Feeding the Therapist

Following my vacation last week, I’ve returned with a renewed respect for the importance of time off from work. Since I first launched this site, and even moreso since undertaking my book on psychological defense mechanisms, I’ve been working very hard to develop good content and enlarge my audience. I’m passionate about this project; ensuring that my posts are of high quality demands a lot of energy. I’ve also taken on a number of new clients this past year; I can’t do my best work without a significant emotional investment, so these additional relationships have also called upon my internal stores. By the time I delivered a draft of my book to members of my writer’s group, just before vacation, I realized I was very tired.

This is not to say that I don’t get “fed” in important ways by my practice and my writing. I do. But when you’re in the business of caring for others, with underage children still at home, it’s easy to get depleted. When you have important goals you want to meet, it’s easy to ignore your own limitations in the drive to achieve them. At the same time, because I absolutely refuse to give up my time at the piano when life’s other demands suggest it would be wise to do so, sacrificing sleep instead, I can easily exhaust myself. So by the end of July, a combination of professional and family demands, ambition and brattiness had worn me out. I needed a vacation.

As a therapist, especially when you have clients going through crisis periods, it’s difficult to balance your own needs with those of the people you see. When we do take a break, we usually leave someone else on call, but this has always felt like an inadequate solution. How can a stranger, with no knowledge of your client, step in and fill your shoes? Such a substitute can’t possibly make up for lost emotional contact. So how do you take a vacation knowing that someone you see will suffer as a result? Sometimes, if you’re taking care of yourself, respecting your own needs and limits, you have no choice. I know that for a couple of my clients, this past week was an unfortunate time for me to be away.

But I can’t be of much help to them if I’m emotionally depleted. The therapist needs to be fed in order to go on feeding his or her clients. It’s one of those unavoidable facts, difficult for the client in crisis to accept. Especially with someone who has become emotionally dependent, the vacation break can be felt as an intolerable kind of abandonment, often linked to early experiences of parental neglect or absence. For that reason, the weeks leading up to and immediately after a vacation break can be very difficult as awareness of need comes up, along with powerful and sometimes angry defenses against it. In my experience, clients may “retaliate” by cancelling sessions or even quitting in response to “abandonment”, as if to say, I don’t need you after all. I discussed some of these dynamics in an earlier post about the way clients may respond to vacation breaks.

In that post, I talked about the break from the client’s perspective; today, I’m thinking more about it from my own. We all need vacations. But how long? In the psychoanalytic community, especially in Europe, a lengthy vacation break in July/August is the norm. I know several analysts who take a six-week summer break, and a site visitor recently told me that her own therapist would be gone for two months. This seems excessive to me — based more on the widespread European tradition of long summer vacations and with little regard to the realities of a psychotherapeutic practice. My own therapist used to take off three weeks every fall — a more appropriate length, in my view. I probably should have taken a longer break myself this summer but felt I couldn’t do so because I’ll miss another week in September when I leave to settle one of my sons at college.

All the same, this past week gave me some needed rest. I decided not to write any new posts or respond to comments on my website; I read but did not reply to most of the emails I received from current and prospective clients. I slept late several days and twice (!) chose indolence over piano practice. In addition to respecting my limits and getting rest, I hiked the Colorado Rockies with family and close friends, spent time out on the lakes, watched some Olympics coverage, dined out and read novels. I had soul-satisfying conversations with some of the people I love most in this world and have returned to work feeling refreshed and well-fed … though perhaps not as much as I’d like.

Because the first draft of my book is complete and off my plate, I can compensate for the extra week of vacation I didn’t take by working at a slower pace than usual. I’ve already approved and responded to all the website comments from last week. After this post, I can take the rest of the week off from writing. This will make re-entry much easier, with more time to rest.

Now I just need to get my inner brat under control.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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29 comments

    It is good that you took care of yourself and then you can even help your clients better. YOU SENT ME A reply and IT said that it was better that I was abandoned by my mother instead of living with negative reinforcement.
    I guess that could be true, but the abandonment did do a lot of harm, I only learned that in getting help.

    Hi Joseph, an email just to ‘hi’ to clients might be enough to deal with feelings of abandonment or letting them have an idea of what you will be doing or where you will be going could help.

    If a model of therapy brings suffering to clients I think it is time to consider that the model needs changing (clients usually already have enough suffering in their lives). This doesn’t mean that innovation is easy – there are many people and organisations with investment in perpetuating the current system.

