Ending Therapy

Next week, I’m ending work with a therapist I’ve been seeing for over a decade. This has caused me to reflect a lot on our years of working together, and what it’s meant for me. It feels like a strange thing to blog about this, maybe, but I don’t really know what the correct venue is for processing a relationship like this. I don’t feel like there are a lot of cultural scripts for talking about therapy that don’t involve poking fun at it (which I don’t necessarily object to; I’ve seen What About Bob? so many times that I can extensively quote it). But this is a big deal for me.

I moved to the Midwest about two and a half years ago, and was hospitalized about six months after I got here. I was still seeing my therapist via Skype, and they really didn’t like that at the hospital. They told me I needed to find someone local. I could see reasons for doing that, but I was genuinely taken aback by how puzzled they seemed to be that I hadn’t done it yet. The sense I got was that they saw finding a new therapist as roughly comparable to finding a new auto mechanic. You just find a replacement person who has the right skills—what’s the big deal? Looking back, though, I find it revealing about how they conceptualized therapy. It’s just having someone to train you in certain behavioral skills. It’s not particularly personal.

That hasn’t been my experience at all, though, at least with the therapy I’ve liked. And now, with the long distance Skype thing having defeated us at last, I’m trying to make sense of what it means to lose a relationship that has lasted so long, and that has been so grounding for me.

It was the fall of 2004 when some things happened in my life that finally pushed me back into seeking out therapy. I was starting my second year of a doctoral program and had the usual boatload of academic anxieties and imposter syndrome and fears that I couldn’t possibly make it all the way through the degree. As had been the case for me for pretty much my entire adult life, I was dealing with chronic depression and suicidality. But the catalyst that made me realize that yeah, I really need some help, was that I was falling back into interpersonal patterns that had nearly wrecked my life in other contexts, and that were causing me intense emotional distress. (To this day it amazes me that I can move somewhere completely new, think that I’m making  a fresh start, and then go on to recreate all the dynamics with other people that caused so much trouble in the last place I lived.)

At this point in my life I’d been in therapy a couple of times, but only once with someone whom I’d really liked and worked well with. I think having that experience, though, of clicking with someone in the past, gave me a hope that I might not have had otherwise that therapy could be worth it, even if it took some time to find the right person. Still, it’s kind of funny to remember the requirements I’d come up with for a new therapist when I’d periodically considered the question. For one thing, I was determined to see someone with a PhD. Given that I was a doctoral student myself, that seemed reasonable to me; I’d already completed two master’s degrees, and I didn’t want to be more educated than my therapist. I also wanted someone older, and experienced.

But once I actually looked at my options, I realized that I was going to have to make some compromises. My insurance was paltry and would barely cover anything, and I was reluctant to involve an insurance company in any case. But I had very little money, and paying out of pocket for someone in private practice was clearly not an option. So I turned to the other possibility I was aware of: the various clinics that would let you cheaply see people who were in training. I knew that behavioral therapy was a bad fit for me, so I opted for a place that was psychodynamic, and I agreed to let them record the sessions, even though that felt a little weird.

I did not go to my first session and think wow, this therapist is such a good fit for me. For one thing, he wasn’t much older than I was, which made me think it was unlikely he would have much more perspective on life than I did. And while I’d opted for psychodynamic work, I wasn’t entirely sold on the approach. I remember informing him not long after we’d started our work together that I didn’t actually believe in the unconscious, and I really didn’t want him doing things like interpreting dreams. He seemed agreeable to working with that, but I was still suspicious. I feel like psychoanalysts can play this game in which the analyst claims to have more knowledge about your experience than you do—and if you object to their interpretation of what’s happening, they then claim that your resistance to their interpretation is actually evidence of its truth. I was on the lookout for that dynamic from the outset.

This is what I wrote after our first meeting:

“So . . . I went. I don’t know what I think, really. But I think the guy has potential. Though of course I need more time . . . He’s young, and in training (though not a grad student, thankfully; it seems to be another program people can do after their degree). I’m not crazy about that. But I was upfront about my concerns there, and he seemed fine with that and willing to keep addressing the issue if necessary. That helped a little. Sometimes he responded so much like a therapist that I wanted to roll my eyes. But sometimes he also acted like a genuine human being, and I liked that.

