Delivering “Bad News” and Causing Pain: Ending Therapy and Romance

Elvis_at_the_Heart_Break_Hotel_-_geograph.org.uk_-_1147517

Until recently, I didn’t fully understand the upset of various reality TV stars when they have to “let someone go.”

I am referring to shows like “The Bachelor” and “The Bachelorette” on ABC. These programs offer an attractive single-person the choice of a couple of dozen equally magnetic and youthful members of the opposite sex, with the desired goal of “finding love.”

The settings for these mini-series are always extraordinarily (if not exotically) beautiful, involving story-book activities that prime all the suitors to have strong feelings about the targeted object of their affection, unable to distinguish the dazzle of the surroundings from the more ordinary human qualities of the participants.

As the field of contenders is narrowed, the show’s “star” is typically shown struggling with an ongoing set of decisions: who to “keep” and who to dispatch. Much agony is displayed, sometimes to the point of tears, and not just by the people who are dumped. Indeed, as often as not, the individual making the choices seems more upset than the rejected admirers.

I’ve tended to side with the underdog, that is, the feelings of the soul who is being rejected, cast out of the Eden-like gorgeousness of the show’s locale, and set aside in the pursuit of romantic happiness. And while I appreciate the difficulty of making such choices and delivering the bad news to someone you have gotten to know, I’ve thought that the “star” generally tends to make too much of his or her own pain rather than that of those being rejected.

Recently, however, my own experience has opened my eyes a bit on the subject.

Although it has been a while since I retired from doing psychotherapy, this was written in the midst of telling my patients of my plans to set aside my career as a therapist. And, of course, with it, to set them aside.

I anticipated that it would be difficult for some of them. If the therapy relationship had been productive — if the implied promise was that “I would be there for them (forever)” — it could only be difficult. Therapists should be reliable and, for some people, the contact with a therapist is a life-changing relationship. The patient’s gratitude and reliance on a psychologist’s emotional support, which can become a dependency, are precious in any two people between whom those feelings exist.

I knew objectively and intellectually that the news of my retirement could produce a range of feelings; from disappointment to tears to a sense of abandonment to anger to anxiety and a sense of loss. But I had not done it before; I had not delivered such information. I had not had the task of telling people with whom I had a therapeutic relationship this potentially unsettling news.

Since I had not “lived it,” I could not know fully how it would play out. Still, I had a pretty good idea of how they would feel. I was less certain of how I would feel — what it would be like for me.

It turned out to be more difficult than I expected for myself.

A therapist is in the business of helping people, trying to assist them to feel and live better. Causing pain is just the opposite of what we hope to do. Relieving pain, sympathizing with pain — that is the ticket. Inflicting it is not. I was prepared for their pain, but not ready to be the source of it. And in the weeks before the news was delivered, the anticipation and the stress of becoming, however minimally, the instrument of suffering and disappointment, began to weigh on me.

I thought a good deal about how to deliver the news. I tried to tell all of my patients more than three months ahead of the event, face-to-face; and nearly all of them heard it in the space of the same 10 days. I didn’t want anyone finding out through the grapevine.

I explained that I would continue to see them until my retirement, assuming that they wished to continue. I told them that if they wanted a referral, I would be as helpful as I could be in that process, either before or after the end-date of their last therapy session. And that they would be able to email me thereafter. The way I put it was something like, “I won’t be fully out of your life unless that is what you want me to be.”

I was trying, in this way, to cushion whatever blow they experienced and inoculate them against a personal sense of rejection. For those who expressed interest, I briefly explained how I had come to the decision to leave the practice of psychotherapy.

I made my announcement at the very beginning of each session, in order to permit enough time to deal with the feelings it evoked and questions that might need answering. I also mentioned that I would be fully willing and interested to talk with them about their feelings concerning this change as the therapy process with me moved toward its closure.

Although I doubted that any of my patients were so vulnerable as to decompensate significantly, my plans for our termination were aimed at a break-up that did not lead to a break-down.

Seeing the surprise, disappointment, or pain (including tears) in some of my patients was also painful to me. But I don’t want to make too much of my end of this. In any relationship’s end, it is almost always the person who is making the choice who feels better about the parting. I must admit, it was a relief to have delivered the news, to make public what had been private, to get it behind me. But at no point did I feel good about it.

