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Archive for the ‘vulnerability’ Category

All of us struggle with our sense of reality. Sometimes we cannot quite “see” what’s really happening. Other times we don’t question what we see so much as our ability to respond well to it.

In any case, a little thought clearly leads to the fact that our sense of our reality – encompassing both ourselves and what is around us – is something distinct from the reality itself. Unfortunately, it’s just not always easy to get a good sense of what’s really happening.

Consider for a moment, if this line of thought is a little murky for you, that all of science is simply an effort to address this problem – to get a better sense in our minds of what’s really happening “out there”. Science is hard work, which leads me to conclude that the problem it addresses is often not easily resolved.

I find that my own personal sense of reality and myself is subject to many distortions. Rarely do these mental errors help me live better, feel better, or like myself more, in the long run. In fact, such mental errors can often lead to short-term disaster!

In a recent email to a client, I addressed this issue, asking what they needed to remember about themselves and their situation in order to limit such mental distortions as much as possible.  I then offered the following ideas which I personally have found it very useful to remember.

  • I care about the people in my life, and this is good for me and them.
  • I can interact with them in ways that add value to their lives and mine.
  • Direct control of my feelings is not possible (because feelings are an automatic brain response), but indirect control, through attending my physical health, my thoughts, and where I choose to direct my attention, is actually easy, and usually has a powerful effect.
  • There are many aspects of my present situation which are evidence of great good fortune in my life. I am foolish to allow my attention to dwell too long on misfortunes which come my way, unless it is to learn something useful to carry forward in my life.
  • Investing a small amount of time in experiencing and expressing gratitude for what I have can lead to immediate substantial gains in the quality of my state of mind.
  • Progress in any area of my life is almost always possible, if I’m willing to accept the fact of my having limited power and knowledge. It can be difficult to be a mere human being, with all the limitations inherent in this status, but acceptance of my limitations can free me to work at reducing them, through patient, focused effort.
  • Good mental health is strikingly like good physical health: it usually doesn’t just happen, but rather results from intelligent, directed, repeated efforts. Children usually see and react; adults see, then plan, then act. They get better results. It’s better to be an adult.

To get these statements, I just asked myself what is true about my situation in life, and what I need to remember, given these descriptive truths, in order to function well. The set of “reminders” above are the result. They are not a final set, to be sure, but I note that just reading them improves my state of mind.

So…the question NOW is simply…what do YOU need to remember, about yourself and your life, to function well? I’ll predict that time spent with this question will be rewarding for you. I’d be interested to know what you discover…

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I’ve just fielded a question on the Talk page of the Wikipedia article on PTSD. It’s a good question (a couple, actually), and my answer might be useful to repeat here. The visitor asks why the article says this:

“Children may develop PTSD symptoms by experiencing bullying or sexually traumatic events like age-inappropriate sexual experiences.”

The concern is the reference to “age-inappropriate sexual experiences” rather than “rape”.  “Why does it say that instead of simply rape?  The Webster dictionary defines rape is having sex with who is below a certain age [http://www.merriam-webster.com/dictionary/rape%5B3%5D].  And what does age-inappropriate mean?  Would it be less dramatic if the person was their own age, instead of significantly older?”

My response (edited very modestly, for this venue):

I don’t have time to provide you with the reference citations which I’d like to offer, in responding to your questions, but  will respond using the knowledge I’ve acquired from many trustworthy sources in over 30 years of work in clinical and research psychotherapy, involving adults, adolescents, and children, many of whom had experienced what we call age-inappropriate sexual activity, often with negative consequences. I hope you’ll forgive my not backing up what I say with proper sourcing.

First, your questions are excellent ones. Please understand that casual language is often sloppy, and this won’t help us here. What the law, or the dictionary, defines as rape may well be different in important ways from a medical or psychological definition. The dictionary you cite appears to be giving a pseudo-legal definition. There is no “right” definition. Linguists write definitions (and dictionaries which contain them) on the basis of how people USE words. Philosophers and other thinkers are free, of course, to ”stipulate” definitions, as well. In formal, thoughtful writing, we usually stipulate definitions so that they help us with our thinking. They become tools, used to accomplish goals. That’s why legal people see “rape” differently than, say, anthropologists, or therapists. And note that even in groups of professionals in the same field, definitions can differ significantly.

