When therapists go away--what do you think of this?

I read the book about therapy by therapist Lillian Rubin, The Man with the Beautiful Voice, which someone here recommended, and was interested by her thoughts on what happens to therapy when a therapist goes away.

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A therapist's comings and goings can be a challenge for the patients, although one that I think is often vastly overstated. Indeed, I believe that therapists often encourage their patients to act out each time they go away because we're taught that's what to expect. In my more ungenerous moments about our profession and its rewards, I also think we get a certain amount of narcissistic gratification out of believing we're so central to our patients' lives that they're unable to manage without us and will, as we say to each other, "pay us back" for not being there.

The message we too often send, both verbally and nonverbally, therefore, is: I expect you to be upset and angry. We invite them to talk about it, to tell us how they feel; we assure them that anything they say is okay. And as with a child, if you expect untoward or regressive behavior, you'll get it. It takes a wise patient with a solid adult sense of self to be able to say, as one said to me years ago, "Why should I act like a child? Will it get you to stay?"

Certainly, most patients will miss their therapist when they're gone, since it isn't easy when the work is disrupted, whether for other professional obligations the therapist may have or a vacation. And it's useful to talk about those feelings both before and after the separation. But something different happens when that conversation takes place in the context of a therapist's attitude that says "I know this is hard for you but, as you already know, life's not always easy, or even fair."

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What do you think of that? Can the therapist overstate the case of his/her going away? Make the patient feel overly dependent or like it is a bigger deal than it really may be? Do any of you have therapists who expect acting out and angry behavior in response to an absence? And does that expectation increase the likelihood of the behavior?

This was very interesting to me, as the absences of my therapist are accepted by me as necessary, and I don't take them personally by getting angry, etc. I do miss him VERY MUCH when he's away and think of him often, but it is not traumatic for me nor does it make me angry. The hardest separation between my sessions was the longest one, between my first ever session and the second, and it lasted 1 month. I didn't get angry, but anxious that finally now that I had found someone I felt could help me, that we were never going to be able to connect again and do therapy together. I wonder if my accepting attitude toward my T's absences is because he never dwells on this or acts like I shouldn't be able to handle it. He very matter of factly says to me that he will be gone later this month (on vacation, to a meeting, or whatever), and there is the expectation that I will accept this graciously, as it is something that can't be changed. (Similarly, I don't expect him to get bent out of shape when I have to skip a week due to my own absence.) So I wonder if his matter of fact attitude provokes in me this matter of fact acceptance, as Rubin seems to suggest?

I think only Ms. Rubin can know what she hears/expects from her coworkers and patients and I imagine every patient reacts differently, depending on that patient more than on the therapist.

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In my more ungenerous moments about our profession and its rewards, I also think we get a certain amount of narcissistic gratification out of believing we're so central to our patients' lives that they're unable to manage without us and will, as we say to each other, "pay us back" for not being there.

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That's stated as a therapist's belief, not a patients so I don't have any trouble thinking those therapists could misperceive and/or interpret any behavior as "paying them back" or more upsetting than it is, etc.

I believe most clients do manage during their T's absences and it is just "another" topic of discussion, not new trauma or acting out or anything else "childish" that results.

I agree that it's useful to discuss the issue prior to and after. I doubt that there are very many patients that are not affected by a T's vacations, etc. Many patients are so affected, it takes up at least two of the sessions on either side of the absence, sometimes longer, as some need to feel "safe" again once the T is back. They need to be assured it's safe to trust.

I don't think Ts need to overstate what goes on when they go on vacation, illness or whatever. What happens is real. I believe it's because of the therapeutic relationship. Maybe the author doesn't develop, or acknowledge, this with her patients??? I don't know who she has in the mix: clinical psychologists, social workers, group counselors, self appointed advisors?

That therapist's are "taught" to expect the upset of the patients has no basis for the supposition of exaggeration of the fact, imo. There are countless events in therapy that are expected by the T, but that doesn't dictate giving in to poor therapy, does it? No, only with untrained counselors, imo.

It's always a good thing for a T's vacation to coincide with a level, calm, manageable period of time for the patient. I think the affect also depends upon how often a patient sees the T, and how much dependance has been fostered (for right or wrong reasons.)

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I think it's a shame that Rubin can't see beyond behavior.

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"Why should I act like a child? Will it get you to stay?"

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yes, this is exactly what to look at and explore: the magical thinking around the feelings about the therapist being away. it goes much deeper than just reacting behaviorally. it's an insight into how our minds work. Wanting to keep T from going, attempting to hold onto T through mental processes which precede the behavior is interesting to look at.

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"Why should I act like a child? Will it get you to stay?"

</div></font></blockquote><font class="post"> I have experienced this exactly. It was nearly impossble to admit it to myself when in the midst of it, yet at the moment I realized that my grief about her going to be away was about my thinking I could make her stay by holding onto her mentally was one of those insights that was immediately relieving. Magical thinking!

