(or Questioning Everything I Once Held to Be True About the Therapeutic Alliance)
“What is REAL?” asked the Rabbit one day, when they were lying side by side near the nursery fender, before Nana came to tidy the room. “Does it mean having things that buzz inside you and a stick-out-handle?”
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.”
“Does it hurt?” asked the Rabbit.
“Sometimes,” said the Skin Horse, for he was always truthful.
~ Margery Williams, The Velveteen Rabbit
There have been several occasions when I have had to remind my therapist that therapy isn’t real. She always takes offense at my insistence that therapy is actually an alternate, concocted, manufactured universe that doesn’t even come close to approximating reality. If all the people in my life were as compassionate and empathic and understanding and able to listen and willing to negotiate and able to engage in conflict and open to change, not to mention be completely focused on me, as my therapist is, then I wouldn’t have a need for therapy!
I know that therapy is meant to be a petri-dish, where you get to test and experiment and fail in safety with a dedicated guide and cheerleader right there by your side. It’s a chance for a dress-rehearsal, to try things out before you have to do something out there, in the real world. But it is an artificial construct, with carefully appointed boundaries and roles and responsibilities. The real world doesn’t work in the same way. I wish it did, but sadly, it doesn’t.
I also know that what my therapist is really reacting to is my suggestion that the relationship between us isn’t real. She will counter that the relationship we have is indeed very real, and intimate and loving and supportive and everything you’d hope to find in another person you can relate to.
Sometimes in the past I had allowed myself to believe this, to be pulled into the notion that what we had between us was more than a business transaction.
I’m starting to doubt that now. The reality is that the therapist is providing a service, for which you, the client pays a fee. This is their job, and while it may be a very fulfilling profession, it must never be confused with any other mutually-beneficial relationships. You know, the real ones out in the real world.
If I were to suddenly fall ill, I would be able to walk away from my job without a hesitation or a look back. Someone else would pick up my work, things would get done. The transition might be bumpy, some things might fall through the cracks, but nothing would come to a screeching halt. I had the luxury of taking two maternity leaves, and I was struck both times by how quickly I fell out of the loop and off the email chains. Both times I was welcomed back with open arms, and my teammates were happy to be at full-strength again, but I often fear that I am more easily replaced that I would like to think.
Therapy doesn’t work that way. When a therapist gets ill or suddenly has to close up shop, work does come to a screeching halt. The therapist’s absence is acutely noticed, she is not so easily replaced.
I’m in quite a conundrum as to what to do in this space. I have contacted another therapist, a close associate of my current therapist. And while this temporary-therapist has a relationship with my out-of-commission-therapist, she is still a stranger to me – and has absolutely no online presence so she really is a “blank slate.”
I struggle with how much to reveal, how far to let her in. I don’t know how long we will be working together – a few weeks, a few months, more? I don’t know if this is just a transitory relationship and if I’m just asking her to hold me over until my therapist is back. I don’t know if I’m asking to transition to her, in case my therapist never comes back or determines we aren’t able or shouldn’t resume our work together. I don’t know if I’m asking for help leaving my therapist, either by choice or circumstance, and actually transition to another to-be-identified provider. I just don’t know.
I sensed that the temporary-therapist was just as unsure of what to do or make of me. She knows I want my therapist back, and that she is a second-rate stand-in, bound to disappoint.
In our first meeting, I shared my worries that I may have formed an unhealthy attachment to my therapist. The temporary-therapist tried to assure me that the relationship I described sounded well within the bounds of a secure therapeutic attachment and that the feelings I am experiencing are because I’m not ready to leave yet. I need to stay attached because there is more work to do. But what if that work is not able to resume?
This wariness of the attachment and connection is nothing new, and something I’ve struggled to trust from the very beginning. From a conversation nearly 3 years ago:
Me: There’s a part of me that’s scared to attach to you. I want to be with you and in your company, I want to be attached and connected, but I know where this relationship is going. There is a goodbye somewhere down the road that frightens and saddens me. It’s like dating someone you know that you can never marry. You are going to have to break-up at some time.
My therapist: Really? I’ve never broken up with my analyst. Nor he with me. I never wanted or needed to. I suppose one of us will pass away one day – hopefully me first since I am significantly older. And maybe, if you do decide to go some time – it will be a graduation and not a break up at all.
Me: Are we starting to break up?
My therapist: Nope. Not even a possibility on my end anyway. My door will always be open. Always. As long as I have a door.
I think that felt relieving at the time, because I couldn’t fathom the possibility of there ever not being a door.
This isn’t the first time we’ve had a medical crisis interrupt our work, but in the past it was other people’s medical issues that pulled on my therapist’s energies. But the fears emerged then, in many of the same ways:
I’m sure that I sensed your energy depletion and was worried that you might not have room for me. That the other things going on in your life were going to overwhelm you and that would leave me hanging. Not because you didn’t want to make room for me but that you couldn’t.