So, let me begin by saying simply that from my perspective rape is always inappropriate (!), and is AGE-inappropriate when it involves a sexually immature individual. Note that physiological sexual maturity bares only a loose relationship to legal sexual maturity, and for good reasons (which I won’t take up here). If only some rape is ”age-appropriate”, as opposed to simply ”inappropriate”, it is also true that not all age-inappropriate sexual behavior is rape – which I think should be obvious, upon a little reflection. Inappropriate touching, for example, isn’t necessarily rape.

Age-inappropriate sexual experiences, in psychology/psychotherapy are those generally seen as those which involve an individual doing something sexual which is clearly not usual or expected for their age. This can be tricky to distinguish, however. Clearly, many, if not all, infants and children explore their sexual organs, and each others’, as well. This is normal, and generally harmless. At what point is something age-inappropriate occurring? There is no clear dividing line. It not dissimilar to the problem of distinguishing pornographic literature from erotic literature. I can offer no easy solutions to these problems.

That said, the key concept here is that sexual experiences involving children/adolescents who are not sexually mature ”can” have immediate and/or delayed long-term negative consequences. This is clearly cause for concern. It is very important to note that not only are not all sexual experiences children have inappropriate, not all of them cause any problem at all. Event consequences are driven by the degree of involvement, the nature of the act, whether or not there was coercion, how the child felt about it at the time, the reaction of adults who came to learn of the event, and so on. Many factors influence the consequences of a sexual experience involving a child.

We should never simply stipulate that something MUST be a problem (although this is commonly done in courtrooms). Rather, when we let the individual involved tell us of their experience and what it means to them, then we can know the real psychological consequences.

Well-meaning people can create a problem where none existed, with a child. Some individuals come through quite serious experiences with very little if any damage. Others are greatly hurt by what appear to be modest experiences. And, regardless of the consequences, those of us who come to learn of a given experience may have good cause for concern. It would be nice if we could view all this in simple terms, but I don’t think that would be accurate, useful, or intelligent.

Among the problematic consequences of age-inappropriate sexual behavior which we deal with in clinical psychotherapy are these:

* Lose of a child’s sense of safety: Loss of control over what’s done with your body is at the least unpleasant, and at worst traumatic. It may be difficult to feel safe in the world for some time after such an event.
* Loss of trust of key individuals in a child’s life: A sexually inappropriate relative becomes an untrustworthy relative. Children need families they can trust. A sexual abuse incident is one way to lose a functional relationship with a sibling, or a parent, or a grandparent. This can have long term consequences.
* Outright psychological trauma: When there substantial levels of fear involved, and the child is unable to resolve these feelings. enduring trauma may result. This is how once acquires PTSD.
* Premature sexualization of the child: This is the problem non-professionals usually forget or ignore or have no awareness of. Children introduced to sexual experiences before they are ready or desirous of them, may come to think that sex is a part of emotional intimacy. This may lead them to be sexual with other children, or other adults, in unwanted and unacceptable ways, and in ways that can damage others as well. I once knew a very pretty, charming 10 year old girl who had been removed from a succession of foster homes because she couldn’t keep her hands where they belonged. She had been “prematurely sexualized”. She thought what she was doing was OK, and her behavior led to repeated social rejection. This sort of thing is far more common than most people realize, and definitely one of the reasons why we’re concerned about age-inappropriate sexual behavior. It can lead to an child’s experiencing themselves as unacceptable to others in general, which can lead to depression, self-medication with various psychotropic substances, and other long-term damaging consequences.
* Disturbance to individuals associated with the child: Even when inappropriate sexual experiences are not a problem for a child, they can be for others. I dealt with a 9 year old boy once whose parents were quite upset because his female babysitter (age 13 – and not a relative) had climbed into bed with him late at night. They couldn’t imagine that he wasn’t somehow injured by this experience – clearly (one would think!) age-inappropriate sexual behavior. It turned out that he was only annoyed. He couldn’t make sense of what she was doing, and got up, went downstairs, and slept on the family sofa. Problem solved. All I had to do was calm down the parents, so they wouldn’t continue to disturb their son.

