(or You Can’t Always Get What You Want Need)
One of the ideas rattling around in my head before the election madness took over had to do with routines and the impact of disruption to these orienting, centering, reliable constructs that make up most of our lives. As a parent, I know I bemoan any disruption in my children’s routine, be it a snow day, a holiday break, summer vacation, even the weekend. We all know that children usually thrive on routine, when they are fully aware of plans and timings and expectations and what comes next.
I suspect many adults also function better on routines, but for some reason we aren’t allowed to openly admit that. As adults we are somehow expected to better withstand the changes in routine, to be able to adjust the sails and keep the boat from capsizing. Even if it’s a tricky maneuver, we must try to make it look easy and effortless, even in the face of gale-force winds.
I’m likewise certain that the recent election results are unsettling to so many precisely because we are entering unchartered waters, and have no idea of where we are going, or how we will get there or what the ultimate outcome will be. The routine of life as we know it has been completely disrupted and we may never settle into a new, predictable routine again. Responding to rapid changes may become the new norm.
For me, the theme of therapy this year has been disruption in routine. It started back in April when my therapist took a much-needed sabbatical abroad. I didn’t begrudge her (too much) this time away, but I did anxiously count down the 25 days she was gone. Then we ran into a 21 day stretch at the end of June when I was away and another 20 day stretch at the end of the summer when our vacations misaligned.
To fully understand the significance of these breaks, the longest I had gone between sessions before this year was a mere 14 days, which translates into missing two or three sessions. The longer breaks this year meant we missed 5-6 sessions at a time. Interestingly enough, we missed no more sessions this year than we did last year, due to illness or vacations or other commitments, but the missed time has been more clustered, leaving longer periods of time between appointments.
I realize that for some people this lapse in therapy may not be a big deal, but for me, it is. I go to therapy for a variety of reasons, but perhaps the driving force is that it provides me a dedicated time and place to pause and reflect and breathe. And I don’t just mean short in-and-out breaths, but deep, cleansing, restorative breaths that help me clear away the cobwebs of anxiety and fear and anger and sadness that accumulate in my mind.
I don’t depend solely on therapy to do this – I also do yoga, walk to work, go for the occasional run, try to spend as much time outdoors as I can. But I find that therapy helps the most, and it’s the one thing I can fight for in the battle for my time at home and work. I can give up a yoga class here and there, or take the subway instead of walking if I am pressed for time, but I steadfastly guard my therapy time. I block it on my calendar, fend off meetings and other time-intrusions, ask other people to re-arrange around me. This is probably the only part of my life where I put myself in the center and refuse to budge.
Through all these long breaks this year, I’ve noticed that I can go about 9 days before I really start to miss my therapist and the space and connection that therapy provides. (I should note that a year or so ago that number would have been much less, so I’m not quite as dependent as I used to be.) On a normal week I see my therapist twice, so I only have to go 3 or 4 days holding my breath before I am able to exhale again. If we have to miss a session, it’s okay because I can hold my breath for 7 days. But if we start missing 2 or more consecutive sessions, then I start to feel the lack of oxygen to my emotional immune system.
When I know that a break is on the horizon, I can calibrate myself to let the oxygen out a little more slowly, so that I can try to make what I have in my tank last for the length of time between sessions. I get into trouble when unplanned breaks emerge. If I think I am going to have a therapy session in a few days’ time and it gets canceled at the last minute, regardless of the reason, I find myself with a dwindling supply to get me to the next session. I exhaust what I have available to me, thinking I am getting a refill in a set amount of time. So when the refill doesn’t come, I can slip into a state of deprivation. Even when I know I have to go 25 days, I just can’t make it last that long. I never accumulate enough for much of a stock-pile. I need to promptly use what I get out of each session.
This has been a real source of frustration for me, and sometimes I get angry with myself for being so therapy-needy. Plenty of people can go a whole week, or two, or more, without seeing their therapist and not feel like they are about to turn blue and pass out.
I once took a week-long trip on a Schooner off the coast of Maine. Each cabin was equipped with a small sink connected to a barrel up on deck. The barrel held your ration of water for the week, and once it was gone, it was gone – there were no refills. I remember treating the water supply as if it was the most precious of resources. I tried to only use what I needed to wash my face and hands and brush my teeth. I surely didn’t want to be the person who ran out of water before the trip was over! There was no gauge and no way to know just how much water you had used up and how much was left. I often wonder how full – or empty – my barrel was at the end of the week. Was I too conservative and could have allowed myself to use more water? Was I too greedy and barely made it through the week? Or did I use just the right amount, saving enough for an unplanned emergency but not depriving myself of a needed resource either?
I often think about that water barrel when I am trying to calibrate my own needs in therapy. What is the right balance? How do I make use of the resources I have now while saving enough, without squandering away, for the unexpected? How do I keep myself from arriving at my next session on my last breath?
You’ve been my hole in my sky
You’re my shrinking water supply
Before my well runs dry
I’m going round round round the bend
Fill it up again
~ Emily Saliers, the Indigo Girls, “Fill It Up Again”
This has been a struggle for me, particularly this year, and now I’ve been dealt the ultimate disruption. Cancer. My therapist most likely has cancer. There are still a few other potential diagnoses, but it’s looking increasingly likely that she has a very “interesting” form of cancer. It is such a strange cancer that she doesn’t even have a decent prognosis yet – we have no idea of what we are dealing with or potential treatment options or realistic outcomes.
