loss of a therapist

February 26, 2017

Why Therapists Leave

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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.

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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.

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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.

October 11, 2015

When a Therapist Continues to Mean too Much

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Sometimes your patient cannot get enough of you. He might love you or want friendship. He could wish for continuing advice beyond therapy’s end; or desire you as a stand-in parent available for the long haul. Often he doesn’t understand his motivation. The “draw” of the doctor is felt, but not easily articulated. Perhaps the longing for closeness and security are enough to explain it.*

The preoccupation might take the form of attempting to get a glimpse of him: a pattern of observation from a distance, undetected — as he enters his office, for example.  Checking him out on the internet is another possibility. Perhaps not even that. The simple act of spending more time thinking about your ex-therapist post-counseling than you logged in face-to-face is what I’m talking about.

Is the counselor injured by cyberspace scrutiny or residence in the patient’s head? No. How am I harmed if someone reads a journal article I wrote, watches a speech I gave, views a blog post, or wonders about me? I don’t go sleepless with any fear of privacy invasion. I tremble not because of a potential encounter we might have at Starbucks.

Freud expected his couch-candidates to develop strong feelings about him. He thought these emotions were unconsciously transferred to him from people like mom or dad and therefore called the phenomenon “transference.” By working through the intense attachment to him, Dr. Freud believed the patient would overcome his unresolved early-life injuries. Once accomplished, the therapist again became the shrink, not a stand-in for anyone else. Freud understood it was not he who lived in the mind of his analysand, but an idealized (or diminished) version of himself.

All therapists realize that patients often benefit from closeness. Each of us needs to believe we matter. When such knowledge has been absent, treatment can foster an improved sense of value. The doc’s caring, intelligence, close attention, and understanding help repair earlier relationship injuries. Not surprisingly, a lengthy course of psychotherapy commonly produces at least a bit of attachment to the shrink.

On the other hand, there is a problem if the patient experiences continuing, daily, affect-laden preoccupation with the doc and his life. I’m ruling out the occasional cyber search most of us do. Old friends, lovers, and movie stars are fair game. An impromptu internet investigation is an innocent way to pass a few minutes.

Past counselors can so fill the space in the client’s head as to squeeze out his effort to find satisfying human contact in the non-virtual world. The internet realm is safer and the therapist is “known,” perhaps part of the reason he is chosen over the unreliable community of touchable humanity.

The preoccupation can be excruciating. Yet the sufferer’s relationship history is worse. Thus, the limitations of an out-of-reach therapist are benign in comparison.

It is useful to imagine a shrink as akin to a transitional object for some of his clients. Think of how an inanimate security blanket helps a child soothe himself when his caretaker is absent. Indeed, a counselor might even give a worried adult patient a stuffed animal to help him manage the doctor’s anticipated vacation.

To continue the analogy, the therapist tries to comfort the client and enable his development of emotional self-care skills. The patient will ideally attempt relationships after therapy, but generate these on his own with less sense of either fear or desperate neediness. The goal of psychotherapy is self-sufficiency and “wholeness” for patients, even in those life moments where satisfying intimacy might be absent.

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The problem with an unending preoccupation with the memory of the therapist is, to an extent, not different from the continuing “presence” of a deceased or estranged parent, friend, or lover. Even to the degree that these people played an important role in his life, one must “get over” them and their absence. A mourning process is required, not perpetual attention to a shadow version of them in public space — the footprints they left (or continue to leave) in the real world.

Counselors and patients, from the first day of treatment, need to understand the contact between them will be temporary, however life changing. Many clients, nonetheless, cannot conceive of the extent to which their attachment may intensify. Even were they told in a detailed and emphatic fashion, they would be unconvinced.

Treatment is intended to be a stepping stone to “living,” not a substitute for it. Patients are only fully alive when they’ve taken the hard and courageous learning they wrested from the consulting room on the road. The highway of existence is pothole filled. The journey risks disaster, but offers the possibility of achievement, self-worth, and intimacy not available if you are too focused on a one-sided, unreciprocated experience of watching and longing for what cannot be; and therefore not making the best use of your human qualities in the limited time we have on the planet.

In some sense, all relationships — not just the doctor/patient variety — are temporary. We grow apart, friends move away, death intervenes, and our heart breaks over the losses. This is in our nature, a portion of the human saga. Persistent attachment to a therapist is not the patient’s “fault.” Unfortunately, it can take the form of a ball and chain, restricting his growth. Perhaps a better metaphor is to say the client is haunted by the vaporous remains of a too significant “other.”

Unless he turns to a different counselor, the patient must shed the ghost of his therapist by himself. A warm spot inside for someone who meant much is one thing. An internal cauldron is quite another. You will find no exorcist to make the bubbles disappear.

The first step in solving the problem is to recognize it. Then remember why you sought help in the first place. Surely, it was for reasons other than becoming closer to a professional, reasons you can honor by freeing yourself from the abiding distraction his recollection produces. Next, pursue new activities and connections while simultaneously leaving the therapist’s shadow to mind itself. Grieving is in the mix throughout.

As much heartache as may be involved, the door leading to fresh possibilities requires this challenging set of steps.

But then, you’ve faced obstacles before. Indeed, I’ll bet nothing about your recovery has been easy.

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The top image is called Female Spirit on a Street by Bonnybbx. The photo that follows is called Fog-Pocalypse by Zach Dischner. Both are sourced from Wikimedia Commons.

*This post was prompted by reading Staying Connected to My Therapist and Trying to be Kind to Myself.