This is not intended to be a complete list, but I do believe it addresses most major issues.

Relative to a hypothetical age-inappropriate sexual experience, you ask “Would it be less dramatic if the person was their own age, instead of  significantly older?” It could well be, although “drama” is not the issue, as I’m sure you realize. The problem with older individuals is their misbehavior can lead to a needless and inappropriate distrust of all older people. Also, older individuals are likely to initiate more mature (and thus age-inappropriate) activities with younger individuals. At the same time one must note that in most cultures it is deemed appropriate for young, sexually mature hetersexuals to pair off such that the male is older than the female – one major research effort determined that the age difference deemed ideal by many cultures was about 3.5 years (with the male being older).

I will conclude my remarks by saying that I’m concerned about the tendency in some families, communities, and schools, to pathologize the normal. Two six year old girls simulating intercourse, because they are curious and cannot make sense of why adults would do this, do not really need a semi-hysterical, or punitive, or any other negative reaction from adults. I could cite other cases, many of them not so easy to think about…and that’s my point. A thoughtful examination of an event is a far wiser response than is a knee-jerk negative reaction of any kind. I prefer to act from knowledge rather than pre-drawn conclusions based on some principle rather than good data. It think that we don’t yet have all the knowledge about age-inappropriate sexual experiences that we’d like to have. The situation is clearly better than it has been in the past, without doubt, but we’re not finished out work, so to speak.

I hope my responses are useful to you. Thanks for your great questions!

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I’ve been a vegetarian (meat – no, eggs and cheese – yes) for over 35 years, for well thought out moral, environmental, and health reasons. I very rarely talk about it. I basically do not proselytize on this subject. That changes, now, and here. I’m going to talk about it, and I want you to think about it. Suddenly, it matters, as you’ll see.

EATING AS A MENTAL HEALTH ISSUE?

A long time ago, someone who’d been born into luxury and comfort and safety discovered that no one can really escape the fact that life hurts. All of us come to sickness, pain, loss, and death. Or, as it is said that he put it: All of us come to unavoidable suffering. (This person, of course, was Siddhārtha Gautama, more commonly known as “the Buddha“, this being an honorific term translating approximately as “sage”, “wise one”, “enlightened one”.

One of the more interesting things about the Buddhist moral tradition is its concern for the suffering of all beings. In our own time, formal mental health intervention is one of the ways we deal with human suffering, along with medical/surgical interventions, etc. At various times, the tide of human suffering has advanced and retreated. It’s about to advance, again, it appears, and what we eat has something to do with this, as you’ll see.

CLIMATE CHANGE AND STRESS

The fast-approaching climate change crisis has already begun affecting people in the lowlands of Bangladesh and some of the island nations of Polynesia, due to threatened and actual rises in sea levels, and increased frequency of typhoons (we call them hurricanes in the USA).

Imagine the impact on your life if rising water chased you permanently from your home, without hope of return in your lifetime or that of your children. You’ll become a climate change refugee. Where will you go? What will happen to your way of life, to the hopes you had for your children?

At the purely human level, this is about exorbitant levels of stress. In sociology, it is well known that in stress-impacted families domestic violence rates go up, sexual abuse rates go up, divorce rates go up, mental illness rates go up. and so on. That’s quite an impact for something that can be traced to small changes in the percentages of certain gases in our planet’s atmosphere.

Now imagine that this mental health challenge is quite significantly related to what you eat, daily. As it turns out, this is true. It’s highly likely that the oceans will rise around four feet in the next century. That will impact coastlines all over the world, because it’s on coastlines where most of the world’s population lives. The impact of storms will be very much increased.

