Archive for September, 2010

What? You Want to Leave Treatment?

Wednesday, September 22nd, 2010

I got a call last Friday from a friend who said in her message that she told her therapist (it’s never “analyst” or “psychotherapist”) that she wanted to cut down her treatment to having sessions every other week. She said the therapist didn’t agree so she wanted to talk to me & explain her reasons for wanting to do this. She wanted me to call her back over the weekend, if possible, so she could explain it to me.

I didn’t call her over the weekend. Not because I don’t like returning calls. Doesn’t matter if the call is from a friend, patient, possible referral or whatever. I didn’t call because I didn’t quite know what to say because I’m a therapist. In point of fact, I’m trained as a psychoanalyst but because of the licensing laws I can’t say that I am one (yet another story.) So I didn’t say it. But that’s my training and I do practice psychoanalysis.

I didn’t call because there’s really very little for me to say. People want to leave treatment all the time. It happens.  We all know this.

Yesterday I received a different message from her. I was in the middle of a session and couldn’t take the call. Happily couldn’t take the call. In her message she said that she wanted to leave treatment entirely and was considering not even going to her next session. She thought she’d send her therapist an email explaining her reasons. She asked if she could send me the email first (I typed “fist” there and had to correct it. I wonder what Uncle Sigmund would think of that!) to see what I thought of it, but I’d have to send her my email address so she could do that. This message warranted a response.

Like I said, people leave treatment all the time for any number of reasons. We know this. We also know that the reasons aren’t always what people say they are. This is part of the work. I reminded her that I’m a therapist and, as such, I can’t go along with ending treatment with an email. I don’t like getting emails from my patients. Lack of confidentiality and all that. I tell patients not to email me. I don’t email them even if they do. I respond with a phone call. That’s another story.

Ending a course of psychotherapy (or psychoanalysis) isn’t like deciding not to see your doctor or dentist. There’s a more intimate relationship that’s been forged (or was supposed to be forged) during the treatment. Calling your therapist to say “It’s over” (or sending an email to say much the same thing except at greater length) is not “the easy way out.” We have an obligation to make sure that the loose ends that can be tied up are. We also want to know and discuss what is really going on.

In some ways it’s like telling telling the surgeon who’s just finished removing your appendix to not bother closing. No stitches for me. I’ll be fine, thanks. Just send me the bill. Anyone who would do that would be considered a bit (or a lot) bonkers. And psychotherapy isn’t like surgery for a ruptured appendix. You don’t have to have it. You can go through life the same as you’ve been going through life and you can keep getting the same results. It’s also not like recommended surgery for which you get a second opinion, at least not once you’re finished shopping around for the therapist who works best with you. One therapist can’t know what your treatment was like with another therapist, no matter how much you try to explain it. That’s why someone asking me to listen to his or her reasons for leaving a current therapist is not something I’ll do. I can’t know what went on. The reasons may or may not seem valid but WDIK, y’know? I can’t listen as “a friend” because of my profession and I can’t treat a friend for the same reason. If this were a professional consultation I’d be saying the patient should (one of the few times I’ll use that word) swing back around and talk with his or her current shrink to settle up what’s unfinished.

The process is called “termination.” It means an ending. It’s a process. It’s that simple. Don’t just go away mad and don’t just go away. You owe it to yourself and your shrink. I’m not here to talk you into staying in treatment. I may try because of work left unfinished. You and I may agree that it’s time to go (it happens – really!)

Sorry friend. I can’t tell you anything other than I did. Not showing up isn’t the easy way out. It’s just messy. Doesn’t mean you can’t skip out, just that it’s leaving before the party’s over without saying goodbye.