Summer Doldrums

Everything slows down in August, including my attention to this blog. I’ve missed my weekly posting, as it’s now over ten days since my last post…

So a quick topic. Therapist point if view; you’ve been working with someone for several months and things seem to be going well with your patient’s progress in therapy, with his/her trust in you and being vulnerable and with your patient’s progress in using therapy in his/her life to make positive changes and start achieving some very concrete goals. Your patient hasn’t missed a session and comes on time and pays regularly even though this patient, like many others, is struggling financially.

So last week I sat and waited for a patient much like the one described above. The patient did not show up, did not reply to my text or phone message… I was mystified but not overly shocked only because this has happened before, so I’m aware that it’s not a really odd occurrence even though it is as it is so in characteristic of this very responsible and reliable patient who has even complained about such behaviors from others in her life and her frustration with people “dropping the ball” suddenly. So it feels odd that this patient is now doing that to me. Of course I wait a few days and then about five days later, still no communication so I call and leave a message stating my concern about the person’s welfare, wondering if everything’s ok, also stating that if finances are now making it impossible to continue therapy, u understand and hope the person will let me know if that’s the case and an emergency break from therapy is needed. I also asked if the patient wants to keep their next regular appointment in a few days…

Still no word. At this point I can do nothing. I can choose to wait for the patient at their regular appointment time to see if s/he shows up and if not, that’s it. I will be left with feeling the situation is unresolved because it is unresolved and feeling some other feelings that may well belong to the patient and have something to do with his:her attachment and separation issues…

One can’t help feeling foolish on theses occasions when one is completely blindsided. It reminds me of the feeling people report after they’ve gone on several great dates with someone and everything points to a relationship and suddenly the person mysteriously drops out of sight. However it is more similar to being a few months into a new relationship and suddenly the person drops out if sight. I’ve even heard of twenty year marriages ending this way. The family wakes up and one of the parents is gone with no note, no warning sign, no explanation… Obviously the last example is much more extreme…

This is one of the biggest challenges for therapists. We would rather deal with someone telling us they don’t like us or don’t want to work with us. These mysterious types if disappearance trigger abandonment and competency issues in even the confident therapist. How could I not see this coming? Us the big question that hangs in the air. I thought I knew this person pretty well but I can’t figure out what’s going on. Sometimes we get lucky. One of my patients that did this texted me 2 week’s after non appearance and no communication and just stated wanting to stop therapy. No reason given, so still quote frustrating. I managed to look at the situation rationally after processing my confused feelings and concluding that something uncomfortable had come up causing my patient to retreat and flee, at least letting me know about it. Then I was luckier still to have this patient a year later suddenly contact me and return to therapy with me. Very unusual and unlikely to happen five out of six times. Somehow the patient hit over feelings of shame and embarrassment if having to see me again and explain what happened. If course I was delighted to work with this person again. Not to go too far into specifics but suffice it to say that I am more careful about checking in to see if this person is feeling overwhelmed in the session while at the same time being more concrete about goals and homework for this particular individual to see more directly the progress being made and the direct connection with what we are working on. So to some extent I got a chance to refine my skills and be more attentive. Any patient who comes back makes me excited. I can’t help but feel grateful that the patient really values working with me as they have chosen to return. In this persons case, he tried to make appointments with a few other therapist’s first and got no response and then got up the courage to try returning to me.

As last week’s event reminds me, we will have successes and also mysteries where maybe we have helped our patient to the best extent possible, and people often run away from therapy even if they are choosing to get into deeper more painful issues…


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