    Glad you found the break restorative.

    Hey – let the brat out to run for a while. It’s ok :) I’m liking your de-stressing; it helps me feel a little less stress also.

    That brat can run amok when he gets too much lee-way. But I also notice that he comes out more when I’m exhausted. So de-stressing and rest are definitely important.

    Glad to hear your voice again, and I agree that everyone needs a vacation. I am glad you took one, since in your last post you sounded burnt out and exhausted. But when writing a somewhat regular column, whether in therapy or pet advice or anything else ,readers develop expectations. Tell your readers that you will be gone for one or two or three weeks. The feeling of abandonment comes when the other voice, the other part of the conversation, disappears without a word. Welcome back.

    I will do that in future, thanks! And you’ll be glad to hear that I’m feeling rested and again ready for work.

    Two holidays a year is probably the best to aim at, three weeks and three weeks. You can manage your commitments better and breaks in two different seasons provide contrasting sources of renewal. A long summer break is a pattern established during our twelve years at school before college and like other routines and habits established while we grew up should be looked at with a beady eye.

    After this summer, I’ve come to a similar conclusion. I’ll probably take three weeks next July, two weeks at Christmas and then another week in the spring. It is definitely important to have those sources of renewal. Thanks, James.

    Aren`t you living in a country where most employees have no more than 10 days of paid vacation per year?
    Not that I envy you the six weeks, not at all. I live in Europe, so I have six weeks as well. Just wondering what your clients might think reading this comment…..

    So far, I haven’t hear much of a reaction. I suppose that’s because in recent years, I’ve only taken a few weeks’ vacation.

    Hello Dr. Burgo,
    Self care is indeed so important. I have both perspectives. I have been a pediatric health care provider for 20 years. I see an average of 20 patients a day. Anything from a cold to a suicidal teenager to a possible brain tumor…a patient in our practice was seen a little while ago (by a colleague of mine) a 19 day old baby who was fussy, nonspecific findings, parents went home and were appropriately told to come back if the baby got worse and the baby was dead 2 days later. My colleague took it very well on the outside. If it would have been me I honestly don’t know. Anything can walk into the office at any time… 20-30 chances a day to hope you don’t make a fatal mistake. We have to take everything on now, including psychology, which we are not well trained for (not trained at all for). People look to us in desperation because their insurance plans don’t cover psychology and they want a quick fix. Enter psych drugs and the poor management by the primary care provider. Enter kids getting anti-psychotics (not by me). My equivalent to your piano is the discipline of meditation. It is my life goal to meditate daily, hopefully longer and longer. It is a hard daily discipline and I can spend hours beating myself up for not doing it every day. Anyway, I had a bit of a bad day, a suicidal teen…your blog triggers.

    I also have the other perspective from the therapy patient point of view. It is so hard when my therapist leaves even for a week. And it is hard knowing it is hard and knowing my poor therapist needs a break just like everyone else. I can certainly see it from his perspective as he is an overachiever just like you. It worries me when he seems exhausted, I start feeling like a burden. He has 2 young children etc etc… I also used to see therapy as sort of just a supportive thing. Like a self care thing. Turns out this psycho-dynamic therapy thing isn’t so much supportive as, lets say, incredibly tortuous, painful and hard. It brings up feelings of shame, self loathing dependency, defenses and everything else you blog about. In some ways, in the midst of the battle, it is really the opposite of nurturing and supportive. It drains me and kicks my ass over and over again! My therapist definitely doesn’t subscribe to the validation/ platitude “lets just think positive!” therapy. He is a true mirror. He is not afraid to look at the damage and destruction of the shame.

    Having said all of this-a couple of questions. Is all this pain worth it? How does one package up the pain of therapy and go out into the world ready for the battle without bringing that horrible vulnerability? And if therapy is that painful, why do I hate it when my therapist leaves? I should be freaking relieved! And do you feel burdened by your patients? Should we worry about that stuff? I have to say I do sometimes feel very burdened, but I know it is not any of my patients faults. It is the system. Psychology is a crazy thing.
    Glad you got a nice break and thanks for this blog….again.