It brings to mind, I suppose, a very old memory that virtually all of you have experienced at least in some approximate way. It involved a college girlfriend with whom I maintained a long-distance relationship.

Expecting a phone call on her Wednesday return home, one day ahead of Thanksgiving, I called her because that contact hadn’t happen. It turned out that she’d been in town from Sunday or Monday without a word. Still, we made a date to get together the next evening, after the holiday festivities had ended.

As they say, “the handwriting was on the wall.” And, as Adlai Stevenson II once noted, “Most people can’t read the handwriting on the wall until their back is up against it.”

https://i1.wp.com/upload.wikimedia.org/wikipedia/commons/thumb/7/7b/Rembrandt_-_Belshazzar%27s_Feast_-_WGA19123.jpg/500px-Rembrandt_-_Belshazzar%27s_Feast_-_WGA19123.jpg

Belshazzar’s Feast by Rembrandt

In the course of that dreadful visit I learned that she now had another relationship back at school and that, of course, she hoped we could remain “friends.” This kind-hearted 19-year-old was in tears as she delivered the bad news, presumably the message that she had hoped to delay or avoid by not contacting me immediately upon her return home.

The “let’s be friends” overture was, I think, quite sincere, but it never is heard the way the person uttering it hopes. In this instance, it sounded something like, “I know you were expecting filet mignon and champagne, but I think I have a half-empty can of warm Pepsi that’s been open on the counter for a few days. How about it?” That said, she was a lovely and sweet-hearted person, and was clearly very much pained by what she was communicating. It was just that our desires didn’t coincide.

That lack of attunement between any two people is simply a part of the human condition. Not the best part, for sure.

Historically, such communications often came by letter during wartime. The “Dear John” letter to a serviceman overseas was widely dreaded and became something of a cliché during World War II, when duty’s potential cost of a soldier’s life or limb could also include a broken heart due to the infidelity of the wife or girlfriend back home.

Today there are lots more ways to deliver the bad news: emailing, texting, instant messaging, etc. All of these are missile-like missives launched from a distance; bad news that the sender doesn’t have to see hitting his target. But the emotional carnage of the unwanted communication is no less real for all that.

It is easy enough to vilify the person who has placed you on his discard pile. And certainly some methods of delivering the rejection are much worse than others, at times cowardly or cruel.

But we mustn’t forget that it is the human dilemma that sets the stage for such disappointments. It is simply a routine part of life that not all relationships find our interests aligned in a mutually satisfying way forever. People retire, therapists and friends leave town, bosses let go of employees, and romance that blooms in the heart of one good person is not always growing in another who is equally kind and decent.

Only the worst among us set out to do injury with malice and premeditation. Nonetheless — much too often, in fact — we are at cross purposes with each other and someone will be hurt.

If it weren’t so excruciating one could almost call it “normal.”

You may be interested in this related topic: How to End Relationships: a Practical Guide to Rejecting Others.

The top image is of the space reserved for Elvis Presley at Heartbreak Hotel, a cottage on Elvis Presley Boulevard. It was photographed by Evelyn Simak on February 3, 2009. The second picture is a reproduction of Belshazzar’s Feast by Rembrandt, sourced from the Web Gallery of Art. Both can be found on Wikimedia Commons.

Unloading Your Therapist: Breaking Up is Hard to Do

Ending a relationship is difficult. Most of us have been on the receiving end of a relationship “break up” of some kind. We know that it doesn’t feel good. Indeed, we know that it can be taken as a rejection (and often that is exactly what it is). Nonetheless, that doesn’t stop some of the same people who decry the insensitivity of those who unceremoniously “dumped them” from doing the very same thing, in the very same way, when they wish to be free of seeing someone else ever again.

With that in mind, here are a few guidelines for thought and action, and some examples of what people do, when and if it comes time to end a relationship with a therapist. Today, I won’t be talking about the sense of loss or sadness that sometimes accompanies therapy’s end. I’ll leave that weighty topic to another time.