In the USA, large areas of Florida may become to dangerous to live in. New Orleans, Washington DC, New York City, and other major population centers will become at high risk for catastrophic storm damage. Many parts of the world, including in our own country, will have to deal with millions of climate change refugees.

A one meter rise (four feet) in ocean level is estimated to probably create 20 MILLION climate change refugees in Bangladesh. Where will they go?

THE RELATIONSHIP BETWEEN WHAT WE EAT AND CLIMATE CHANGE

Now, let’s talk about what we eat. To put it plainly, what you choose to eat can have a huge impact on the mental health of others (as well as your own health), through the mediating factor of climate change. I want you to understand the relationship better.

Here is an article in which a British Lord, a well-informed, well-placed fellow, says some things to say about the relation between industrial meat production and climate change, something about which we’re going to be hearing much more in the near future.

The point he makes is that among the lifestyle changes we need to seriously consider are some that have nothing directly to do with fossil fuel consumption. With industrial meat and milk production, methane gas is the problem, not carbon dioxide. (This is more generally known as “natural gas” – yeah, the stuff people can cook and heat with.)

This aspect of the climate change crisis – the methane produced by the meat/dairy industry – is not well known…yet. I’ve know about it for about a year.

METHANE IS NOT YOUR FRIEND!

Here are some basic facts you should know about methane as it relates to climate change, with some quality documentation:

  • Methane is lighter than air, and is naturally produced in a variety of ways, including the decay of organic matter in low- or no-oxygen environments. One of those environments is the digestive tracts of rumiant animals (cattle, etc.) Such animals produce “16% of the world’s annual methane emissions to the atmosphere”, [1]
  • “The livestock sector in general (primarily cattle, chickens, and pigs) produces 37% of all human-induced methane”. [2] (quoted in [1])
  • “Methane is a relatively potent greenhouse gas with a high global warming potential… Methane in the atmosphere is eventually oxidized, producing carbon dioxide and water. As a result, methane in the atmosphere has a half life of seven years.” [1] (The core reference used here is [3])

OTHERS DIE SO THAT YOU CAN EAT AS YOU LIKE

An additional aspect of this mess, which is worth mentioning, is that to produce one pound of edible protein from a cow, that cow must consume 22 to 26 pounds of vegetable matter. Feed that matter (or similar crops more suitable for human consumption) directly to people, and you can feed roughly 20 people instead of one. [4] Now you know one of the two reasons I stopped eating meat over 30 years ago.

This doesn’t matter, of course, if you think that the death of a little brown/black kid from nutritional inadequacy (it sounds so benign, yes?) doesn’t matter as much as the death of a little white child. Most people don’t have to think about this, of course, thanks to the blessings of the “out of sight, out of mind” phenomenon.

But…I’m asking you to think about it. At some point the relationship will become unavoidably obvious. Imagine the impact on your mental health if you have someday to realize that you could have done something about this problem, personally, but just walked on past the opportunity, as if it didn’t matter.

START SMALL…KEEP GOING

A final thought: It doesn’t have to be either/or. Simply reducing the amount of meat you eat will be helpful. You can walk slowly toward omitting it entirely from your diet. And you should know this: the concern expressed in Lappe’s book [4] for correct mixing of vegetable proteins to simulate meat protein turns out to be unnecessary. I gave that up a long time ago, and just eat a variety of vegetarian protein sources. My health is,  and has been, excellent. Dr. Andrew Weil confirms the legitimacy of this more relaxed view of the protein sufficiency of vegetarian diets. [5]

It’s easier than you think to do the right thing – for the health of your body, for your eventual mental health, and for the mental health of large numbers of people you’ll never meet. You can do this simple think yourself, and tell others about it. You might even send them here to read this.

References

[1] “Methane” (Wikipedia article). Downloaded 2009.10.26 from http://en.wikipedia.org/w/index.php?title=Methane&oldid=322309918 – mostly a chemistry article, but with some good summaries and references relevant to the industrial meat/methane issue.

