Client abandonment scenario

A general scenario:
1) A person suffers serious misattunement or neglect or abuse in childhood.
2) They begin working with a therapist who is, or seems to be, attuned psychologically and emotionally.
3) The client becomes habituated to this attunement, and possibly dependent on it.
4) Therapy ends prematurely or abruptly, beyond the control of the client.
5) The client experiences massive dysregulation, similar to that of early childhood.
6) The client is now alone with this.

How often is this actually happening and why is there seemingly no statistical data available?
Why aren't there safeguards in place to avoid this at all costs?
How can the industry claim legitimacy in the face of this?

These are mostly rhetorical questions. Just looking for thoughts from those who understand.

Happened to me.

Sometimes therapists die. That's about as abrupt as it gets. There is no way to safeguard someone from that.

Sorry about your troubles.

How often? Quite a bit, I bet, and abandonment both physically (therapist terminates) and emotionally (therapist withdraws from client).

Why no statistical data? It's not to the advantage of the profession. Also it would be rather hard to collect unless you want to do something like keep a database of all therapy clients and check in with them OR get someone to fund a long-term, sizable study of therapy clients.

Safeguards? See not in the interest of the profession above. Therapy is a business. You could force mental health checks as part of the licensure process, a la the police or the armed forces, but therapy schools claim to do that, don't they? The guards will guard themselves, to alter the old quote.

Why can they claim legitimacy? Because studies have been funded to argue that therapy is beneficial to most clients. Because too many people (not just clients) grant therapists authority - mental, emotional, guruishness, and so on. Because the business polices itself.

You know, I have not been harmed by therapy, but I'm a cynic about it. And whenever I find them helpful, I assume it was an accident.

You are saying what I was thinking but did not say, more or less. I do think collecting some data would not be that difficult. But yes it would not be done, presumably, unless the outcome was likely to be a good one.

Re: emotional abandonment, I'm glad you mentioned that. I was going to include that, but skipped it for sake of brevity.

Re: safeguards, I was thinking more along the lines of oversight and checks and balances built into the process. The process appears to be designed to make abandonment not only permissible but rather easy.

First, I'm sorry to hear your story or the list anyway. I too was neglected early, have felt abandoned in life and in therapy, experienced dysregulation when that happened in therapy, caused huge pain and suffering.

I think schools do "guard themselves," but it depends. Some schools are over worried about getting sued so dismiss students who show the slightest sign that they may not be OK as a T. So there are oversights. Many schools make personal therapy a requirement so that you work out all your stuff before or during seeing clients.

And there is some data out there, maybe not published, but one study I vaguely remember reported that many mental health professionals go into it because they have their own issues so think that being a T somehow proves they are not "crazy" after all. This is a high percentage, like over 90%.

That is scary if you really take it in. That the healer is the wounded, when we are wounded and want a healer. Sorta backwards.

Therapy is a business, but it is not just any business. People who do it could make more doing something else and avoid sitting with people's pain. I don't think people do it for money. There may be some who are really only in it for that, but I'm not convinced. I don't even like the word "client," because that is a business term. What is so wrong with "patient"? It means something like someone who suffers. That is why we go to therapy, suffering. Now they want to change from client to consumer, even more about money.

My T has made mistakes, sometimes owned them, but he has said that the work is the closest he gets to feeling a sense of what he calls "the sacred." I don't really care about money or even religion. But the fact that he sees therapy as something other than a business transaction make the space and time something important, something I don't really get elsewhere.

Happened to me. And I'm confident that previous T handled it poorly.

I have experienced it, and it is very difficult. I do think the profession has safeguards in place, I just don't know how many therapists put them in action in their practice. This is an excellent article on the subject.

https://www.camft.org/ias/images/PDF...ponse_Team.pdf

By safeguards I meant within the system of practicing therapists. Even a therapist with relatively stable emotional/psych health can be catapulted into various defenses and wounds that blind them to possible harm they are inflicting. Or their mental health might deteriorate over time. My T was able to turn my life upside down, then exit the process with nothing more than a few referrals. She could choose to ignore my messages about termination launching me into suicidal thinking. It was entirely at her discretion. There was no oversight. It all went down in isolation. And yet she was clearly somewhat out of her mind at that point.

What is equally scary is that a therapist might be, consciously or unconsciously, seeking therapy from the client. I know mine was. And that to me sorta undermines the whole deal. Hence my questioning the legitimacy of the entire enterprise.

Excellent article.
I suspect that less than 5% of therapists follow these guidelines, possibly 1%.

Great article. I so want my t to read it.

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It is a good article but I don't think therapist death or illness is the sole concern of the OP.

There is no legitimacy to it at all. I think most therapists are as messed up as the rest of us.

Correct. I am thinking specifically of cases where the T imposes termination on the client, rather than the a scenario where the T is no longer able to practice. Seems to me the dynamic is quite different, with possible implications of rejection and shame in the case of an imposed or forced termination.

It seems that much of what is written in the literature and ethics codes about termination and abandonment assumes that what constitutes abandonment should be defined by the biz. For example, if your T gives you some referrals, it cannot be considered abandonment. Or if they grant you a final closure session, it's not abandonment.