1. The “I’ll call you” strategy. Usually, this is delivered by phone message. The patient probably has an appointment with the therapist and cancels it, adding that he will call to reschedule. Experienced therapists know that many people will attempt to end the therapeutic relationship in this way. It avoids a face-to-face conversation which the patient might imagine as uncomfortable, and it avoids actually giving any reason for terminating therapy. It leaves the therapist a bit in the dark, not knowing whether the predicted call will ever come, and probably not knowing what the reason is for the decision to end treatment.

2. The “end of session” termination. Patients often wait until the end of the therapy session to say something of importance, in part because it is uncomfortable or they don’t want to discuss it in any detail, at least not yet. This method of termination has the advantage of being done face-to-face; what it doesn’t do is to allow the two parties to process the reasons for that decision and discuss any concerns. Without some time to talk, the therapist cannot be helpful to the soon-to-be-departed patient, or find out much about the client’s reasons for his decision. Without knowing what those reasons are, its hard for the therapist to learn from any mistakes he might have made, anything he did (or didn’t do) that made the patient uncomfortable, etc.

3. The “no-show” departure. Some individuals who are receiving counseling decide to end therapy by simply being absent from their next scheduled appointment. This is rude, of course, and also risks that the therapist will charge you for the time even though you didn’t come to his office (most therapists expect 24-48 hours notice of cancellation in order to relieve you of the obligation of payment).

4. The “nasty phone call” ending. While this is a rare event, sometimes people want to hurt the therapist because they believe that they have been hurt or neglected by him. They leave an angry phone message and avoid any chance for the therapist to find out why they are hurting, just as they make it impossible to come to a more amicable resolution of the issues at hand.

5. The “I need a break” message. It is, indeed, sometimes appropriate for patients to take a break from treatment. It can get too intense for some, who realize that taking a breather might be helpful. On other occasions, the complications of life outside of the counselor’s office make continued therapy difficult for the moment. However, when giving the message that you “need a break” is simply a way of leaving therapy, with no intention of return, it doesn’t allow for any closure to the relationship, or any of the benefits that such closure provides (which are described below).

6. The “best” way. Whether you have been seeing the therapist for a long time or a short one, the issue of termination is an important one. It is appropriate for you, even from the start of treatment, to ask how long it is expected to last. If you are finding counseling unsettling or unproductive at any point, it is best if you discuss your concerns with the therapist as they happen. Since many people who enter therapy have a hard time with being assertive and direct, it might well be tempting not to talk much about anything that you believe the therapist doesn’t want to hear, and simply to end the relationship unilaterally. Unfortunately, you and the therapist are short-changed if you do this.

Ideally, your concerns should be expressed early in a session, when there is sufficient time to talk about them. Be prepared for your therapist to ask you why you are thinking of ending treatment. You might be surprised that the therapist agrees with you. Alternatively, you might be persuaded if he makes a good case to continue for a while. But if you are certain that it is time to end things, be sure to hold your ground. A good counselor should accept this without trying to make you feel bad about your decision.

Once an understanding is reached about ending treatment, that doesn’t necessarily mean that it must end at precisely that moment. You and the therapist might decide to taper-off sessions or to have at least one additional session to sum up the history of your work together and to say “goodbye.”

There are several reasons for having just such a final session. First, it should allow the two of you to review what you have accomplished, how your life has changed, and what you have learned. Equally, if nothing or little of value has occurred, it can give you the chance to inform the therapist where treatment went wrong. Therapists should be grateful for this information since it allows them to learn, adapt, and improve so that they can help those patients who will follow you into their offices. And, a last session gives the therapist time to point out treatment alternatives or refer you to other available therapists who you might wish to consult.

Finally, a good therapist who has known you for a bit of time usually has some very nice things to say about you, about your courage, wit, grace, intelligence, and the guts it took to look your problems in the face and try to change your life. The last session also gives you a chance to say “thank you,” if that is something that you believe appropriate. The counselor will usually let you know that he would be grateful to hear from you again, just to know how you are doing. And, the door is almost always open if a return to therapy is required.

So, therapy, even when it wasn’t as helpful as you had hoped, can and should end with an expression of respect and good wishes for your future well-being. You will usually feel good about being direct in doing what you believe is in your interest, and having the self-confidence and respect to tell it to the therapist face-to-face. Your therapist will be grateful too, in almost all cases.

No losers here. Only winners.