I know a few years ago when Steve went on vacation to Florida I had a meltdown and became very symptomatic and didn't realize that was the trouble until it was pointed out to me.

I know when I was in the hospital this summer my pdoc had to take a day off and he told me the day before and that he was coming back and I wasn't to feel abandoned. It helped some but when the pdoc that was taking his place didn't see me it pissed me off. I did act out that night and learned that isn't a cool thing to do in the hospital. When my pdoc got back he took my silverware away.

Jbug

Hey Sunny,

I think that anything is possible. I also think that every therapy situation is individual. The work that is being done, where you are in that work, the relationship at that moment, how strongly attached you are to T, your childhood and how interruptions were handled, how supportive or present your parents may or may not have been; whether you had parents or not; whether you were alone a lot; -- there's soooo much that plays into a T's absence or vacation.

I'm sure it's possible for a T to overstate the effect his absence may have on a client but that has not been my experience and I have never heard of anyone complain about this. My T is very matter of fact also about scheduling including his vacations. He simply lets me know when he will be away.

I have been the one to bring up the difficulties his absence creates for me. So, I can't say that I fell apart because he overstated the importance of his vacation. It was simply a result of my attachment during this very sensitive time in my therapy.

Maybe this could be true if the T was not in touch with his own feelings, and was not as in touch with how close (or not) his client was to him and overestimated the attachment?

Interesting topic.

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sister said:
Maybe this could be true if the T ... was not as in touch with how close (or not) his client was to him and overestimated the attachment?

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Yes, I think this may be what Rubin meant when she referred to "narcissistic gratification" of the therapist. Maybe this is a feeling she guards against in herself and so somewhat projects onto other therapists. Who knows. I found the passage intriguing as I had never experienced the "overstatement" from the T before and wondered if others had. Every therapy is so individual, but it sounds like no one who has responded here has experienced that. (I think that is a good thing!)

Well, for me, usually the S*** hits the fan whi;e they're away. Coincidence. And they tend to stay gone for a week and a half to 3 weeks... so that is a long time and anything can happen. Usually tho, mine have said i can call or email at any time (tho I may not hear back) and one even made call sessions to check in - that was sort of nice, but I couldn't talk over the phone, so not much was accomplished. Now I have a new one and i know she is "out of the country " from time to time.
Kiya

I really haven't had much of a problem with my T's planned vacations of absences. This probably has alot to do with the fact that I was seeing somebody weekly for 3 years and was VERY attached. One afternoon, I opened the mailbox and there was a form letter saying he had "health & family issues" and was closing his practice. He was "very sorry" about the issues it would cause and was kind enough to inclued a list of other therapists. So thoughtful!

I have been in therapy with somebody else for appx. 6mo. now. Don't know if I'll ever get remotely attached again.

i think that therapists should be sensitive to what is going on for the client and that they should be careful not to make assumptions either way.

it affects me significantly when my therapist goes away because i have issues with abandonment. it brings up a lot of traumatic memories and feelings for me but...

i don't want to talk about it.

not really. it is hard but... i need a little emotional distance both before he goes and after he has come back. it is a way of coping.

i can talk about it at other times... but not when it is around then. it is interesting, actually, that what i've been talking to my therapist about is letting ME set the pace more.

he turned out... to be respectful about that. let me prattle insessantly last session about my work and stuff like that. didn't push me... so next week... i'll try and talk about something that i feel vulnerable about.

i think that it sounds like what she is concerned with is enmeshment. therapists manipulating clients to meet their needs (my client loves me so much she can't cope without me!) etc. sensitivity and willingness to look at ones own %#@&#!.

t'was weird, actually. i was expressing admiration for David Lewis (he has a metaphysical view that possible worlds are as real and concrete as this world).

T said something about how... that must seem appealing to me... to think that there are more options than just what is happening in the present. opening up possibilities... sense of freedom... it was weird. i was thinking of it more as an example of what Bertrand Russel was saying (what we were talking about previously)

The aim of philosophy is to take something that is so crazy that no rational man could believe it...
Then show that it follows deductively from premisses that are so obvious that no rational man could doubt.

Possibilities... Hmm... D'ya think he would appreciate it if I got him a copy of "the god delusion" for christmas?

I know my T has always tried to respect my protests toward her going away but has never "used" them. Infact its my own narcissitic projection that is the problem, I percieve T as gaining some sadistic pleasure at her going away, but maybe its me that enjoy's those moments of being needed by others? I always use to feel T wasn't really getting how hard it was for me when she was gone, but she would always remind me that there are things I can do for myself while shes not there. I use to hate that, reminding me that I am now an adult and not totally incapable and that I do exist without her.

Ya....OUCH! that would be hard to stomach. =(
kiya