Back to the Wild

Ending and Unending Part 3 of 3.

Clinical social workers call it the “termination process.”

I prefer to think of it as being released back into the wild.

There are quite lovable clients that I have been glad to see go, as they twist in the wind – stuck, sticky, and untangle-able, by me at least. Some begin, and remain, perhaps with good cause, suspicious about therapy and its usefulness in their life. Some may need other therapists, other modalities, or entirely different paths up the mountain than the routes I know how to travel. I try to think about what or who might serve them well, better than I, and refer them on.

And there are a rare few that, after a good start, settle into a sour, toxic relationship – clients who merely and consistently refuse or are unable to match my energies in the office, or in their lives. The people who really want just to be fixed without getting their own hands dirty – who expect me to work harder at making their lives better than they do. These are the relationships that challenge me to protect myself from being drained, used, drawn into a masochistic space. For the most part, I’ve gotten very good at protecting myself and my practice from these ill-fitting relationships, offering referrals to better-suited services.

There have been times, usually when someone needs to move away after a long stretch of work, when the final brave-faced goodbyes have left me alone in the office, that I have set my head down in my hands and wept for a good bit. Moved by the depth and arc of the entire emotional journey. Following years of investment of my energies, attention, and nurturance – I sometimes need to grieve the symbolic empty nest that will not be filled ever again, by the same person, in the same way. These are clients that have driven me forward, made me face my own deficiencies, nipped at my heels, making me a healthier, wiser, better, bigger person.

Most people leave without really leaving. They begin to reduce sessions, schedule only as needed, returning for occasional tune-ups. Most often, the “as needed” appointments become fewer, until my function as a safety net simply fades away.

Several times a year, I open my e-mail to find wedding photos, a graduation announcement, a thank you note, baby pictures, family portraits, obituaries, or news articles: messages from the long ago past about the future, about what happened or didn’t happen next, after, later. I am always glad to hear it, and grateful for the chance to rejoice or grieve. To hear some news of the subsequent chapters in a story where I have served as a narrative device for a chapter or two, helping only to drive the story along.

These are relationships that stop taking place in the office, but the sense of the other is clearly retained – so the relationship itself continues to exist, internally, for both of us, without regular external contact.

We have changed each other, been made a part of each other’s lives, written our names on the other’s neuropathways. We have committed some small or large acts of permanence upon each other. We are free to disconnect when we have been authentically connected in the places of our Selves where nothing is ever really lost.

For others who come to therapy to focus exclusively on single crises or targeted problem solving, I watch for the signs: a growing number of sessions that begin with self-satisfied self-conscious smiles with “not much to report. ” I often hear “and then I suddenly knew exactly what you would say!” in the months before a client is able to head back into the wild.

Many people excel at reaching out for others to share suffering, complaints, pain, anger, and problems. But it can be a new relational milestone to learn to share happiness. Like an animal defending its kill, we have been conditioned to protect our joy from those who would snatch it away, contaminate it, claim it as their own, or diminish it out of their own unhappiness or envy. We also fear our own inflation at those self-satisfied moments, worried that we will appear insensitive, grandiose, braggadocios.

It takes time, safety, and practice to be able to share the good-stuff (and, even then, it should probably be reserved for the special intact people in our lives who are actually capable of being happy for others.) It’s important for people to sometimes linger a bit in the treatment, to be able to feel their own powers, giggle over their new accomplishments, express pride in their growing skills, flex their strengths and flap their wings in front of me, practicing the intimacy of happiness. When it becomes clear that I am impressed and pleased to see how ready they are to fly, we will take on the task of leaving safety behind.

And then there are the Lifers:

There are those that have absorbed unimaginable wounds, who are absolutely entitled to a lifetime of support and admiration for having survived the unsurvivable, scars and all. For others with sufficient disposable income, therapy becomes an integral part of their wellness in the world, like a gym membership – a part of their preventative care.

There are the types, like myself and most of my colleagues, who have attached to the process of psychotherapy itself – as a path, as a sacred practice, the road to salvation – as part of their on-going spiritual hygiene. These are often those in helping professions, artists, writers, creatives, other therapists, people who court the unconscious, who work with their intuition, whose calling in the world requires vigilant self-awareness, who need a close, well-maintained relationship with their inner life.