[2] Livestock’s long shadow: environmental issues and options. Food and Agriculture Oorganization of the United Nations
Rome, 2006. Downloaded 2009.10.26 from http://www.fao.org/docrep/010/a0701e/a0701e00.HTM A PDF download version of this is available here: ftp://ftp.fao.org/docrep/fao/010/a0701e/A0701E.pdf (for broadband use only – it’s a large file).

[3] Chapter 2 of: Climate Change 2007: The Physical Science Basis. Contribution of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. This is a section of the most recent publication of the Intergovernmental Panel on Climate Change of the United Nations Environment Program (UNEP) and the World Meteorological Organization (WMO). This group of 500+ scientists of international stature was established “… to provide the world with a clear scientific view on the current state of climate change and its potential environmental and socio-economic consequences.” (http://www.ipcc.ch/organization/organization.htm)

[4] Frances Moore Lappe. (1991). Diet for a Small Planet. New York: Ballentine. This is the book, originally published in 1971, which turned me into a vegetarian. I bought a copy on the way out of town, leaving the University of Colorado with a fellow graduate student to go deer hunting in Montana. I went along as a  “participant-observer”. I helped skin and dress 5 deer. The amount of sheer wastage we produced was staggering to me. I had no idea meat production involved such waste, and this was only in the butchering part of the process. It was an incandescent experience. The book gave me the rationale for my diet-change, but this experience gave me a good part of the motivation. I’ve never looked back, in 35+ years. What’s to miss?

[5] Weil, Andrew. (2001). Eating Well For Optimum Health: The Essential Guide to Bringing Health and Pleasure Back to Eating. New York: Harper.

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[ Psychotherapy may end, but the popularity of this topic may well not. There’s a follow-up to this post, which you may wish to read: Leaving therapy – so what’s the problem? (2009.01.15) ]

Everything ends eventually, including psychotherapy. A grace-full, well managed ending is ideal, but, in reality, ending psychotherapy – leaving a psychotherapy relationship – is a problem for some individuals. Mental health professionals would do well to acknowledge this more often, and respond with some specific suggestions for our clients, before they start wondering whether it’s time to stop, and then how to do it.

PSYCHOTHERAPY AS AN INTIMATE RELATIONSHIP

Intimacy takes many forms. Most intimacy in life is familial. Some occurs in the context of friendship. And some occurs in psychotherapy. In all cases, it is true that intimates know things about each other not generally known by other people in their life.

Intimacy is not always between peers. We may know significant details of the life of our First Family (President, etc.). It’s unlikely that they know anything of us, as individuals. Mothers know more about their children than the children know of them. Psychotherapy relationships are similarly unequal, for in them therapists know more about their clients than clients about therapists.

INTIMACY AND VULNERABILITY

Intimate knowledge creates vulnerability. Where intimate knowledge is asymmetrical, vulnerability is also. Whoever is known most about is usually the vulnerable one, for multiple reasons. In psychotherapy, this vulnerable one is the client.

The specific vulnerability I want to address here has to do with the likelihood that leaving a psychotherapy relationship will be a distressing time for a client. I want to consider the possibility of reducing this distress.

WHY LEAVING PSYCHOTHERAPY CAN BE DIFFICULT FOR YOU

There are so many reasons why this may be so. Here a some of the reasons most immediately obvious to me:

  • You may never have done it before.
  • When the issue of leaving occurs to you, you may not feel finished with therapy.
  • Your therapist may not talked with you yet about leaving, at the time you begin thinking about it.
  • You may have real conflict about leaving.
  • You may not be the one who brings the issue up.
  • You may be aware that your therapist is more engaged in working with your problems than you are, and you don’t have any idea what to do about this.
  • You don’t want to hurt your therapist’s feelings.
  • You may have no idea how to justify your leaving.
  • Other people in your life who matter to you may want you to stay in therapy.

GETTING YOUR THINKING STRAIGHT ABOUT LEAVING

I want to take up here each of challenges I listed above, and possibly a few others that come up as I work things through.

