In my last post, I discussed how clients need to become emotionally dependent upon their therapists for psycho-dynamic treatment to be effective. How difficult the client finds it to tolerate his or her own needs obviously plays a major role in the development of that dependency. As I’ve said before, neediness is often one of the first issues we confront when we begin therapy: early experiences of untrustworthy or unreliable caregivers may have taught us that it’s unsafe to become too dependent, making us reluctant to “commit” to the psychotherapy relationship. These are ongoing issues that repeatedly come to the surface during treatment, especially around the therapist’s vacations, which often stir up abandonment issues or cause the old doubts as to the safety of the psychotherapy relationship to reemerge.
I recently returned to work from a 10-day vacation, and many of my clients had strong reactions to the break, none of them the same and each reflecting the person’s particular defenses. During my early years as a therapist, I found that I often lost clients immediately before and after my vacations; nobody decided to quit this time (with the possible exception of the client I described in my last post, discussed in more detail below), but there has been more “instability” in my schedule than usual — one session time “forgotten” by a client, some re-scheduling, emails expressing confusion about the appointment time, etc. This type of behavior usually (but not always) has a psychological meaning that you might uncover in the next session if you listen carefully.
In the weeks leading up to the break, sessions with one of my long-term clients had become quite lively in a way that was relatively new for her; for years, Janice had tended to a kind of psychic collapse related to her autism-like symptoms, where emotions and relationships tended to go “flat”. But in recent months, she has been becoming more “dimensional” and emotional. When I remarked to her early in one session that I thought she was very glad to see me, and also felt that I was glad to see her in return, she laughed in a joyful, embarrassed way. During the rest of that session, we often laughed together in a way that felt appropriate and affectionate, not defensive. This felt like a sign of progress to both of us.
In our first session after my vacation, she looked stony-faced and joyless. She felt that over the break, she hadn’t done particularly well, and we could both see how she’d retreated to an emotionally “flat” place. In a peculiar way, she felt as if she had no mouth (she told me), as if that part of her face had been cut away. The mouth expresses the earliest form of our needs — to be fed at the breast — and continues to stand for neediness throughout life, often on an unconscious level that shows up in dreams. Janice’s feeling that her mouth had been cut away shows how she has “gotten rid of” her needs, or at least the awareness of them. For people who come from families as disturbed as Janice’s, trust in dependency takes a very long time to establish and is easily shaken.
Alan, one of my newer clients, told me that he’d been incredibly busy during the entire break. Most of this busy-ness was inevitable, caused by the demands of his career; but telling me about it during our first session back, he expressed surprise that he hadn’t even set aside some time for himself during our usually scheduled hour over the break, hadn’t really thought much about himself at all. With a different client, I might have said that he filled up the gap left by my absence so thoroughly that he didn’t even notice I was gone, but that didn’t feel exactly right in this case. Alan is the sort of man who rarely depends upon friends and family, who other people usually turn to for help when something needs to get done; it would be more accurate to say that, during the break, he simply did what he has always done: avoided his own feelings and “got busy.”
Clients often begin to express doubts about the value of therapy just before a therapist’s vacation, or they come back for their first session afterward doubtful that they want to continue. “I’m not sure what I’m getting out of it,” she might say, even though she felt clear about the value a few weeks earlier. It’s a typical response to dependency and feelings of abandonment: I didn’t miss you at all. Why should I? You give me nothing of value anyway. I haven’t heard that response this time around, not yet, but there are still two more days to go in this first week back.
Which brings me to the client I discussed in my last post — the one who abruptly terminated. One detail I neglected to mention was that these interactions took place on the cusp of my vacation. In one of our exchanges, when I had pointed out to her that she was mis-using my special cancellation policy to avoid becoming dependent upon me, she replied that I was the one who had cancelled twice in a row (meaning the two sessions we’d be missing over my break). Although I didn’t say so, I wondered at the time if, in addition to her other reasons for quitting, there was a kind of tit-for-tat going on. After a lifetime of serial abandonment, she would naturally experience my impending vacation as but another instance of an unreliable caretaker letting her down; she was then “showing me” what that felt like by “abandoning me” in return.
I never got the chance to make that interpretation and find out whether it might be true. Over the years, I’ve had other clients who quit just before or after my vacations and never came back. For some people, if it comes too early in treatment, the experience of “abandonment” — of being left with needs that go unfulfilled for any length of time — is unbearable. For others, it’s an emotional challenge that often sheds light on their emotional issues, especially their feelings about what it means to be emotionally dependent on other people — people who will inevitably frustrate, disappoint and let you down.