Termination; therapists point of view

The termination has been messy. Not a positive ending to be honest. I've written about it in another post somewhere. I know she cared very much about me, too much maybe, blurred boundaries, transference, attachment, and a whole lot more led to our down spiral. It's been awful.

I think she does care about me and i know she wanted me to get the right help, help she wasn't trained for. She had to let me go even tho i didn't want to. There's been mistakes and i've paid the price. But i wish i knew if this was even halfway as hard for her as it is for me. Or if she's just glad it's all over.

I wonder if this is in part or in whole a desire to have some feedback about yourself, about how your T experienced working with you, about your impact on her? In my previous 2 terminations, both my T's offered me some bits about what it had been like to work with me, to observe how I grew and progressed, about the strengths I brought to the work and to making changes in my own life, and things like this.

I have occasionally asked my current T to comment on my progress, occasionally he offers a comment or two unsolicited, but I think this is part of the value of therapy. Sometimes our T's might sneak in a little bit of feedback without being asked, but I think it can be part of the learning of therapy.

I wonder if your T might be more open to discussing you as opposed to her. Can you not make another appointment with her? Or can you start here with a new T, asking the questions you raised here?

I am sorry that this is so painful.

This is it! Yes i want to know if i've had any impact on her life as she has in mine. Does she still care, or has she moved on already? Will she forget about me, or hold me inside her somewhere? I only feel real while she holds me (metaphorically) Will i be replaced by someone she loves more? What is my worth to her? Will she remember me? What is the depth of her care? How long will it last for? Does she mourn me as i mourn her? Was her care real?

Isn't that terribly narcissistic of me???

I can't see her again. I have a new T, only seen her twice but i think i will ask her for regular feedback, that's a good idea, thanks Anne x

I only feel real while she holds me (metaphorically)

I think this is the key to explore with your new T. The rest is transference, and I'm not sure you could ever get an answer that would reassure you and fill this need.

((((((Asia))))))),
I don't think that is narcissistic, I think you are normal I agree that a major part of terminations are probably transference-laden, but there is a part of the relationship that was real.

I have decided to let go of my xT, knowing that he will never tell me if I ever mattered or if he ever cared because I would hate like hell for him to be a positive influence, to say that I mattered, even though he can't fill a void, it would be nice to know. Obviously this is not important enough to him.

Asia,
I am glad that you know that your T cared, I think that will go a long way to helping you heal, although it will at first be very painful. I am glad she allowed you to see her if for just 20 minutes, that shows me that she does care, and that she doesn't want you to be in pain. I hope you can carry this with you as you heal. She may not have filled the void, but she helped a little, and she didn't make it bigger. (((((Asia))))))) I am glad that she was able to take responsibility for her part. Take care and keep posting.

I agree with this. I think that most people enjoy receiving (positive) feedback from others and many people are grateful when you can give them some constructive feedback that may feel negative. Part of connection depends on feedback; when we don't get any, it makes us kind of crazy-- like Harry Harlow's old psych experiments with the wire monkey mothers who provided food with a bottle and "touch needs" if they were covered in terry cloth. The monkey kids survived but were socially pretty deranged; at least part of that, in my opinion, is because the kids never got anything back from their mothers-- which may harm social development more than getting back the bad stuff.

That was a beautiful article! Thank you very much for sharing it, MKAC.

I agree, thank you! It reminded me very much of how I felt that my former T's felt about my terminations and how I feel my current T feels in general.

I think I might have been this kind of client when I first started therapy, but not when I stopped:

"Some begin, and remain, perhaps with good cause, suspicious about therapy and its usefulness in their life."

And I'm glad that I've never been this kind of client:

"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. "

And I hope that I was somewhat like this kind of client the first time I terminated, and will be the next time:

"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."

Good stuff to ponder.

I hope I never have this kind of therapist I prefer a therapist who doesn't expect me to meet his/her energies, but who meets me where I am, so I can then start to grow. This has happened with my current T, I feel contained and that he has set boundaries but is flexible. Due to his flexibility, I have met him in the middle. My xT expected me to meet his expectations, and I couldn't, so I did nothing but fail over and over again. I realize that everyone needs a different type of therapist, though.

"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. "

I find this particular blogger to have a theme on this and I would not see one who seemed to blame the client like this either. I don't think just because a client does not appear, to the therapist, to match that therapist's energy, it means the client is unwilling to work or that they expect the therapist to do all the work. I think this blogger is completely off base on this and she has other posts which relate to this blame the client attitude too. I think it is good she refers out people she feels like this about.
(note I am not criticizing the link or anyone who likes this blogger)

The fake mother is inauthentic, and I will bet the monkeys, if they could think, would rather not have survived. I believe in shaping behavior, but as far as constructive feedback, it depends on the person delivering the feedback. If their mother did it in a non-shaming way, that is what is supposed to happen.

