility for my actions, it’s just not enough to erase the harm done. I felt this long before he told me and have been allowing my fear of his judgment to affect my feelings of myself to the point of wanting to give up. The pain feels neverending, and it feels impossible to ever again trust another therapist. I have many of the same thoughts and questions you voice above.

      It looks like it’s been over avyear since you posted about this. Are you still checking posts? If so, I’d love to hear how things turned out.

      All the Best,

      Lauri Ink

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      • Thank you for this report of your hard experience, Lauri. Judy Sullivan’s book is still on Amazon, so perhaps she will respond to you. In any case, thank you describing an experience, the fear of which, keeps people from taking the therapeutic risk.

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      • Dr. Stein- I have been meaning to send you a big thank you for some time, so this is a little late. I appreciate your thoughtful and considered responses to my rather lengthy posts. I am still progressing through this situation but am in a far better place. This experience has pushed me in ways from which I didn’t expect to survive (!), much less grow. I expected to repeat the past. Whether or not any of my perceptions about my therapist are accurate, I do believe that he cares deeply for me as a patient, and I’ve been growing through all of this. At this point, I’m experiencing manageable pain of separation from my therapist because we’re going to continue meeting less frequently (once per week). I. feel stronger and more capable of compassion for him.

        Thank you.

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      • Very glad to hear this, Lauri. You are more than welcome. Keep at it and grow stronger still!

        Liked by 1 person

  3. Thank you so much for this. I have asked all of the questions you list above, over and over again – coming up to breaks in therapy, or even just between sessions. I still struggle to make it to the final understanding you write about.
    My therapist recently gave me a book to read – ‘Between therapist and client’. I’ve had it for a week and been afraid to open it. No matter how much I read about therapists caring for clients, I cannot yet apply it to my own therapeutic relationship. I still feel I am constantly letting her down, that she tolerates me but doesn’t like me, and continues to see me merely because it is her job etc etc. History should tell me otherwise, but……..
    I’m to see her later today and then ironically enough, we break for two weeks due to a bank holiday, and she doesn’t allow email contact on breaks. I believe you’ve just given me something to talk about!

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    • You are welcome and thank you for commenting so openly. Lots of questions come to mind. Is this experience true only of your current therapist or has it been true of other counselors (or, indeed, non-counselors)? Does she have any measure of personal warmth? Does she have a good memory for what you’ve been working on in treatment and what you’ve told her recently? What I’m getting at here are questions that might reveal the extent to which the things you describe are “your” issue, “her” issue, or some combination. No way for me to know, of course, but matters of importance. Good luck with this.

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      • Just getting used to this site and apologize if I have inserted this in the wrong place..

        How commonly do you truly think therapists are able to talk with their clients about what is an issue of the client’s vs some kind of countertransference? This is a FREQUENT question in my work with any therapist.

        For me, it seems like this has been clearly demonstrable in the early months, but as the relationship becomes more intense (eg, twice a week, 3-5 years, deep work), do you think there may be some kind of burnout or something else that makes it much harder for the therapist in particular to look at him/herself in session and own their contribution as they did earlier? I often feel this, and I’ve made the error of bringing it up with them beford it’s clear to them, resulting initially in defensiveness (I feel like I get pathologized for their issues otherwise and start to feel I’m going crazy)

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      • drgeraldstein

        An interesting question, Lauri. I think a therapist has to be very secure in himself personally and in his ability as a therapist to answer this. A therapist should be self-aware and should be aware that some of his “magic” comes from being an authority. If the question of his personality/his counter transference comes up too often it might mean that 1) he has too many personal issues to do effective treatment or 2) the client is using this as a way to deflect attention from his own personal problems or defenses or 3) both. For sure, therapists can burn out. However, some become more secure, wiser, and more able to react to the kind of question you have raised in an honest and therapeutic manner. Thanks for raising a very important issue.

        Liked by 1 person

  4. Thank you for the Beethoven. Wonderful and perfect.

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    • I’m happy you enjoyed to it. It appears classical music is a minority interest among my readers. I’d be pleased to be corrected on that point, however.

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  5. Thank you Dr. Stein – for mentioning the book – I can see where one of your commenters is in the same condition I was in the book and would probably enjoy it. If you ever have time to read it, just give me an address and will send it. I’ve always said the reason I wrote it was just to make a difference in at least one person’s life (I only make $1.35 on each sale so it certainly wasn’t for the money- it’s only $5,99 online). I’d really like gradute students, interns, those being trained as social workers and psychology majors, as well as clients and patients, to have access to it, but I don’t know where to send it so a new and upcoming generation of therapists just might learn of the pain and the joy – the anger and the love… and how just saying a few simple words could make all the difference in the world to a client both during therapy sessions and forced terminations. P. S. I like Beethoven too! And Red Sox baseball. Oops. Sorry.

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    • Thank you, Judy. One possible way of reaching grad students would be to send copies to the heads of clinical psychology doctoral programs, clinical social work programs, and clinical internships. Glad to hear you also like LvB. I’ll forgive your rooting for the Red Sox 😉

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      • Sorry for your patients you retired…happy for those of us for whom you chose to compassionately explain therapy, especially from a therapist’s viewpoint. What we didn’t or couldn’t ask our therapists, you explain simply and clearly and make us feel better about the process. BTW, saw an old column of yours re Johnny Podres. He was from very close to where I live and I have met some of his relatives who live in this area. He and Duke Snyder and the old Brooklyn Dodgers were my husband’s favorite team. We have a backpage headline from the NY paper when they won in 1955 – my husband stayed home from school he said to see the game. He worked at the Post Office with his son and his brother owned a very popular restaurant nearby in Glens Falls, NY back in the day. Very nice man. Those were the days.

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      • You are sweet, Judy. Though not from the NYC area, I have a team poster of the ’55 Dodgers. To me and lots of others, Jackie Robinson was the greatest athlete of the last century and one of its great men.

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      • drgeraldstein

        In case you haven’t seen this, Judy, the BSO’s Music Director, Andris Nelsons, throwing out the first pitch at Fenway Park: https://www.youtube.com/watch?v=o8yni2G3A1Q

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      •  Just checked online they are tied 1-1 with those Damn Yankees.  I think Beethoven would have rooted for the Red Sox.  He suffered from bouts of manic depression, right?  That’s been the case in the past for most Red Sox fans – we’ve had a few highs – lots of lows.  We’re crazy but loyal.  Even the Boston Symphony loves them.  I was at the Hatch Shell once when I lived there when the Pops played.  Boston’s incredible.  From sports to music and education.  I hear Chicago’s not too “shabby” either!  Have a nice evening.  Thanks for thinking of me.  

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