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Thursday, June 14, 2012

Attachment and Transformation in Therapy

When the therapist fails.

Sometimes it happens that a beloved, depended upon therapist dies suddenly.  One of our Grand Rounds presentations was by a colleague who had this unfortunate experience when her analyst, with whom she was in the middle of her work, suddenly passed away.  (this was by Robin A. Deutach, PhD and called, A Voice Lost, A Voice Found:  After the Death of the Analyst; tell me in the comment section if you want to hear more about this talk.)  Also, The Healing Hour, by V.C. August tells the story of another analysand who lost her therapist.  "Every love relationship bears the risk of inevitable loss, and so to offer one’s heart is always an act of emotional courage. The two main characters in The Healing Hour are not a likely pairing. The narrator, V, is an independent, feisty, witty businesswoman who is in a committed, happy relationship. Dr. Alex is a psychiatrist who helps her when she becomes quite ill with lupus, a disease that puts V at risk of losing both her eyesight and her business. But it is only a short time before Dr. Alex herself becomes ill, terminally. The healing hour now involves V’s support and feelings for Dr. Alex. The memoir shows how being willing to love everywhere — your mate, your career, the streets of New York, your family, and then, even your doctor — can be healing for everyone. Even the readers.")
More commonly, will be the situation where the therapist succumbs to the flu or a sinus infection, a virus or some other medical problem.  Besides not being above human ailments, we are also in a closed room for nearly an hour with sick, symptomatic people a lot.  Why do people come when they are ill?  Some of it is probably wishing to avoid paying the fee for not having given adequate notice to cancel the session.  But, also, therapy can make a person feel better.  It isn't talked about much and I haven't seen any scientific studies on it, but, I do think that therapy can contribute to good health, overall.  After all, our bodies are not disconnected from our minds.  Your therapist is probably one of the most compassionate people you can see when you are feeling lousy.  Even just that is sometimes enough to create a relaxation response which, if nothing else, relieves pain (and that is documented).
I've had a lot of therapy myself and done personal growth and self development work almost all of my adult life.  I think it is in part, a result of that effort that I don't often get sick enough that I have to stay home from work and I am generally healthier than average for my age.  But, recently, I did come down with a bacterial infection---not something one can power through.  I
was forced to cancel appointments at my office.  It was interesting how my patients reacted.  There was a whole range, from some who simply took it as an ordinary bump-in-the-road type life event, through those who felt quite sorry, to those who were angry.
 It made me recall an experience I had, many years ago with my dear therapist of the time, Marty Johnson, MFT.  While I was early in my career then, nonetheless, I was a practicing therapist myself.  I was an adult. But, when she called and left me a message that she was sick and had to postpone our appointment to the next scheduled time that we had, I called back and left her a message, asking her to call me.

  Despite being an adult professional myself, I was quite dependent on her at that point.  I feel a bit chagrined as I remember this.  (Poor thing.  She did call me, though she felt so poorly, and I really didn't have anything to say.)  However, from my current vantage point, I  recognize that some dependency is a normal stage of therapy for most patients.  I went through that stage with her and, eventually on to a good conclusion of the therapy and came out with more independence than I went in with. 
  With my most recent therapist, when he called, sick or, once when he had to have a knee surgery, these things were no problem to me.  So, I got to see my own growth by comparing the two experiences.  I share it partly because it is a good illustration of how therapy, while engendering dependency to some extent, eventually can afford the patient more autonomy.

You have to be willing to trust your therapist enough to allow that dependency to develop so that you can then grow out of it.  If you stay at a more superficial level in the relationship, you can utilize the therapist's ability to problem solve, you can enjoy the sympathy when airing out your difficulties, and still gain a lot from time in therapy.  But, if you want deeper changes, you have to agree to hold that person in a special position within your own psyche.  Meanwhile the therapist, for their part, has to be capable of carrying whatever projection their client has on them.  This is why it is important that we (we therapists) do a lot of personal work and sort out our own issues as much as possible, so that we can hang in there, in that neutral, compassionate, holding position as long as you need it.                                                                                                                                                                                Artist JohnMaggiotto
This is an exposition, in brief, of part of why I have said previously that the therapy relationship is central to the success of the therapy; it is part of the source of healing.

Does this post remind you of any of your experiences?  Please share.

(For a related article on dependence and autonomy, re. adult couples and parenting relationships, rather than the therapy relationship as I have written about above, take a look at this one:


  1. I was in therapy for about 3 years in undergrad. My therapist was a woman I'll forever be in love with! She changed my life so completely, because she was so patient and always saw the best in me. I'm so grateful we parted on easy terms, I was graduating and our time came to a natural end. But we are still in touch!

    She very, very rarely had to cancel an appointment, and when she did it was pretty crushing! But she made up for it in so many ways. I've since learned that an unexpected change in routine is always a good thing. I've come to see it as the universe shuffling the deck - if I didn't get a new hand, my game could never improve. I love to hold on to what's working for me, but being flexible means opening up to bigger and better.

    Thanks for a great post!

  2. Hi Jessica. You may be aware that I have been visiting your blog. I like it very much and see you offering something so helpful to others. I posted it on Facebook.
    This is a beautiful comment you offered here---thank you for sharing what sounds as if it were a compelling relationship you had with your therapist and part of what you learned from the relationship---that's what I think therapy is about.
    So glad for you that you and she have been able to stay in touch.
    I hope you'll continue to visit here. paula

  3. Having a therapist die is definitely one of the hardest things I've experienced. You aren't a friend, you aren't a family member so it's very hard for people to understand or accept your grief and also hard to mourn in a way that usually happens (funerals, contact with the family etc). Suddenly the person who you have shared everything with, the person you look to for support is gone. You are left with incredible pain and also a great sense of shame for the selfishness you feel for feeling grief not just for their death but for the loss of that one person who played a role nobody else could. It's something you can't really talk about with others and something that doesn't really get covered much in the literature relating to grief. I do know a therapist should never promise their client that they won't die the way mine did at the time, because it is one thing they really can't control.

    As far as when a therapist is sick, I think that it's one of those things where clients often hold a variety of views. Concern and care for the therapist and wanting them to be well again; but also upset (anger, fear, sadness etc) that the person they need isn't available when they are really wanting and needing them to be. Having experienced a therapists death I also fear that happening again which makes even a cold for my therapist something to be concerned about. I wish more was written about therapists dying and how to cope after; I'm thankful for what you shared here.

  4. Dear Caz. You have shared a very personal experience here. It will be helpful to both therapist and patient readers. It is just so very hard to lose people we love and / or depend on.
    There is a book mentioned in the 1st paragraph of this post-just noting it since you said you wished for more to read on this subject. Thanks for your contribution here.

  5. Thanks Paula, I did mean also to say it would be great to here more about the talk you heard. I'll look for that book :)

  6. Paula today I'm missing you terribly, you will always hold a special spot in my heart. I find myself reading your blog more often now...