Shirah Vollmer MD

The Musings of Dr. Vollmer

Internalizing The Therapist

Posted by Dr. Vollmer on December 13, 2012

Brit, sixty-five, decided to end 2012 with the monumental step of stopping her twenty-year long weekly psychotherapy. “I will talk to you constantly,” she tells me, explaining that she will keep our conversations alive and she will wonder what I would say as she navigates her world. “I am sad,” she says, knowing that she is making this decision, which is, of course, layered with feelings of strength and autonomy, as well as deep sorrow for the change in our routine. “You know how to find me,” I say, understanding that on the one hand, I am still in practice and happy to see her, but on the other hand, I respect her decision to leap forward into the world in a new way. “It is sad for me too,” I say, gently reminding her that our relationship is a steady part of my mental existence as well. I tread lightly, knowing that I want to communicate both that she is important to me, but at the same time, she should not come to therapy to make me feel needed. We reflect back over our twenty years together. Her children have grown up. I feel, in some small, but meaningful way, that I have helped raise them. She agrees. “You are one of my longest relationships,” she tells me, reminding me that she has been married multiple times, and that both of her parents passed away when she was in her twenties. I think about that. I am not sure I appreciated that before. Wow. This is the privilege of my work. Brit and I have been on a long journey together, and in different ways, we are both very appreciative. “Happy Holidays,” I say, ending our last session, feeling deeply that I hope things continue to go well for Brit. I also know she wishes me well. “I will think about you and I hope you keep me posted,” I say, reminding her that my curiosity continues after our official relationship ends. “Oh, I will,” she reassures me. Happy endings, I think to myself.

6 Responses to “Internalizing The Therapist”

  1. Melanie said

    After 5 years of seeing my therapist multiple times a week, I once again have thrown out the idea that maybe I need to “quit.” Monday night I was “confident” in my assertion that maybe now with being newly married (4.5 months) and a new house (much longer drive home from her office) and thoughts of starting a family (as in at almost 31 years old, I “should” be the one taking care of someone else and not the one being taken care of) that I needed to cut back. As the week has progressed, my “confidence” in my assertion has digressed. Front and center in my mind is that the relationship is super important to me and quitting will suck (in whatever form quitting actually is) and that I am the only party to the relationship that will be upset when I quit. However, in the back of my mind I want to believe (and I think I know) that my therapist will be also be upset because of the importance of the relationship to her. I feel that if I don’t make a “clean break” (sort of quitting cold turkey), I will never leave. I feel like I need her “blessing” to leave so I know we will both be ok. I want to be able to walk out of her office when that day comes and wish her well and for both of us to know that it will be a “happy ending.”

    • Shirah said

      Thanks, Melanie. You articulate clearly the complexity of termination. From the patient’s point of view, it is hard to know when the right time is. From the therapist’s point of view, it is also hard to know whether to be supportive of termination or to examine the motivations. Thanks Again.

  2. Jon said

    So, according to the popular misreading of the Mayan calendar, the world will end at the solstice this December, and also Brit will end a score of years of psychotherapy. It will be a brave new world for both Brit and you.

    However, this brings up an unanswerable question. What are the stopping criteria for psychotherapy? The question is unanswerable in the analogous way to which Tolstoy begins the novel Anna Karenina, “Happy families are all alike; every unhappy family is unhappy in its own way.” All needs for psychotherapy are needs in their own way. That said, there are probably generalizations that can be made about the inner strength that a patient gains, the insights the patient attains, the support network the patient builds outside of psychotherapy. How do these play in the ending of sessions? What, if anything, can be said in general about how to end formal treatment?

    • Shirah said

      The general principle, Jon, is that people come to psychotherapy with mental pain and they leave psychotherapy when that mental pain becomes manageable on their own. This is obviously subjective, but I have found this notion very useful over the years. The fictional Brit is a good example. After twenty years, she still suffers from anxieties which detract from the quality of her life, but on the whole, she is able to have a greater perspective on her world which allows her to deal with the ups and downs of life with equanimity and joy. She is also able to see how her perspective changes her internal world, such that the problems she deals with are mostly internal and not external. As such, she can work on her perspective, (by talking to me when I am not there) which will, in turn, help her cope with her bumps in the road.

  3. Shelly said

    So, does the therapist want to hear updates of how the patient is doing now and then? Does the therapist wonder how the patient is doing on his own, without weekly sessions? Is the therapist thrilled when the patient is doing well, upset when the patient isn’t? What happens when the therapist runs into a patient in the supermarket or movie theater? Is it awkward?

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