You may never have done it before. First-time therapy clients have a lot of “firsts” to work through in therapy. Leaving is certainly one of them. If this is not your first therapy relationship you’re more likely to have some knowledge of the challenge of leaving, even if you don’t yet quite know how to do it well. If this is your first time leaving therapy, you really ought to talk about it with your therapist. They, after all, are not first-timers, relative to this issue, and just might be able to help you. If you find it a difficult topic to bring up, then the difficulty you’re experiencing needs to be the first thing you talk about. That difficulty may well be a legitimate “therapy issue”.

Your therapist may not talk with you about leaving before you begin to feel like the time is close. If we therapists don’t take up this problem and make sense of it, what chance do you have if doing it at all well? We’re interested in getting you into therapy, and keeping you there until we can get some real work done. And then what? We seem to have little to say about this.

When I brought up this topic to my very capable faculty adviser during my internship in graduate school, his reaction was that this concern was not for us to address. “The client determines when therapy ends”, he said. OK – there’s a very good idea in that sentence, but the problem remains. (And I suspect that if I’d asked the question better I’d have gotten a better answer!)

We have many ideas to offer you. How to leave therapy well seems not to be among them. I’ve never heard this issue seriously discussed in a professional context. We seem not to think about it. We should, because it’s too often a source of distress for our clients. As a client, you cannot fix this problem, but you can realize that part of the problem for you is that too often you’re on your own with the problem. You shouldn’t be, I think, but you usually are. There is a remedy for this, however, and it’s under your control.

You will probably not feel finished, when the issue of leaving comes up. It is rare for a person to have addressed all their problems when they leave therapy. There really isn’t a need to have done this. It’s better to take up focused issues, make progress (any progress at all is better than staying stuck), leave, and then return later if this seems called for. It is realistic to see life as a series of ongoing challenges – and to accept that you’re not going to run out of problems. Do you really think psychotherapy is going to fix this? I wish!

You may not be the one who brings the issue up. If you have to deal with “managed care”, or have a seriously limited budget, you know that external factors and people can have a real say about when therapy ends. Or…your therapist may be moving, or retiring, or going on vacation. Your situation then is one of feeling unfinished but having to leave anyway (see the paragraph above, concerning this). This can be difficult, but it can also be talked about, and learned from. See that this is how it gets handled in your case.

You may have real conflict about leaving – feeling like you want to leave AND you want to stay. This is very common, for many reasons. The best thing to do is to take up the matter of the conflict(s) you feel with your therapist (do you notice a theme in my remarks, here?). Such conflicts arise from the fact that our mind virtually always holds multiple points of view about critical issues. These conflicts are part of being human, so talk about it. It’ll help, and it’ll often work to actually resolve the conflict.

You may be aware that your therapist is more engaged in working with your problems than you are, and you don’t have any idea what to do about this. In a sense, this shouldn’t happen, but it often does, anyway. First of all, it’s probably generally true that your therapist experiences a degree of fascination with your problems – dealing with them is his/her chosen profession, after all. You, on the other hand feel something other than fascination, and in this there is an essential imbalance.

Nevertheless, the rule is that the client leads. We may invite you to go certain places, but when you indicate disinterest, that settles it. It’s YOUR opinion that counts. I hope your therapist doesn’t forget this, but if they do, you still shouldn’t. If your therapist appears to need to engage with your problems, they have matters to take up with their therapist. This kind of problem is actually common in psychotherapy. Freud talked about it, and we’ve been talking about it since then. What you should know is that it’s OUR problem, not yours.

Therapists are people, and they do have problems, at times, but that should not be your concern. In psychotherapy, you’re expected to be self-centered, and you should maintain this focus right on through the time of your leaving. Your therapist can take care of themselves. They have access to excellent resources for doing this.

You don’t want to hurt your therapist’s feelings. I see this issue come up most often with young women, who are often deeply in contact with their maternal side. Such instincts are one of the glories of humanity, but really don’t belong in the psychotherapy relationship. Your therapist does have feelings, and you likely will be missed. Your therapist also has experience with this problem, and can take care of themselves.

