The Plan

(or How to Call a Minga)

I have something I want to say to all the therapists out there, novice and experienced alike.  Perhaps this message will fall on deaf ears and go unheeded, much less unread.  But I still feel the need to put it out there, just in case someone is listening.

So here’s the thing: you have to have a plan.

I know it’s easier to think that you are the omnipotent being you undoubtedly project onto your clients. But I’m here to remind you that you are not.  And that while you may try to promise your clients (and probably yourself) that “you’re not going anywhere,” life happens and you need a plan for when it all goes careening off the rails.  You are not immune just because you are a therapist.  And I would argue that you have a responsibility, a moral and ethical imperative set higher than many other professions, because of the work that you choose to do.  If this seems like too much to reconcile, I would ask that you give serious thought to your current career path.

I’m not saying that this will be easy (it won’t) or pleasant (it won’t) but it must be done.  Make a plan.  Not a theoretical hypothetical plan.  An actual plan based on real-world scenarios.  What happens if you get sick?  What if the illness forces you to go on short-term disability?  Long-term disability?  What if you need to retire (for whatever reason)?  What if you burnout?  What if your kids get sick or your parents need care?  What happens if you die?  Immediately or after a long illness?

Then what?  You have to think about this.

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First Impressions

(or I’m in Therapist Limbo)

Over the last few weeks I’ve been therapist shopping – never an easy or pleasant task.  Many of the therapists I’ve seen have no online presence at all – no website or Psychology Today profile, certainly not a blog or Twitter feed.  So I go into each appointment blind, not sure of what I am going to find, having to rely just on faith of the referrer who provided the name and contact details.  Suffice to say that connection has been elusive.  This is a hard enough task under normal circumstances, made even harder by my particular circumstances.

You see, I don’t even know if I want to be in therapy right now, as much as I might need it.  One therapist remarked to me that I have to find the will to be in therapy, that she couldn’t provide the will for the both of us.  Fair enough – but truthfully I don’t know that I have the will or energy to start this process over again.  I thought I had found the right therapist for me.  I didn’t think I would ever have to start back at the beginning.  I never thought I’d find myself sitting in strange offices across from complete strangers, re-telling my sad little tale.  I thought that part of the therapeutic journey was long behind me.

And although I always feared it, I never fully considered the possibility that my therapist (or I should say ex-therapist?), with whom I had connected and bonded and attached to, would become so ill as to not be able to work anymore or, worse, circumstances would so dramatically change as to preclude us from continuing our work together.

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Lost

(or My Therapist Broke Up With Me Via Email)

After 263 sessions, it all ends with an email.

I guess I got my wish after all, my worst fears realized.  I also got the answer to my question: “Can a therapeutic alliance survive cancer?”  Apparently, no.

I think the fairest and most responsible thing I can do is entrust you into the hands of a therapist who has the capacity to supply an appropriate level of care for you. 

This is going to take too long, it’s simply not fair to you, and ultimately even if/when I do “come back” I won’t be able to give you the frequency or regularity of care you deserve. 

I know this email was written from a place of love, but it was actually quite a cruel message to have to read, and process, all alone.  There was a crassness in her tone, her usual supportive empathic voice missing (not necessarily in the above passages, but in the email as a whole).  In the end, it felt like a kindly worded “fuck off,” but a fuck-off nonetheless.

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Real

(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.

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Holiday Wish

(or Guilt in a Box)

A few weeks ago a colleague asked me “How was your Thanksgiving?”  I replied by letting out an audible groan, to which he laughed and replied “You are the first person to respond that way.”  And in that moment I realized that not everyone sees the holidays as a detonated minefield ready to explode.

For me, the holidays highlight loss.  I become acutely aware of what I’ve had to sever in order to stay true to myself.  I have a heightened sensitivity to people who are no longer in my life – either by death or estrangement.  I look wistfully at friends and neighbors, who seem surrounded by family and who never have to contemplate the question of where or how to spend the holidays.  Of course they will be with family, of course everyone will get together to celebrate.  I live in hope that we will find a “chosen” family of our own, but it never seems like there is anyone around us who is also family-less.

And yet, I find myself trapped in the traditions of my childhood, unable to completely let go and forge a new set of traditions for my family.  The past is hard enough to shake free from, under normal circumstances.

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Out of Control

(or More Tantrums Required?)

Our 4 year old is currently in a battle for control, or lack thereof really.  He will launch into these emotional tantrums and irrational tirades, seemingly over nothing at all.  Or perhaps they are over everything.

Which is how we found ourselves at the beach at few months ago, on a mid-September day, with our son in his pajamas.  When he has these fits, if we can even figure out what he is upset about, we do our best to concede some point or decision to him.  The director of a local preschool advised parents not to fight their children on what they wear to school.  She even suggested that if they want to show up naked, that was perfectly fine – and that after that one time, they wouldn’t try that antic again.  I’m not sure I support the peer shaming of preschoolers to get them to conform to societal norms, so I’m okay with most things as long as there is no inherent danger present, physical or emotional.  Pajamas on the beach seemed to pass that test.

Since it was mid-September, we were just planning on sitting on the beach.  It was a clear, sunny day, but not the beach weather of the height of the summer.  We had left behind our beach umbrella, our sand toys, even our swimsuits.  But sure enough, our son in his pajamas wanted to go into the water.  I said we could go dip our toes in the water, certain that it would be too cold for much else.

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Raw

(or In Session, with Cancer)

The long-awaited text had finally arrived.  “Can you do Tues at 1:00?”

The text had been sitting on my phone for more than two hours before I saw it.  I stared at it for several minutes, trying to make sense of what I was reading, trying to get my brain to take in what this really meant.  I checked my calendar, then responded “Sure.”  It was the only answer I could give that captured my mixed-up feelings of anticipation and dread.  I wasn’t feeling a “yes” or “absolutely” or “I’ll be there.”  I definitely wasn’t feeling anything punctuated with an exclamation point.

I had been waiting for weeks for this moment to occur.  Of course I would be happy and relieved to see my therapist, but I was also feeling anxious and sad and scared and overwhelmed.  I hate it that our relationship has to be confined to the four walls of her office.  And that the only way I get to make physical contact with her is in that space.

About 30 minutes before I needed to leave for my session, a headache emerged.  My entire head hurt, as if some invisible and unrelenting force was pushing down squarely on the top of my head, but also down the back near my neck and towards my forehead.  I probably should have taken something before I left my office,  but I was hoping it would pass.  On the subway ride downtown, the pain intensified, my head hurting more with each jerk of the train.  By the time I arrived, I was in full-on headache mode.  Not the best way to arrive at a long over-due therapy session.

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