Any beginning predicts an ending. Permanent relationships can become impermanent with time’s passage. That knowledge unsettles those in long-term treatment. Abandoned before, they wonder not “if,” but “When?”
Why do therapists leave?
An example: the man and woman had been married for six years. In mid-life, however, he was afflicted with a rapid and permanent hearing loss. In the midst of the crisis, his mother-in-law was diagnosed with cancer. She lived 1000 miles away. What was the wife to do? She chose to spend the last six weeks of her mother’s life with mom. She’d have done the same thing if she’d been your therapist.
Granted the departure was temporary, but such disruptions happen and are sometimes more lasting. A lovely psychologist of my acquaintance, a being so calming as to make quiet moments with her almost holy, fought illness off and on for years. Her resilience seemed infinite. In her ninth decade she banged against infinity’s wall and retired abruptly, having met physical problems even she could not shake off.
The choice is usually not so harrowing. My own retirement was the consequence of the increasing depletion I felt from doing my work. The weight of the problems of others pressed heavily, even though my clients were less troubled as a group than they’d been earlier in my career. Then too, books called out to be read, courses of study beckoned, and new wonders of the world awaited.
Therapists are notorious for burning out, though not all do. Unfamiliar places trigger our wanderlust. Everyone seems to believe California or some warm spot would be nicer, at least if you live in the Midwest. Grandchildren need attention while they are small. You cannot place their youth in a safe deposit box for later use any more than you can your own.
Life intervenes in unexpected ways. I do not mean to minimize the pain when a therapist departs before a patient expects the end of the relationship. I helped clients grieve such losses when they came to me afterwards. I also caused unhappiness myself by deciding to leave practice. Unexpected finishes, however, cannot be allowed to finish us off.
When I was about to embark on the capstone or giant-killer to a graduate education, the dissertation, my advisor disappeared, vanished. I found out he was going through a messy divorce. Fair enough, but to another state? Without telling me? I adjusted. I lined up a new dissertation committee chairman and was ready to proceed when my initial advisor returned, as unexpectedly as he departed. Granted, he was not my therapist, but still …
Therapists also, on occasion, change as people. Funny, one wants a transformative counselor, not a transforming one. The patient expects to be the only person to make substantial self-alterations, setting aside any desire for a reduction in boundaries allowing more intimacy with the doctor.
A young therapist/colleague became a carpenter in his ’30s. I met a lawyer with a towering income who opted out of his partnership to opt into a seminary. Charles Krauthammer, a syndicated conservative columnist, was a psychiatrist. Granted, not many established counselors change careers, but an occasional dropout happens.
Close to the end of my career I’d hear the question from a patient, “Do you expect to retire soon.” I think I answered, “I have no plans.” Until, of course, I eventually did and then announced my future unprompted.
We (and by “we” I mean you and me) have no crystal ball, no bewitched mirror on the wall. We don’t expect to divorce when we marry, don’t enter careers anticipating they will end soon, don’t fall into friendship with a vision of its erosion or collapse. I can only tell you — only tell myself — the things I know for sure. And sometimes what we think we know we don’t know. Fate’s hand spins the top of our lives in directions never imagined and, when the spinning stops, a new idea forms and informs us.
Therapists leave and it’s not personal, except it is. When you don’t think you are “enough,” a therapist’s departure (at least not one caused by a lightening-strike) says “You’re not enough to cause my staying at the job.” I get it and I also get the absence of an intention to harm.
So yes, your therapist might leave you, but your departure is more probable. The latter is best, for sure, if you’ve gotten what you came for. The good news is we have encouraging career-longevity data on doctoral level psychologists. The American Psychological Association’s Center for Workshop Studies reports that among those already “retired” in 2013, 42% were still working. The median age of retirement was 61, meaning half retired before 61 and half after. The sample included all doctoral level psychologists in the year of the study, not only clinical or counseling psychologists in practice.
Therapists, like most of the rest of us, are living longer and need to make a living. They have multiple incentives to continue. The satisfaction of meaningful work, the intimate contact with good people, and the words of thanks are enriching. The work is interesting and research offers us new tools. It’s an exciting time to be in the field, in the lab, and in the office.
We cannot guarantee our lives, any of us. The retirement or side-lining of a therapist probably won’t happen while you are in treatment. The answer to the “What will I do if it does?” question is that you will do what is required. In the meantime, avoid living the infinite variety of doom-laden scenarios available to imagination: a “thought-error” called catastrophization which can be treated with cognitive-behavior therapy (CBT).