It was kind of nice just to talk about stuff, even though of course I was doing it in a very intellectual, detached way. I’m remembering why therapy has helped me in the past. It’s not so much the insights I get . . . It’s having the space to talk about the chaos in my head.

Anyway, I’m willing to give this a chance. For a little while. We’ll see where it goes.”

So I stuck with it, and we started to get to know each other. Looking back at those early sessions, I was pretty hostile at times. I deliberately talked like a grad student, with lots of complex vocabulary, to see if that would bother him or would cause him to dismiss me as “intellectualizing” things. I informed him that the entire discipline of psychology was morally dubious because of its track record of objectifying people. (He responded to that one with the astute observation that of the two of us, the one who kept objectifying me and dismissing my experience was . . . me.) I said flat-out that therapy was in a basic way no different from prostitution, that I was just paying to get my emotional needs met. Sometimes I felt like I’d managed to land a pointed observation and gotten him to react, but on the whole, he stayed pretty unflappable.

And slowly—very slowly—I started to trust him. I remember telling him that I was uncertain about bringing up particular topics, and he asked me what made me feel like the space between us couldn’t hold them. That was a useful question, and one we often came back to. What could our relationship stand? What would be too much? I got immensely frustrated early on because it felt like all we talked about were issues of dependency. Like no matter where we started, we always ended up there. But I finally realized that there was a way in which that was ground zero—if I couldn’t work through my extreme fear of depending on anyone, ever, there was no way we could really work on anything else.

I’ve found that this is not what people want to hear (and especially not what insurance companies want to hear), but it took years to build that foundation. It took years before I trusted him not to bail on the relationship if I got too difficult. I’m not saying everyone who goes to therapy needs that, of course—but I did. There wasn’t a shortcut I could take to get there. We talked about all kinds of different things during those early years—we didn’t just talk about my fear of abandonment—but it was an undercurrent that showed up pretty regularly. And I don’t think he could have said anything that would have convinced me that he was genuinely committed to sticking around. I had to experience it happening before I could trust it. But rather to my surprise, I did eventually get to a point where I mostly stopped questioning his reliability, or whether he actually cared or was emotionally invested in what we were doing.

One of the things I most valued in working with this therapist was the extent to which he saw the process as collaborative. He didn’t set himself up as authority figure who weighed in on my decisions or told me what to do. He regularly told me that he didn’t think he knew more than I did,  and emphasized that I was ultimately the authority on my own experience. What he did have to offer, he would say, was a different perspective. He always used “we” language rather than “I” language—for example, when things were difficult, he would ask, “how can we help you get through this?” Therapy genuinely felt like something we were doing together. Though he was also very good about not making it about his emotional needs, and when I inevitably found myself trying to take care of him and not hurt his feelings, or wanting to get better to make him feel like a good therapist, we talked about that. This might seem like a small thing, but you know how sometimes in a conversation two people will start talking at the same time, and you have to figure out who gets to talk first? When that happened in therapy, the default was always that it was me. The implicit message was that it was my therapy, and what I had to say was more important than what he had to say. I appreciated that, that he didn’t seem to think that he had such brilliant insights to offer that they should ever override my talking (sometimes incoherently) about my experience. (Though I did value his insights, and would often ask what he’d been going to say.) And he took me seriously, even when I contradicted myself or didn’t feel like I was making much sense.