As adults, there are a myriad of reasons why adults have difficult with constructive feedback. Respectfully, imo, they may have had constant negative feedback when they were young, so any feedback is unwelcome. It also could depend on who the giver of the feedback is, if the person trusts this person, or if the feedback is given as fact or if the feedback is given in the wrapping of if you don't accept this, you don't want to improve, or something is wrong with you. (such as this therapist, imo) "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. "

I see nothing about this therapist that owns that she is one-half of the relationship. It is easier for her to blame the client then to accept any responsibility of her own for the therapeutic failure. For the people who she feels match her energies or who she feels doesn't just want to her to fix them without getting their own hands dirty, the ones who expect her to work harder at making their lives better than they do (??), I am sure those are her favorite clients, the ones she feels that she can help change. If the client doesn't meet her expectations, it is their fault. It takes a really skilled, knowledgeable therapist to help these people see their own worth and to take them toward health. My current therapist is like this, and I am working my *** off to get better, while admittedly at the moment am in between wanting to change and being afraid to change. Just my two cents worth. (I am also not criticizing anyone who likes this blogger or link

I would like to think that's how it is with my T and me. She's told me things she's learned from me, and that I inspire her. Plus she likes my baking.

My T and I terminated rather abruptly (2 weeks notice) after 9 years together when I had to move. Nine years after that termination, I called her to make an appointment to resume therapy and I will never forget the sound of welcome and joy in her voice as she greeted me on the phone and remembered who I was and her comment about now maybe now we'd be able to work through some things we had left incomplete with the first termination.

It seems my T is in the minority then, because I've leaving right now and she's not telling me anything. And she didn't when I left the last four times.

stopdog and Antimatter, that same therapist also says this: "On some level it’s hard for us to accept (and help clients accept) that talking itself is progressive and that we must be vigilant about not being too demanding of our clients"

As you both probably guess, I have a certain amount of sympathy for her position. Just in my attorney life, I don't enjoy having clients that simply refuse to try to do anything to improve their situation. In my personal life, I have little tolerance for people who just keep complaining while refusing all advice or suggestions to try something different. I know people say they must be ready to makes changes, etc, but if you're not ready to make changes, why waste everyone's time? I don't mean that to sound as harsh as it probably does, but I can just see this from the therapists side. If they are truly in it to try to help people and not just for money, I can see them wanting to move on to a different client in those circumstances.

She also said something else I really liked (stopdog, you will probably hate it):

A few years ago I sat before a panel of professionals who run a regional referral service. I was hoping to be added to their referral network. I came in with my CV and my suit and took my seat. They asked a bit about my background, and then asked me what modalities I use. When one of the interviewers spoke up and asked, “What do you do with difficult clients?” I was quiet for a minute.

“I listen and I love them,” I said finally. “And I help them to talk.”

I think you don't always know yourself when you're making changes. I only see things I've changed once they start to happen.

That is a really looong article, but a good read. I'll admit that I've had fantasies this week of being passive aggressive on T and terminating suddenly like that because I know it would get a reaction out of him. I guess I'm feeling irritated about the whole one sidedness of the T relationship this week.

The discussion and linked articles here have been helpful to me. I am wondering if I am becoming ready to TALK about termination (not do it! Just discuss it!) and this helps me think on it further. Thanks, guys.

MKAC,
I just have a different viewpoint, so I guess I have a little more tolerance. I think there is no wrong or right, really. At times, I have been stuck in place in what seems like forever, but my insights usually follow. I understand that it would be wasting people's time if they feel that people are choosing to stay in place (sometimes they are, sometimes not, etc) and I would urge those people not to waste their time, honestly. I guess as an attorney, though, sometimes you have no choice.

I think if therapists are truly in it to help people, that they will follow what they learned in their training and follow what they believe and who they are. If they are anti-complaining/no-changers , then, yes, I can see them wanting to move on to a different client. If they have a different understanding of these people, then maybe they are the ones who can help and the ones who want to help. And anywhere in between.

I, like MKAC, identify it in terms of my own professional work. I turn down cases and clients if I feel that I cannot work effectively with people. It doesn't mean I am blaming them for being "bad" clients, it is simply that I feel that I know what I have to do in order for a client in the particular area of law I work in to have a shot at making her case. If I don't feel she can work with me in the way I need her to, if she can't trust me enough to tell her story, if she can't respond to my questions and have the ability to articulate certain pieces of her experience, then I don't feel it can be a productive working relationship. I'm a good attorney for certain kinds of cases and certain kinds of clients. For others I am not good. To me, this is the point that underscores what the T wrote.

However, I also believe there are people who go to therapy, just like there are those who go to lawyers, with unreasonable expectations and a belief that the professional is there to do all the work. Some clients think it's a lawyer's job to make up a story that explains whatever their position is, and to tell them what to say. Honestly, there are of course lawyers who are willing to do that. I am sure that some of my clients' cases would do better as a well thought out fabrication as opposed to a true understanding of what happened and why. It's hard work to do the later. When I get clients who understand that it's my job to be a voice for them but not THEIR voice, I think they feel a sense of empowerment.