Good advice comes from John Steinbeck’s The Grapes of Wrath and his character “Ma” Joad, the rock of a migrant family almost out of chances. She is the lady responsible for their emotional and physical sustenance, including cooking the salt-pork packed for the clan’s trip to an uncertain life in California. Her 16-year-old son Al asks:
Ain’t you thinkin’ what it’s gonna be like when we get there? Ain’t you scared it won’t be nice like we thought?
No. No I ain’t. You can’t do that. I can’t do that. It’s too much — livin’ too many lives. Up ahead they’s a thousan’ lives we might live, but when it comes, it’ll ony’ be one. If I go ahead on all of ’em it’s too much. … An’ (what I concentrate on is) jus’ how soon (the family) gonna wanta eat some more pork bones. That’s all I can do. I can’t do no more. All the rest’d get upset if I done any more’n that. They all depen’ on me jus’ thinkin’ about that.
The top photo is entitled Goodbye Grenada, Goodbye Karabik by giggle. The cover art for the sheet music for Long Boy (I imagine this means “So Long, Boy”) was drawn by Gar Williams. Both images are sourced from Wikimedia Commons.
I’m curious to know, also, what happens to therapists when their clients decide to leave – whether it be a mutual agreement between therapist and client, a good parting from a client who had given reasons for their leaving therapy, or a not-so-good parting from a client who may or may not have given any reason for leaving. Do therapists get attached (in a healthy, ethical) way to their clients, and as a result, miss them when therapy is done or when it has been terminated by the client? I try to see things from both sides, since both parties are human and have feelings.
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I’ve written a few posts that touch on your question. Speaking for myself, I certainly did and do remember people. While therapists sometimes will hear from a client who simply wants to let you know how he is doing and what you meant to him, mostly you either don’t hear from former clients, they refer someone to you, or they return to treatment. So the biggest desire I’ve always had is to hear the rest of the story: what happened after therapy and how are they doing now? I suppose what I’m describing is something like being a coach who helps train someone for a race, but never discovers whether he made it past the finish line. It is more than curiosity since you’ve invested a part of yourself in the outcome and you want what is best for the person. Thanks for the question.
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Thank you, Dr. Stein. I have put my future on hold to take care of myself for a while, but I’ve been thinking about a career in clinical psychology. I have been so used to being on the side of the client/patient until I graduated from college and started thinking about the perspective of the therapist. To me, it’s easier being the client. LOL. I can’t imagine the responsibility a therapist must have to be not only ethical but also effective and yet human, a healthy role model but yet realistic for one’s own personal (and professional) mental health. It’s strange how college changes your perspective on things, and even more strange when you try to put yourself in someone else’s shoes. What you said makes complete sense – regarding the coach bit. I’m a bit of a romantic in that I think about how many people touch our lives, and how many times we ourselves have touched others’ lives – knowingly or unknowingly.
I agree with your notion of how often we are touched, if we are open to the experience. As to being a therapist or a client, I think there are no real hiding places in life, we only think we are succeeding by hiding. Life, in part because it is short, must be embraced. Good luck if you choose clinical psychology.
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This is something I struggle with increasingly as I become more attached to my therapist over time – it’s been over a year now, the most successful therapeutic relationship I have had, and we are now doing some really meaningful work.
Lately, I’m constantly worried about being abandoned in the midst of it. So I thank you for this post, and especially the Grapes of Wrath reference and this line – “In the meantime, avoid living the infinite variety of doom-laden scenarios available to imagination”. I will try.
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Good for you, Paper Doll. You, Rayne, and all those who are worried about the possible departure of a therapist have my admiration for not being scared away by the blog’s title. In a certain sense all of us must live with the knowledge of the vulnerability of ourselves and our fellow creatures to the many uncertainties in the world, and the one absolute certainty: we all will die. My post was, in part, an effort to normalize this human dilemma, with particular attention to the fear of abandonment connected with long-term psychotherapy. Therapists almost always make it to the end of such a process. Brave souls such as yourself must look straight ahead and pursue your goal with a fierce determination. You sound like you are doing just that. Thanks for your comment and your praise.