I think the only way to accurately measure the effectiveness of therapy is to survey clients - something many therapists don't want to do. From my own experience, CBT Ts are often more willing to survey clients, probably due to their more goal oriented approach in general. Keeping Ts accountable in many ways would make it harder for a lot of Ts to continue using smoke and mirrors with clients. So, the relationship would still matter, but not to the extremes that it seems to with some individuals. Whether therapy would still be appealing after such changes probably depends on what clients are looking to get out of process.

I mentioned ERT plans years ago on this forum, and it was a foreign concept to most, not needed, or to scary for some to broach with their therapist.

My therapist had one, and we talked about it in depth, because of my fear of abandonment, even in death; a childhood fear. I said, she needed to be female, older than me, and I wanted to know her name. My therapist was willing to tell me her name, but wanted to check with the therapist first. The savior "T" did not want me to know her name. My therapist was surprised by this. This had my therapist reconsider her ERT, and make changes. She chose a guy for me. I knew of his work, so I was okay with this. He was the therapist she used as a consultant on my case, and he was perfectly fine with me knowing his name.

I remember my therapist saying that her state's licensing board required them to have a plan in place.

What has been described here is outrageous! Even though I've seen and read stuff, I'm shocked. The T's I know have never done anything close to such terrible things. They have made mistakes, ones that ally hurt and were about their personal stuff, but abandonment is illegal in most states. You lose your license for that, not that a legal thing is going to help; could cause more pain to go in that direction.

It is the emotional pain caused that is so hard to bear. I'm so sorry to hear about this. I don't know what to say.

Not all Ts are screwed up though so maybe try to believe even half-heartedly that this kind of experience is not what everyone does or gets. Some Ts have to complete a full course of therapy before or while they practice. Like in current psychoanalysis, a gentle form of therapy, the T has to undergo real personal analysis, like everyday for 3-5 years. Very expensive, very hard, but that is a kind of oversight in the sense that Ts cannot claim to be an analyst unless they themselves have been through it, worked out their junk, and are clear about what is unconscious and what to do if something goes wrong.

I know that doesn't help; just shocked, trying to reach for a few examples of things that aren't totally terrible.

I'd say moreso....at least we have the self-awareness to acknowledge it.

This is very, very true. And I'm not pretending I know how to fix other people's lives. It's such a messed up system.

Yes plenty of shocking stories out there. But there are more subtle forms of abandonment such as emotional withdrawal, as atisketatasket mentioned earlier. And everything in between. My ex T did not abandon me outright. She gave me some referrals and allowed some brief phone contact before vanishing for good. But i experienced it as a lethal rejection and abandonment, even if the ethics codes do not. Devil is in the details. These subtler forms are easily dismissed by both the biz and the client.

It would be almost comical, were it not so tragic, to think of people with some morbid fear of abandonment being professionally abandoned in therapy.

There are subtle forms of abandonment, that's true. Still, what you have described seems to be outright client abandonment, which is covered by codes (depending on the state and type of T).

If you suffered, felt it as distress, already had issues with abandonment that your T knew about, then it can't be so easily dismissed.

Have you considered an advocate? or checking out the codes where you are? It's a drag to report, but if this T did this to you, then others might have the same thing happen. Reporting the T is not revenge; it's protecting yourself and others from mistreatment. Just thinking aloud.

These subtler types of abandonment some people feel isn't written into the codes, unless there was a boundary violation of some kind. Otherwise, many of these situations can be explained as misinterpretation. It's much like a break up, really, with both people having very different versions of the same event. One one will inevitably claim to have been misunderstood - they never explicitly said the things the other person claims they did. Therapy is so often left open to interpretation that I do think some therapists have idea what impact they are on a client until it's too late. At that point, they may feel they can no longer provide adequate care (which is probably true) and that is a common basis for termination.

I'm not saying this is the right thing to do, just how it seems to play out. In my opinion, I think someone with attachment/abandonment issues may do well with structured, goal oriented therapy, because even though there is definitely a relationship, warmth and empathy there, it is still kept professional, with goals to work toward. I think this just makes it harder to create a dynamic of dependence, since the nature of the work is strengths based.

I had abandonment/attachment issues and we did attachment therapy. My therapist, at all times kept it professional during therapy. I could have worked toward every goal known to man, but my bucket would always have drained dry. I needed that hole filled: "The Circle With The Missing Piece" closed or I would be dead by now. Thank goodness she was willing to give me the therapy I needed. I had No strengths. In previous therapies I was a FAILURE even though I had excellent therapists. I certainly was not dependent or attached to them. No phone calls, and mails, etc. I needed that dependence from my last therapist because I spent my whole life being independent. She taught me balance:interdependence. A therapist has to really have their SHYT together to be able to do attachment therapy, and go the distance. Most therapist CAN'T do it, and they shouldn't try, or are unwilling, and that is okay. It is unfortunate for those who try, and leave their clients in a heap of a mess.

Attachment was a psychoanalytic concept, but has now been accepted as science. T's are required to keep up with the field. They have to take classes or workshops to keep up. It's required to keep their licenses. So if a T has not accepted that attachment is part of therapy, then there is a problem.

This may be straying off topic from the original poster's questions. Not sure. Just don't think that what has happened is ethical or legal. Also don't think it is muddy.

Client abandonment is not OK. Doesn't matter if there are different points of view. If the client is in distress from the T's behavior, the client has a right to say something about it.

There are studies that say that the client, not the T, has a better sense of what works, what doesn't, and what the T is doing that is wrong. The client may not have enough information, but they still are more sensitive generally and are often not wrong.