Psychotherapists are flying blind at termination. We sometimes leave or change therapists, but we have never left therapy behind. Once upon a time we staggered into treatment as patients, and just stayed there. We moved into the office. We made the consultation room a template for our own practice, and now spend our days creating the healing space that someone offered us. Becoming a therapist is the best way to never leave therapy. You channel the voices of your therapists by day, in your own office, say what you think they might have said or what you wish they had said. If that isn’t enough, you can also make regular appointments to meet your old treatment team – now mentors, supervisors and training-analysts, back in their offices, for tax-deductible sessions as part of your “on-going professional development.”

Recently, my family and I visited a wildlife rescue center. The animals – wounded snakes, owls with injured wings, abandoned birth-blind litters in need of bottle feeding, are expected to return to freedom once they have grown sufficient strength or maturity.

One crow at the refuge, loudly, uncannily introduced himself to my daughter. “Hello! Hello! Hello!” He is one who will never leave – he greets the visitors; he has learned to speak the language of his rescuers. His communications alternate between the wild guttural avian cry of his own kind, and the American English equivalent learned from humans who tried to speak crow language: a perfectly articulated “Caw.” He is a translator, living in the crack between the worlds – mastering both the language of civilization and the primal cries of wild instinct. Preserving the calls of the wild for those that are in danger of forgetting. Allowing those who know little of their own animal instinct to listen in a language that they can tolerate.

I imagine to myself that there are other creatures, drawn by the transformative and transitional energies of the center, who visit regularly, circling overhead, marking their scent-trail, reminding themselves of the path back should they, or their offspring, ever need assistance again. Perhaps some even stay nearby after their release, hoping to catch a glimpse of a hand they licked; or even waiting to help escort others, disoriented by their own sudden wellness, back to the culture of freedom and wilderness. But most, I’m sure, ultimately take flight or race for the thickets – and rarely, if ever, look back again.

Just as it should be.

copyright © 2011 Martha Crawford

On Leaving and Being Left

Ending and Unending, Part 2 of 3

In NYC, the traditional psychoanalytic models still reign in lay-peoples’ imaginations. For many, being entrapped in a Woody Allen-esque interminable, lifetime analysis is an active barrier to entering into any helping relationship at all. There is a fear of dependency, a fear that the therapist won’t let them go, that they will be held hostage, infantilized, exploited by the therapist’s never-ending hunger for the weekly check written at the end of each session.

Oftentimes at a first consultation, clients, like anxious airline passengers, want to know if they can find the clearly designated exit before they will settle into their seat. “How long do you usually see people for?” or “I think I will only need to come for 5 or 6 sessions, is that okay?”

And, to give their fears credit, there probably are some clinicians who are reluctant to let clients leave, who do hang on to people as long as possible, for many different kinds of reasons, conscious and unconscious, selfish, fearful, well-intentioned, loving, clutchy or well-reasoned. And all of the above at once.

Traditionally, patients’ attempts at “premature” terminations of the analytic process are viewed as resistance. And many people do choose to take flight from the treatment at the moment when it gets difficult and threatens to re-organize life as they know it: changing relationships, work, or long-held beliefs about themselves.

I let them go. I trust my clients’ larger psyche, their higher Selves, to make their own choices and to assess their own readiness. I also trust Life itself to put any essential lesson they are fleeing from in front of them again and again – until it is either digested and assimilated or it returns in force, threatening to consume them.

And by the way: I’m not going anywhere and I won’t lock the door after you leave. I’ll still be right here, same cell phone number, same e-mail – happy to roll up my sleeves and get right back to work if and when you decide to return.

Many do.

8-10 sessions, a year, two years or ten – it’s all fine with me. I also don’t think that everyone needs to work it out in a therapy office. I’ve known too many people who have taken just one or two small tools received from a very brief “incomplete” therapy, and put them to remarkable use for many years after a consultation or two. I don’t underestimate the impact of brief but transformative contacts in my own history, and I don’t assume that I – or psychotherapy in general – are the only mechanisms for learning and growth.

My own first departure from therapy was in my mid-twenties. Working in restaurants while applying to graduate school, I was struggling to financially emancipate myself and set more adult boundaries with my complicated family of origin.