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As you know, I struggle with abandonment, and is the one thing that I fear more than anything else. I’ve grown to trust my therapist more though, and those fears aren’t as intense as they used to be. I know that life happens, and we can’t predict when things might come to an end. It’s a terryfying thought, but having lived through a lot of abandonment and trauma, I know that life goes on. For now though, I don’t even want to think about losing my therapist. So I’m grateful for the time I have with her now. Thanks for this post.
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Yes, the danger is there, as are the many other dangers of life. Your survival of past abandonment and trauma speaks to your resilience. If you remind yourself of that, I suspect there will be many other challenges that you can successfully take on. Whatever inside of you enabled your survival is still there. THAT will never go away. Thanks for having the courage to read what I wrote.
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Unfortunately, we can’t control life, so we just have to learn to deal with everything that comes our way. Resilience is so important. Thank you for your lovely words. 🙂
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Dr. Stein, I could identify with Ma Joad in The Grapes of Wrath. When I made the decision to migrate to the US with my two sons, I had to focus on each stage of the process going forward. Imagining all that could go wrong in our new adopted home would’ve been paralyzing. I had to trust in our ability as a family unit to face and overcome each challenge as it presented itself.
No one, then, can better attest to the value of such a strategy, Rosaliene. Therapists, myself included, are often inclined to dig into things. Sometimes vision needs to be narrowed, not widened. Thanks for your comment, Rosaliene.
What does one do if one’s therapist develops a serious illness or, God forbid, dies? Do you have any advice for patients in that situation?
I read your post on why therapists can’t be friends with their patients, and it makes sense. I get it. But if one’s therapist suddenly develops a serious illness–well, as a human being, the patient naturally wants to help. But he can’t. The inability to do anything creates a sense of helplessness that’s difficult to articulate.
Also, because of the unique (and isolated) nature of the therapeutic relationship, a patient who is dealing with his therapist’s illness must deal with it alone. There aren’t others who can support him because none of his friends know his therapist. And if the therapist dies, the patient must grieve alone. It’s a horrible situation to be in, and I don’t think the profession has paid enough attention to this unfortunate scenario.
This sort of thing almost never happens in real life. In real life, if you are close with someone, you usually know other people who know that person. So if that someone suddenly becomes ill or dies, you know others who are similarly affected by the tragedy, and you can support each other. If you know someone but not anyone else who knows them, you’re likely casually acquainted, and their illness or death probably won’t have a catastrophic impact on you.
This is usually the case, and it’s how we survive death and tragedy. But with therapy, none of the usual rules apply. However the therapist feels about it, the therapeutic relationship is incredibly important to the patient. The grief one feels over the loss of a therapist is real, but there is generally no guidance on how to deal with such grief. The patient is left to deal with it COMPLETELY ALONE because no one else in his life knows his therapist, and most people don’t even understand what the big deal is. “Oh, your therapist died? That sucks. Why don’t you just find a new one?”
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You are on to something important, Kayla. I think the situation you describe is akin to a person who experiences some kind of injury but who does not having legal “standing,” so that a court of law will permit him to file suit against a person or governmental agency. In my own life I can remember being told by a close friend that she had cancer, but sworn by her to secrecy, thus handcuffing me from dealing with my distress about her condition with the other people who knew her but were not let in on the secret. I saw a handful of people who came to me after the death of a therapist. Ultimately, they did their grieving work with me, even though, as you say, the world might not have validated their loss in the same way that it would have in the case of a close relative. It might be helpful to think of this kind of misfortune as still another example of the various forms of invalidation that so many patients face in the course of their early lives. The risk of seeing another therapist, fraught with the memories of the one who left them through death, is nonetheless important to overcome in order have support in the grieving process. Many thanks for commenting, Kayla.
That’s another wonderful & interesting article. I can certainly identify with catastrophising & I did have to chuckle when I read that bit. I worry that I’m too much for my counsellor & that he will be traumatised by me & eventually ‘throw me overboard’ I used to think that when he went on holiday each year, whilst he was away, he would decide that he really didn’t want to work with me after all when he returned. I worry that when my inner teenager gets angry, he won’t be able to cope with her because she’s trouble & verbally vicious! I’ve been with him now for nearly 4 years & although I have a level of trust with him, I still feel that maybe, one day, he will abandon me, just like everyone else did.
Four years is a pretty serious test, I should think! Besides, from what I can tell, you are worth the effort. Is he like the others? Doesn’t sound that way. Thanks for your thoughts, Joanna.