Dear GoodTherapy,

I had been seeing my therapist for 28 years. Around March, she was unwell. This was a rare occurrence in our time together. But her viral infection persisted until about six weeks ago, when she texted me to say she would not be returning to her practice. I was and am devastated.

I asked if it would it be okay to email her. She said yes, but when I did, she said she was still ill. Initially, I drew on our relationship, which I had come to internalize. However, as the weeks have passed, I have felt angry at the way it ended. And as a recovering alcoholic (dry for 10 years), I am fearful of the future. I would value your views. —Hung Out to Dry

Dear Hung Out to Dry,

Thank you for asking this question, and I imagine other readers thank you as well. Few things can be more painful than the sudden end of a relationship, particularly one in which we felt a strong connection and entrusted with our vulnerabilities. I can hear the loss and confusion you feel and what I presume is a sense of abandonment. These are huge, potentially overwhelming emotions. Congratulations for reaching out for help.

When therapy ends prematurely, especially when it is characterized by a deeply established relationship, it can feel like your world is being turned upside down. It is not uncommon to feel the way you feel. I imagine it is hard to understand what led your therapist to terminate her practice so abruptly and taper off communication. It is understandable to take this as a personal loss. In an ideal scenario, when a therapist plans to retire or end their practice, they communicate this plan with clients well in advance and they discuss and process the transition in session, perhaps even over time.

No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist.

Unfortunately, sometimes illness and/or other circumstances beyond a therapist’s control may necessitate a less-than-ideal end to the therapeutic relationship. In this case, it is up to clients to pick up the pieces and move forward, perhaps with the help of another therapist. (It is worth noting, though clearly not what is happening in your case, that when a client leaves therapy prematurely or without closure, this presents another challenge for recovery.)

You mentioned that you recognize how you have internalized this relationship. No doubt you have drawn many associations between the role of your therapist in your recovery and progress. It is clear from what you wrote that your therapist has been instrumental in your healing process. I would like to point out something else: YOU have made it through the challenges you have encountered during the time you worked with your therapist. YOU have maintained your sobriety for the past decade. Your therapist was likely not with you during every one of your darkest moments, but YOU were. While you may have internalized the voice of your therapist when experiencing these dark moments, ultimately YOU have managed these circumstances. You made the decisions yourself.

It is understandable to fear what lies ahead for you. Hopefully, you are able to consider your future from a place of empowerment based on your past successes. Another important step is rebuilding your support network. This has been instrumental to you in the past and will likely continue to be instrumental in the future.

If you haven’t done so, you will want to explore options for therapy for yourself going forward. I see it as a positive indicator of success for your future that you formed such a strong alliance with your former therapist. You can do it again. The new relationship will not be the same because the therapist will not be the same. The new therapist will not always respond in the same ways, nor offer the same insights. This is okay, and arguably a real positive.

Change, though scary, can sometimes push us further into growth. You can explore options and consult with more than one therapist before starting anew. As you know, finding the right fit can make a world of difference.

I hope this feedback was useful, and I wish you luck as you move forward.

Marni Amsellem, PhD

Goodbyes suck.

They really do. They’re often uncomfortable. They’re also inevitable.

Goodbye experiences are as final as a death and as common as leaving the embrace of your partner to get a snack from the kitchen.

They begin the first time someone takes us out of our mother’s arms when we are born (or maybe we didn’t even get there; for some of us, they start at birth).

Well, we say, everything comes to an end. Or, harsher, we all have to learn to live with disappointment.

Our first “task” as humans is to learn what psychoanalyst Erik Erikson called basic trust. Developing basic trust means learning that even though our parents leave us in our crib, they will come back. Someone will feed us, hold us, change us, and comfort us.

[fat_widget_right]

Hopefully we learn that. Not all of us are so lucky.

For those of us not given the chance to develop basic trust, goodbyes can be even harder. They’re hard because we’ve barely learned how to connect and attach to someone else and we think if we don’t attach, we won’t feel bad when the time with that person ends. Or so the theory goes for people who try hard not to connect.

Over time, we realize that strategy doesn’t work. We continue to get hurt and, worse, don’t understand why.

As a young clinician, I hated goodbyes. I resisted the idea and would have preferred therapy just end. “Oh, you’re done? Goals met somewhat satisfactorily? Good luck, so long, be well!”

But I was taught to allow people in therapy to have an ending—or “good goodbye,” as we called it. (The technical term is “termination process.”) So many people have stories in which other people just disappeared from their lives—a common core issue in therapy—that the therapeutic relationship should not only not replicate this, but heal it.

At least, that was the message I was given. But it was difficult to sit with.

This process could last three months, and the difficult part was what happened in those three months.

Have you ever noticed what happens when you know something is coming to an end? Think about the last time a friend moved. Notice anything in how you treated others?

As endings near, we get to see the stuff that was being held back. Maybe you snap at someone you never felt angry with before. Perhaps you find it important to make their final party perfect or hold out hope that when they see how much they will be missed they will change their mind. Maybe you start to see and remember only the amazing and wonderful things about this person and forget the difficult times you’ve had together.

If you’re having a really strong termination process, you’ll cycle through all of these. Because if you can move through the stages of denial, anger, bargaining, and depression, you can get to acceptance. You can really say a “good goodbye.”

Endings are powerful because, if we allow, we get to release all the feelings we’ve attached to the other person. When we do that, we are truly in relationship with them.Endings are powerful because, if we allow, we get to release all the feelings we’ve attached to the other person. When we do that, we are truly in relationship with them.

Allowing this process to happen with your therapist can be incredibly helpful—sometimes the termination may be the most insightful work you do in your therapy.

Because it’s so difficult to fully trust that someone will hang around after they’ve seen the “worst” of us, we inevitably hold stuff back. From friends, from relationships, from family, and from others. It’s rare we show all of ourselves to anyone.

When saying goodbye, there’s a “what-do-I-have-to-lose” quality at play. And we can become closer because of it.

Sometimes, we avoid the goodbye because we’re really angry. A friend of mine was telling me the other day she stopped seeing her therapist. She had been working with this therapist for several years and said the treatment was very good … at first. It was helpful to talk about much of what she’d been holding in, but she wanted something else and wasn’t getting it. So she emailed him and ended the therapy.

By emailing, she missed out on letting her therapist know how disappointed and angry she was.

Of course, she also avoided the discomfort. Why put yourself through that?

But that’s also what you’re going to therapy for: to be able to say all you feel and have it be heard without being judged. You might not get that chance anywhere else.