I told my therapist that after six years of meeting with him, for much of the time twice a week, that – after years when being a patient had practically been my primary vocation – I had to stop. I could see no way to extend my pending student loans to cover school expenses, rent, and therapy and individuate from my family. I had to leave.

What came next startled me. He said: Okay.

He didn’t fight for me, protest, or seem to feel rejected. He also didn’t seem particularly upset or happy to see me go, or insist on over-processing the how’s and why’s and unconscious muck beneath my decision. He just said, OK, and wished me luck.

I was stunned. And a little unmoored. Maybe I even felt a little abandoned. I just hadn’t expected him to drop his end of the rope when I let go of mine. I’d thought that I owed him something for all that he had seen me through. I thought that he would need something back from me, something more than my paid fees and my heartfelt gratitude. I assumed that my leaving would disappoint him. I thought I should feel guilt about disrupting his income stream. But, here he was: kind enough, but essentially unaffected. He hadn’t been dependent on me just because I had been dependent on him? It was confusing and liberating. I understood for the first time that I really did not have to take care of him at all. I did not have to worry about harming him. I did not owe him anything emotionally. We were even. I was not in debt or indebted. Fresh oxygen filled my lungs.

(A year or so later, when my financial circumstances changed, I was happy to get back into his office to resume the work.)

Another memorable termination comes to mind. In my first year out of social work school, I briefly joined a supervision group led by a woman who taught at a group therapy institute in the city. I learned a great deal from the supervisor and found her very specific practice methods borne out of the “modern psychoanalytic” model provocative and intellectually fascinating. But after only six months or so the group was wearing on me. I knew that I was not going to absorb their clinical values as my own. Although I respected the therapeutic model and saw that it had much to offer, it also felt too cold to me and, at times, too calculating. I felt that my studies in this group were stimulating but supplemental to my practice, not essential. I also knew with certainty that I wanted to transition to group work with one of my former teachers from NYU.

As I began the process of trying to extricate myself from the group, my fellow therapists/ co-group members began trying, in earnest, to “solve” whatever problem they felt was causing me to leave. The discussion was becoming increasingly frustrating as the group clung to me. I had wanted to leave gently, respectfully, and with gratitude – not to be pressured into pushing anyone away or devaluing anyone’s practice model.

Just as the tension began to peak, the supervisor said: “Do you need the group to help you to leave? Or help you to stay?”

Help me to leave?

Help me to leave.

Help me to leave you.

What a sacred, generous idea.

I could think of so many people that I wished could have helped me to leave, in so many ways.

It was the most important gift I received from that group, a gift that I still cherish. It is also one of my favorite gifts to pass on. I enjoy watching the surprised, relieved expression on a new client’s face when I promise I will help them to leave, if ever they need me to. And then, they take the first deep breath of the hour and settle more deeply into their seat.

copyright © 2011 Martha Crawford

Queries Before You Break Up With Your Therapist

Ending and Unending Part 1 of 3

Two or three times a year, I’ll unwittingly schedule an initial consultation with a potential client who reveals that they are “thinking of leaving” their current therapist – and are meeting with me and several other clinicians as they shop for the quickest exit strategy.

Here is the deal: if you’re single, it’s not a great idea to date someone who is going to leave their partner any minute now, but just hasn’t told them yet. And it’s not a great idea for me to take your case when you are in an active relationship with a clinician who has committed to working with you, but hasn’t been told that it’s not working.

So: how do you know when you should break up with your therapist?

Unless there are some shockingly obvious ethical violations involved – in which case you are permitted to head for the hills without looking back – the answer is very simple:

Talk to them.

Ridiculously obvious advice about how to use the talking cure.

You may feel that the therapy has reached a state of impasse right at the edge of a wonderful milestone, a fantastic accomplishment: the moment when it is discovered, with absolute certainty, that you know more about your own needs than the therapist does. Many people become fearful or disappointed at this crossroads – certain that their therapist will feel diminished, injured, enraged, or may never be able to be of use to them again.

We all just prefer to have our minds read, don’t we? We don’t want to have to explain all the time. We want our partners, parents, and friends to guess exactly what we want for our birthdays. And we want our therapist to just “know” what makes us sad, upsets us, what we need from them. Why on earth are we paying them if not to be understood – magically, instantly, completely and without having to explain a thing?