It feels unsettling to be in a relationship predicated upon my need and dependency for you, which goes completely un-reciprocated. You may like me, you may even have genuine affection for me, but you don’t need or depend on me. I would feel utterly lost if you disappeared tomorrow.
So what if the door ceases to exist? I don’t know if I can do this again. I don’t know if I can make myself as vulnerable as I have with my current therapist. She is one of the very few people who I trust on this planet, I have let her into places very few others have been allowed to tread. It’s heart-breaking for me to consider that I may have been foolish to place my trust and my vulnerable humanity in a relationship that wasn’t all that real to begin with, one that can so easily be cast aside. I guess that’s the risk you take in any business transaction. Maybe my downfall was losing sight of the fact that it’s not personal, it’s just business.
I was quickly reminded of this reality when I made initial contact with this temporary-therapist. After establishing my reason for reaching out, and finding a time to meet, the next issue to tackle was, of course, the fee. How could I forget? This support is not offered for free, out of the goodness or kindness of one’s heart. Not even when your therapist has cancer.
This sudden rupture has given me great insight into what it’s like to try to provide uni-directional care and concern, and why the therapeutic relationship is so unique because of the very frame that defines it – the focus on the client, the role of the fee, all of the things that enable it to be all about just one person. When other relationships are one-way, the relationship doesn’t last very long. When it’s all about one person, the other doesn’t hang around. When my expressions of care and concern go unacknowledged, not to mention unmatched, it feels like an unwise expenditure of energies and I find myself retreating, reallocating. It’s very hard to try to care about someone and not get any care back in return.
My therapist once asked, “Do you experience the psychotherapeutic frame as evidence that I don’t care for you?” I think that’s sometimes the case. There is a fear that she only cares about me in the confines of a well-defined therapeutic relationship. The relationship can’t exist without the frame, and yet it’s sometimes what makes me most question the authenticity, the realness.
The temporary-therapist summed it up as this: “It sounds like it’s hard for you to believe that someone could care about you that deeply.” Yes, that sounds about right too, both in general and more specifically, this one relationship.
This therapeutic break is particularly agonizing because I have no idea when or if it will end. Long breaks before always had an ending, I could always get through with a mental countdown. But not this time. There is no timeline. There is not even a guarantee that we will each resume our respective places, physically, emotionally.
Every time my therapist talks about how cancer is changing her outlook and how it may change her practice – her work values, professional identity, fees, frame, availability – my heart sinks further. I desperately want an assurance that there will still be room for me, in this altered future, if and when she returns to work. She doesn’t have room for me now, and I get that, as much as it hurts and feels rejecting.
I keep having this image from the end of the movie E.T., when the little boy Elliott starts to fall ill as E.T. is dying. I feel a part of my soul fading away. It’s physical too. There have been several days over the past few weeks when I had little appetite and a lot of gastrointestinal discomfort and I generally felt like a ball of nervous energy with nowhere to discharge. And then my therapist shares an update of her own physical symptoms from the chemo and the timing always seems uncanny. Is it just a coincidence, or does our connection extend to the physical realm too?
Sometimes I just try to disconnect, cold turkey. But it usually leaves me starving and jittery, as is often the case when a gradual taper isn’t available. I just haven’t figured out how to stay connected, in a way that doesn’t feel intrusive or burdening, but that alleviates some of my own fears and needs. Silence sometimes feels like the only option.
My silences in session can be unnerving to clinicians who don’t know me very well (like the temporary-therapist, for example).
What do the silences mean? Usually that I’m just trying to process my experience, my feelings, in that moment and in a broader context too. Often that I’m trying to find the words, to match the thoughts going at warp-speed in my brain. And if I do find the words, then I have the challenge to connect my brain to my mouth, form the words on my lips and get it out. Sometimes it’s because I’m overwhelmed with feeling – too angry, too conflicted, too scared – and a retreat to the safety of silence seems like the best option.
My therapist understands my silences. She knows when to pry and when to let me be. She knows when to launch into a story of her own, giving me a momentary reprieve from talking, and when to stay silent and wait to see if anything shifts. It wasn’t always this way. She had to learn the nuances.
It’s not like we sit together in complete silence. She always talks. Sometimes I join her – when I find the words, when I’m ready to, every so gingerly, trust the connection.
And I felt this too, years ago, but the words still resonate: I’m starting to question whether I am cut out for this journey. But it’s too late to turn back now. I’m too far from shore, yet can’t see the destination either. I feel like a little boat without a compass, being bantered about in the ocean by forces unseen, no shore in sight. I don’t know quite where I am going, or how long it will take. And I just hope I don’t drown in the process.
I feel her slipping away. I miss the contact, the interaction, the connection. I miss being able to tell her things going on in my life. I miss the lifeline. Real or not.