    I don’t know how you do the work that you do; I would most definitely feel burdened by that level of responsibility for so many people. But no, I do not feel burdened by my own clients. I think that’s because (in spite of being an “over-achiever” as you put it), I do respect my limits and make sure not to take on too many clients. It helps that I love the work I do and genuinely care about everyone that I see. It feels deeply meaningful to me.

    As for the pain you describe, I think it’s understanding the meaning of all that pain that makes it bearable and worthwhile. Because I’m in empathic contact with my clients all day, I feel an awful lot of their pain, but it doesn’t feel overwhelming. It feels meaningful and important. Isn’t that why you stick with your therapy in spite of the pain? Isn’t that why you miss your therapist when he’s gone?

    Yes, for me meaning and depth and understanding trump the pain. It is why I stick with it (therapy). It feels very important to me. I am very grateful for my therapist holding this space for me where we can explore my inner workings. It is such a loving and courageous thing to do for someone. At least I feel that way when I am not thoroughly confused and pissed off at him. I have to say, I work a 4 day work week, my practice is pretty good at trying to “balance” things in the factory medical world we live in. I think about my patients lots. And worry about them too. Thank God I can get fed a little with therapy, it makes me a better care giver!

    It’s funny – I really do expect my therapist to take care of himself so that he can be there, fully, for me. I need to be able to throw whatever I’ve got at him, and have him maintain the capacity to take care of himself so that he doesn’t, I don’t know, freak out at what I throw at him. He HAS to be up for it. I remember him saying, probably about 1 year into my therapy, that I didn’t have to take care of him – what a novel thought in a human relationship.

    I have just seen some episodes of In Treatment where the therapist, Paul, holy hell, in my view, did not take care of himself, to the HUGE detriment of his client. I would be shocked to my core, devastated, and feel betrayal of such huge proportions, if my therapist of over 2 1/2 years were to transgress boundaries as Paul did. I guess the deal is, my therapist has to feed his own horses if he is going to be able to be in a sound position to help me feed mine. As he is currently on his own, in my view, very well-deserved 2-week break, I hope is he feeding his horses, even as hugely difficult as it is for me to be without, who I view as, my partner in what feels like constant open-heart surgery. What a beautiful gift it is, this therapy. I miss him dearly. I am keenly, keenly looking forward to his return.

    It’s interesting to read your piece, to really try to see this seriously problematic time (problematic at least from my perspective of a client) from the perspective of the therapist. Dr. Burgo, do you miss your clients when you’re on vacation at all? I’m a commercial lawyer, and one of the things that I struggle with is that I analogize myself as a therapy client to one of my files at work. When I go on vacation, I work really hard to be in a position to put those accordion files away so that I don’t need to think of them while I’m off. This is one of the fundamental things that my therapist and I continue to work through. I lash out at him as I think he just can’t wait to get the hell away from me, as I can’t wait to get away from some of my files. I can get pretty ugly. This might be tricky for you to answer as I’m sure at least some of your clients read your blog (?).

    It might be tricky to answer, except that I don’t feel that way about my clients. I don’t feel like I can’t wait to get away from them. I wouldn’t say that I “miss” my clients during break but I do think about them. I can’t just shut the file drawer … although this isn’t burdensome to me. I don’t feel worried or preoccupied; they just come to mind from time to time, as something will remind me of one of them, what he or she happens to be going through.

    Dr Burgo,
    I’m not in the therapy profession, but I can understand that you would have to have a much needed break. I find it hard at times and to be very draining and tiring when a friend calls with some very troubling problems…. even though I try to be helpful and supportive. So I can only imagine what a therapist goes through in a day. You deserve vacations :)

    Spouse and I were going weekly for marriage therapy and the therapist went on vacation so changed us for every 2 weeks. Things went downhill from there….. I think because it went to 2 weeks and it was too easy to quit so we never returned. But the reason wasn’t the vacation in itself. So how do therapist’s feel when clients quit after a vacation?

    Plus Also I had told her to have a nice vacation before she left and she gave me the strangest look without saying anything? Are clients not allowed to wish therapist’s a nice vacation?

    Thanks for all your help with the website and answering questions!

    Because of the dependency feelings that can come up in therapy, and defenses against them (such as denial), clients sometimes do quit right around vacation breaks. I don’t know how other therapists feel, but it always hurts me a little bit when someone quits under those circumstances.