Even if we did know more at this time, I would be suspect. In the past few years, I watched a friend’s back pain turn out to be lung cancer. I’ve seen the prognosis “highly treatable” turn fatal within a year. So it’s hard not to catastrophize at this point and start mulling over worst-case scenarios. Despite her telling me more times than I can count “I’m not going anywhere,” I fear I may lose her.
My heart aches. My heart aches for my therapist’s children, who despite being a quarter of my age, have had to deal with far more loss in their short lives. My heart aches for my therapist and the potential silencing, far too soon, of her steady, clear voice – she has shared and given so much to me and to so many others and I can’t imagine a world where she is not adding to the cacophony of life. And my heart aches, selfishly, for me.
My therapist is keeping her caseload updated via regular emails. At first I hated these blind cc’d mass emails because it was a very real reminder that I am not her only client and that there are many others fighting for now even more limited resources. Now I hate them because each one seems to bring only more bad news.
Much has been written about the unique bond between client and therapist. It is such an intimately private relationship, and yet I know that she is far more important in my life than I am in hers. She is the only one. I am one of many.
She has explicitly given all of us permission to go and agreed to help with any needed referrals. But I’m not going anywhere. It would feel as if I am abandoning her. After four years together, after more than 200 hours staring down my demons from the safe confines of her office, I can’t just walk away. And I surely can’t start this process over with someone new. There is too much history, too much learned, too much shared. We’ve changed each other in more ways than I can count. There have been so many times when I could have left. But I didn’t. I stayed.
She doesn’t want her unpredictability to be a source of stress to her clients. And I don’t want to be a source of stress to her. There have already been disruptions for appointments and tests, and she doesn’t know how much time and energy she will have to devote to being a therapist. She has committed to giving what she can, knowing that her priorities are to her children and her family and to herself. I feel like I’m back on that sailboat, and now is the time to conserve whatever is already in the tank. There is no gauge. I don’t know when it will run out, if/when I can get a refill (or even how much of a refill I will be able to get), but when it’s gone, it will be gone.
We’ve often talked about the connection between us, and how it remains even when we aren’t together. Even when we miss a session – or six. I struggle to hold on to that connection. If I can’t see it or touch it, it feels out of my reach. I even have physical items to hold on to in an effort to bridge that gap of time and space, but nothing is the same as being in the same room, face-to-face, in deep, honest connection. And I have no idea if that connection transcends death.
I think one of the things I fear the most, should this turn really bad, is that I don’t really know my place in her whole, outer world. I know I am definitely behind family and friends. But I have no idea where I fit into her clinical landscape, past or present. I don’t know any of her other clients, I have no idea how big of a piece I take up in that map of her life. I know I am more than an insignificant dot, but I have nothing to compare myself and my experience to. For as long as I’ve known her, it’s just been the two of us.
And even though there have been times I’ve been raging mad or intensely frustrated or painfully sad, I’ve always been grateful that I found the path to her door, that she opened it and took me in. I regret not considering that “time’s up” might be called so soon. I might have used my time differently. I might have chosen different words.
I always imagined that I would be a client forever, continuing to see her well into both of our old ages. It wouldn’t be every week, or even in an office, but I fully expected to be on her caseload until the day one of us dies. I always knew we would have to cross this bridge one day, I just thought it would be more like 40 years from now.
My therapist has talked to me about what it’s like to mourn a client, how you don’t usually get to go to the funeral, and even if you do, you can’t be open about the relationship. It’s a very private, lonely grief. So what happens when the therapist dies, ending an intimate yet deeply private relationship? I expect, and fear, my grief may be very much the same.
I am scared that I will be relegated to role of just a client – cutoff from those who know her publicly, unable to offer support, mourning in the shadows. I want to support her for even a fraction of the way she has supported me. I’m just not sure what that “support” will look like, how it will manifest, if there is room or space for that wish to help.
So at this unexpected and deeply scary and saddening cross-roads, I am committed to being brave and strong, for me and for her. I know (because she has told me) that the boundaries are changing. There are some things that cannot be brought into the therapy room. I am going to have to process my anger and grief at her and her illness and her finite capacities elsewhere.
For now all I can do is take stock of where I am in the present. I must figure out what I had hoped to learn or extract from her and our work together, and try to determine what’s still possible and what’s not. I know I can do this on my own, but the journey will be much lonelier without her by my side.
I’m trying not to rush to a fatal conclusion but I am being realistic. If this turns out to be something other than cancer or a manageable/treatable cancer (or other illness), I hope we will pick up where we left off, both having grown from staring the prospect of death in its face. And if this is the end, I don’t want to be caught off guard, with an empty basin. But I can’t contemplate that quite yet, can’t begin to think of the hole that would be left in my heart, in my life. So I’m going to slow it down and try to make what I have in the tank last as long as I can.
No way construction of this tricky plan
Was built by other than a greater hand
With a love that passes all out understanding
Watching closely over the journey
Yeah but what it takes to cross the great divide
Seems more than all the courage I can muster up inside
Although we get to have some answers when we reach the other side
The prize is always worth the rocky ride
But the wood is tired and the wood is old
And we’ll make it fine if the weather holds
But if the weather holds we’ll have missed the point
That’s where I need to go
~ Emily Saliers, the Indigo Girls, “The Wood Song”
If you want to learn more about my journey of having a therapist with cancer, keep reading…