I think that just because a client is not what the therapist expects (or any other professional) that it means the client is not willing to do their part. It may be that professional is not the one for them, or it may mean the client is confused and the professional is doing a crap job at explaining, or it may mean that the client is willing to do one thing but not another which creates a difficulty if the professional is stuck on that one thing. Or it may mean simply that they are not good at working together. I have had few private clients, I have almost always been appointed counsel in criminal or civil commitments. But sometimes another attorney was a better fit with a client than I was and I was always glad to find that other attorney who could help the client = even it if was just they communicated with each other better or that other attorney was better at helping the client to understand the situation. That was not the client's failing.

stop, it has taken me FOREVER to stop getting frustrated when my clients engage in self destructive behavior, or refuse to do what I know that they need to do in order to protect themselves, or not to get sued. Even now, I struggle with focusing on the fact that I am getting paid either way. About eight years ago I was particularly frustrated at my case load and went through and fired my "worst" clients -- those who refused to follow my advice and then raged about the consequences of not following my advice; the guy who absolutely would not go to rehab and who I thought was going to die of an overdose any day (it actually took a year before he OD'ed); etc. For me, it was not worth the aggravation or the potential heartache in the case of the drug addict. One of the people actually offered to pay me double, but unless he was willing to actually change his behavior, I was just done. I dunno. I guess I'm rambling tonight. I just personally refuse to engage in the same situation over and over and over with people who are unable, unwilling or whatever to actually make changes in their lives.

On the other hand, I had another client who habitually used drugs. He kept trying to quit and kept relapsing. No matter how many times he relapsed, when he got back on his feet to try again, I was there doing whatever I could to help him with the legal parts of it. He was honest to god trying to overcome a lifetime of bad stuff. His parents gave him joints when he was five, to calm his nerves for kindergarten. Because I could see his efforts, and see how hard he was working to get his life together, I was totally on board with him and kept telling him I had absolute faith he was going to get past his problems. He has a steady job and a little boy now, and I think he is absolutely amazing.

Wow, I really am rambling. Sorry.

MKAC - I think we just approach it differently. I do agree that if the professional is finding themselves personally frustrated by a client, then it is sometimes better to help the client find a better fit.
I don't usually struggle with clients not changing. If they keep landing in jail or the psych ward, it is not because of me. I am not really concerned with them changing in my view of it. I will tell clients, to the best of my knowledge, what they can do to stay out of the way of the authority and if they choose to do it or not do it, it is not my problem = it is not my life. It is their life to live as they choose. I don't believe their choice has anything to do with me. They are simply choosing differently than I might. But that is just how I look at it (and I did almost all criminal appeals or post-conviction work. Civil commitment work is where I am in lower court. I am not a trial litigator as such - so that also could be a difference). I also have to step back when students do the same thing over and over. I figure that is what they have to do until they can do something different. And sometimes that involves them blaming me for awhile or forever.
Just like with therapists as I see it.

It seems to me like it would always be a very fuzzy line and judgement call as to whether the client is trying to make changes. But I think more so in therapy than with a lawyer-client relationship? I imagine lawyers for individual clients are a lot less likely to be paid by insurance than therapists are, so the lawyer is either conscious of taking a more significant amount of the client's money, or working for free, which I imagine is sometimes another big difference in comparison to therapy? Could lawyers feel they have to assess the value of their outcomes more strictly if they cost a lot more money than a therapist does? Or is it common that in the types of situations you're discussing some third party is paying for the lawyer, like Stopdog's situation? Anyway, I'm thinking it makes a difference that the expectation that therapists get inside the client's head is probably more than the expectation for lawyers to do this (even if lawyers or any professional actually does get inside their clients' heads a bit). This is a rather long, rambling post where I am even less sure of what I'm talking about than usual, but I was in the mood to think about this stuff, so here you go.

With therapy, the act of going to therapy itself is sometimes taken to signify an acknowledgement of the need to change and an effort to start the change. But how to draw a line about when the client is willing to make enough of an effort seems often inherently murky. Therapists generally don't tend to push hard for a particular solution (as that would be counterproductive), right? And clients themselves often don't understand how/why to channel their efforts in a particular direction.
With therapy, the client does not understand what they need to change, and the therapist is helping the client to figure it out. For example, a hypochondriac doesn't understand, at least in the moment they're having a panic, that the fear of dire health consequences is not legitimate, so the idea of doing some deep, mindful breathing does not seem to them to be a legitimate or rational way to channel effort to solve their problem. If the therapist just "tells" them to do deep breathing, the client doesn't have any reason to think it is a good suggestion, especially if they're panicked about dying. To the client it may seem they only have a little while left to live, and it wouldn't be smart to spend them on some crazy, flighty therapist's idea about breathing and mindfulness, instead of rushing to the doctor. So of course the therapist doesn't just "tell" them, the therapist tries to get their trust, tell them at the right moment so they can understand emotionally (maybe by experiencing that it works during a less severe episode or something), etc. When this therapy doesn't work, whether it's the client's fault for not being willing to try hard enough with the therapist's suggestions or the therapist's fault for not being patient enough to gain the client's trust seems like a very unclear line to draw.

Also, judging whether the client made an effort seems difficult because one could say the client made a lot of effort in the wrong direction, since the client doesn't very deeply comprehend (at an emotional level) the direction s/he needs to go to solve the problem. The hypochondriac client may have made a ton of "effort" to try something "different" from their point of view, by visiting a gazillion different doctors.