    Dr. Burgo,
    I have been struggling with a different issue triggered by therapist absence. My problem occurs when my therapist leaves for a few days to take his wife to a special medical center. Some time ago I inadvertently learned that she is seriously ill. We have talked some about it, along with some larger transference issues, but he knows it is a hot button issue for me and is very careful not to let any details slip. But sometimes he leaves town, and I can sense that it is for the medical problem again. I feel the usual anxiety about his being away, abandonment, etc., but the greater problem is that I always experience a huge wave of guilt; I think “I am so despicable to demand his attention with my trivial nonsense when he has a sick wife to worry about.” As it progresses, I begin to think of her as saintly and more deserving of life than I am, and him as being heroic and superior. I tell myself I should feel grateful to be healthy and able bodied and just go out and live my life like a proper adult, instead of childishly soaking up all this attention in therapy. I feel like I should be brave enough to terminate.

    I’ve talked to him about it some, but it is horrendously painful to raise the issue of his wife (with respect to jealousy, not just her health). I’m afraid that if I find out that her illness has worsened, or that the situation is grave, my shame and guilt problem will engulf me, and I will be unable to share anything in therapy due to self loathing. I almost feel I need to punish myself.

    As I said, I think it’s a little more involved than the usual transference. Do you have any thoughts? Thank you.

    This sounds very much like what we refer to as the “infantile” transfer, because the kind of feelings that come up seem so different from the adult “you” and more like what a baby might feel. I suspect that the true source of your guilt is to be found in those jealous feelings you mention; the baby part of you who feels jealous and left out probably wants to get rid of the wife. Of course you’re not responsible for her illness, but I understand why you might feel guilty.

    Thank you. I’ve tried to read more on the infantile transference and also reread some of your posts. The fourth paragraph of “Envy and Jealousy” hit the nail on the head for me (unbearable shame, magical solutions, idealism/extremism–other person represents all that is good, I am a piece of crud–and lethal guilt). Bingo. I did talk to my therapist about it pretty candidly, and he responded in all the right ways, but I still feel like crud. Worse, even. I guess it all takes time.

    I wonder how many patients have been seriously effected by an extended period of “abandonment” from their therapists? I am only now realizing how lucky I was that this NEVER happened during my therapy. I guess commitment was more important than number gains to my therapist. My need to contact him outside of sessions was rare, but that might be because he was always available for emergencies.
    Food for thought?

    I think the suffering of many, many people has been made worse by abandoning therapists. Over the last two years, I’ve heard so many horror stories!

    Dear Dr. Burgo,
    As someone with abandonment issues. I ought to be pulling my hair out right about now, as my T took three weeks off. Instead, I hope they had a fabulous time recharging their battery! I just wanted to let others know the fear can subside and to not abandon hope!

    I like reading your posts it helps when I can not feel I could contact my own therapist. I have been suicidal and don’t know if my therapist understands that talking about it just for a brief moment helps. She is a wonderful therapist and am sure she doesn’t know how much she has meant to me. I have an attachment issue so I am having trouble bonding for fear of rejection later. I would like to hear your input on the bonding issue.

    I’ve been seeing my therapist for about 1.5 years. This has been the first sustained bout of therapy I have experienced and at times I feel like I am making progress. But other times I feel like I am just treading water or backsliding. I think therapy has been most helpful when I am able to see my T regularly.

    The problem: she goes on monthly vacations that result in missing 1-2 sessions every month. I understand that she needs to recharge, but this seems excessive. It makes me feel as though she doesn’t have the time or interest to help me, even though I don’t really think this is true. It makes me frustrated and sad. I waited so long in my life to do this and I don’t want to waste any more time not making progress. But I also don’t want to start all over again with someone else.

    I read this as when it said ‘feeding the therapist’, I was thinking that being ill and talking to a therapist was actually feeding the therapist as it is thought that therapists have a great need to be needed and liked therefore being ill and making the therapist feel needed and liked feeds a therapists emotional needs.
    Obviously, if this is true, satisfying a therapists own needs takes a lot out of the therapist and rest is required due to the sheer amount of stress their own needs also places on the therapist, but does being ill and making the therapist feel needed and liked not also feed a therapist?
    Is it really about us and our needs or is it about you and your needs?

    Both. I think helping people is gratifying to most therapists but it’s not the same thing as having your own needs met. Like mothers who feel gratified caring for their babies — they also need to have relationships with their husbands and friends where they are not exclusively in a care-giver role. Therapists have “baby” selves too!

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