If we have to tell someone what we need – or say that we don’t know what we want but are pretty sure we aren’t getting it – well then, it just ruins things somehow.

It disrupts the illusion that there is any way (after two years of age) to have our un-verbalized needs read and met by huge, magical, intuitive all-loving parents. And part of us thinks that should be quite doable somehow; because there was, in fact, a time in our lives when our needs were quite simple: food, human contact, sleep, diaper change. Simple needs, clear clues, good odds (1 out of 4) of getting satisfaction without having to say a word.

Subsequently, in adulthood, we all occasionally feel terribly, unduly burdened:

1) We first have to figure out our own complex, mature, interpersonal needs -

2) Then formulate a plan to take responsibility for them ourselves -

3) Next, we have to ASK for the need, or some part of it, to be met and cared for by others

4) We then have to weather the disappointment of rejection or the mere partial fulfillment of our needs –

5) Worst and last: We are then left to cobble together some plan to take care of the leftover hunger on our own.

Too, too many steps: It would be so much easier if our partners, care-providers, healers, loved ones, bosses, shrinks – would just guess correctly and spare us all that work.

Often, clinicians/therapists can be pretty good guessers. The more intuitive and experienced they are, the better they are at seemingly pulling our most subtle needs out of thin air. Still, they aren’t magicians and – even if they were – at some point they will need to start failing, or just stop guessing because it doesn’t serve our process of growth to keep waiting for the grown-ups to show us what we want. Our needs are our own responsibility to negotiate.

So, you have to talk to your therapist about your dissatisfaction even if you don’t like them very much right now. Even if you know they are limited, haven’t been of much help, or will never “get you.” Even if you know that you have made up your mind, like them well enough, feel they have done their best by you, and you don’t want to hurt them.

Even if you dread it.

Tell them you are unhappy or dissatisfied with the course of treatment, that you don’t feel sufficiently challenged, supported, listened to, pushed, understood, whatever.

Tell them.

You will learn a great deal about the viability of the relationship from their response. If, as you fear, they become defensive, angry, anxious, injured, avoidant, accusatory, or calmly and completely blame only you for the relationship’s failures – that is in itself very important data.

Perhaps this is not a good fit. Perhaps you are activating some counter-transferential difficulties for them that makes it hard to respond due to their own history and their own wounds. Perhaps they are narcissistically attached to being right, to giving you advice, to your dependency on them. Perhaps they are extremely healthy, excellent at what they do – but they are loyal to a model that you don’t find useful.

Even if it’s a total miserable dead-end, you will get to leave clean, like a grown-up, making a self-respecting choice, after eliminating any doubt that you could have worked it through.

You will also have seized a great opportunity to create a corrective experience: what if the “no-longer-good-enough” therapist displays sincere interest in your “bad” feeling? What if they are pleased to have the opportunity to grow, to change, to accommodate, to learn more? What if they deeply yearn to take responsibility for errors and mis-attunements they may have committed? What if they can apologize, and take their share of the responsibility without collapsing in shame? What if they value your feedback because it will give them information they don’t know, maybe even information about themselves of which they were unaware? What if they are grateful to you for showing them an unknown bit of their shadow and giving them a chance to integrate it?

What if they treat your concerns, your anger, and your disappointment as if they are important and valid? What if they have enormous empathy for the hopelessness that has emerged in your relationship? What if they can still care about you and remain intact in themselves, in the face of your negative feelings? What if they have felt blocked and frustrated as well but were not yet able to identify it? What if this discussion is able, in and of itself, to break through the logjam?

Even better: What if they are proud of you? Impressed by your self-regard, and your ability to stay loyal to your own experience? What if they want to help you keep strengthening this newly discovered muscle?

What might that mean to you?

Or perhaps they can at least agree that the clinical relationship has not been a good fit, and the therapy can end honestly and mutually? What if they can release you to a new scenario, a new therapist, and still feel proud of whatever you were able to accomplish together or the integrity that you both showed at the resolution of the relationship?

What if you don’t need to protect them from your feelings, needs, wishes, desires?
What if you never did?

I’ve been in many relationships, personally and professionally, where the greatest growth came from the way we left each other. The real failure is not the necessary ending of a therapeutic relationship; it is missing out on the opportunity to be further healed by leaving well.

copyright © 2011 Martha Crawford

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