The religion thing was another concern for me. I know lots of Mormons who want to see LDS therapists not even to have their beliefs affirmed, but just because the thought of explaining all the ins and outs of Mormonism to an outsider seems daunting. I can relate to that, certainly. But my experience with LDS therapists had been uniformly negative, and the one therapist I’d liked hadn’t been LDS, so I was okay with going outside the church. Still, I worried about my religious beliefs being pathologized, and I was initially hesitant to talk about them too much. But of course they came up. And I was actually impressed at the extent to which he managed to work within my religious universe. He would push me on my beliefs that were actually pathological (like that of a God who was deeply punitive and basically out to get me), but I never felt like he was at all dismissive of my being religious. Working with him, I realized that while there are advantages to seeing an insider who already understands your religious context, there are also advantages to seeing an outsider who has a fresh perspective. We talked a lot about my church-related angst, and Mormon feminism, and even blogging. For some reason, he seemed particularly enamored of the doctrine of Heavenly Mother (I think the male-female balance in God appealed to his Jungian outlook). But while he listened to my struggles with the church and took them seriously, he never gave any hint of pushing me in any direction as far as whether to stay or to go. It was clear that he didn’t see that as his decision to make. Honestly, I never would have guessed I would get as much spiritual direction as I did from our work together, but it turned out to be a hugely helpful place to talk about what was going on with me and God. My therapist once said something about finding a life-affirming God, and that was really valuable to me in my ongoing struggle to discern whether various things I was feeling that I thought were from God actually had a divine origin. Because it was clear to me that messages like that I was eternally damned and God hated me now weren’t exactly life-affirming. And it felt good to start thinking of a God who was above all on the side of life, of thriving, of human flourishing.

We met a lot—two or three times a week for almost the whole time we worked together. I liked that it was so frequent because I felt less pressure to be productive every minute of our sessions together. When things were bad for me, we spent a lot of time talking about what was wrong. But when things were going somewhat better, I occasionally did things like reading him bits of the papers I was working on, or sharing my favorite poetry. Looking back, I think that was time well-spent. We talked about philosophical questions and theology and world events, and I tried to explain to him why Star Wars had been so formative in my life. When I was thinking about what I wanted in a therapist all those years ago, it never would have occurred to me to consider intellectual curiosity as an important quality. But the fact that he clearly liked to learn things and was interested in ideas was something that added a lot to our work, and helped us connect.

It was by no means always a smooth relationship, though. There were definite misunderstandings. I got mad at him fairly regularly, and he consistently conveyed that he wanted to hear about it when I was angry. He would defend himself sometimes, but he never tried to talk me out of what I was feeling. I am terrible about talking about it when I’m mad at people, so that was a really new thing for me, to be in a context where it seemed like the other person genuinely wanted to hear about it. Which isn’t to say that the clashes weren’t sometimes difficult, and painful, or that I didn’t feel disappointed and hurt and unheard at times. And there were certainly times when he was frustrated and angry with me as well. Often he would simply point out the dilemma I was putting him in. When I was suicidal, for example, he noted that if he challenged my narrative that the only possible answer was to kill myself, I would accuse him of not really understanding just how bad things were. So he had the choice of going along with my suicide plans (not exactly an option for obvious reasons), or having me be mad at him for not getting it. And honestly, sometimes it was pretty rough. I would show up and argue with everything he said, or just withdraw and act hostile. And I would be so incredibly frustrated with him for not magically managing to make it all better. I would wonder what was the point in talking about how bad things were when I felt like I’d already talked it to death and there was nothing more to say. When he pushed me to talk about what I was feeling, I would say that I was sick to death of talking about feelings.

But what I can say, about both of us, is that we kept showing up. Even when I was at my worst, it was very rare for me to flat-out skip a session. And he didn’t check out, as I feared he would, and keep coming but just go through the motions. He was really there. And occasionally I got desperate and acted out, and there were a few times that he didn’t feel comfortable letting me leave on my own and pushed for hospitalization. He told me more than once that my pattern was to tear down everything good in my life when things were hard, and it was difficult to watch me keep doing that. Sometimes it didn’t feel like we were going anywhere. But the relationship between us, the trust between us—that was a powerful thing. I remember once that I told him I thought he was an excellent therapist, which was actually kind of hard for me to admit, and his response was that there was a way in which we created each other, that what we’d built had been a joint effort.

And now we’re ending our work. It’s incredibly disorienting. For the last 13 years, I’ve known that if I needed to, I could call him. I can’t even say how stabilizing that has been for me. I’m getting started with a new local therapist, and there are good things about that. But it’s also very different, and I know it’s going to take some time to build something there. I feel a whole lot of things about ending things with the therapist I’ve seen for so long. But if I’ve learned anything from our work together, it’s that it’s okay to let myself feel a lot of things about a situation—even contradictory things. That I can survive the feelings. And even when I’m no longer seeing him regularly, I’ve developed what I can only describe as a sense of him in my head. That, I hope, will survive.