It’s good for you to notice that your therapist values you. You do have value, and we all need to know this. However, children leave home, clients leave therapy, and we all leave life, at some point. It’s the Way of Things. If this is a persisting problem for you, you owe it to yourself to bring this problem to therapy. Doing so is an excellent idea.

You may have no idea how to justify your leaving. Many people in therapy have a history of being disrespected, and thus have some trouble respecting themselves. They often feel defensive or in need of justification. Try to understand that this is a developmental problem which you don’t have to have, and really should not tolerate. If you DO have this problem, take it into your therapy as a topic.

The best reason to leave therapy is a very simple one: you want to. I teach assertion, and I’ll say it plainly: Your feelings are your best justification for anything. (You do well to see that your feelings are based on correct perceptions of course.) If you find this difficult, then you’ve just identified and area in which you need some work, and definitely some practice. Assertion skills definitely have to be practiced. I look for opportunities to practice mine. You should too.

Other people in your life who matter to you may want you to stay in therapy. Who? Parents, spouses, children, friends, employers…did I leave anyone out? While sometimes therapy may be mandated by a judge, in all other cases, it’s your call. People can have any opinion they want. It’s a free country. And you need to keep your own counsel. Participation is your decision. When someone else has feelings about your leaving therapy, take it up with them. Understand that THEY are having a problem. Talk with them to see what’s at the root of the problem (it’ll usually be some fear which isn’t well enough identified). This will help your relationship with them, and may even give you some useful information.

SOME THINGS I WANT YOU TO KNOW ABOUT LEAVING THERAPY

You may not be the only one distressed by the idea of your leaving. We often come to truly like and enjoy our clients. I know that in mine I virtually always see the essential problems of all of us as human beings. I usually develop a strong sense of compassion, and come to care significantly about each individual I work with. How can I look casually upon the prospect of coming to the end of our meetings? I don’t know how to do this, and I’m not sure I want to learn. So, that your distress is likely shared is a very good reason for taking up leaving as a topic, with your therapist. You both should talk about it with each other. Very often the problem is one of dealing with loss – and that’s a problem that challenges all of us, in various ways.

Some therapists are as puzzled by the “leaving” problem as you may be. Not all therapists grasp that clients will leave with some of the problems they brought into therapy. I can recall our being confronted with the necessary “unfinished client” problem, by one of our teachers in graduate school. I was already familiar with it, but some of my fellow students had not thought of it, and found it troubling. If your therapist has not grasped this reality, and the fact that it’s not necessarily a problem, you still can. You must, in fact, because everyone leaves unfinished. We’re all a work-in-progress. You think this is a problem? Wait until you face dying, unfinished! (You’ve been warned – so now you have some time to prepare for that one…)

Loss is one of the great themes of everyone’s life – you do well not to turn away from it. Some people, when the time comes, simply run from therapy. It’s the only way they can handle it, but it’s not a good response. Losing your therapist is but one of many losses you will have in your life. USE the experience to address the issue of loss and what it means to you and how you handle it. It’s an excellent chance to add to the benefit you get from your therapy.

Your therapy is about you and what’s good for you. This may seem obvious, yet concern for others and a desire to take care of others, sometimes in inappropriate ways, is common, especially in psychotherapy clients. Your therapist, if she/he has a lick of sense, has done psychotherapy work themselves, and has taken up the issue of loss in the course of that work. He/she comes to their work prepared to handle the eventual loss of clients. You don’t need to be worried or concerned about them. Your attention belongs on you.

You can come back. Surprise! This doesn’t occur to many people. You can think of leaving as an experiment. Do it and see how it goes for you. You can return, if you find that you’re not ready. I’ve had a number of clients return, virtually always for only a short period of additional work. Some have come back 2-3 times. One came back four, and the fourth time was the one where she really got down to work. I was thrilled, and I think she was as well. You can simply take things as they come, just like you have to do with the rest of your life.

SOME GOOD WAYS TO TALK ABOUT LEAVING THERAPY

I want to offer here some little “mini-scripts” which may help you deal with leaving.

(To your therapist) – “I’ve been thinking that I’m about finished with therapy. What do you think about that?”

(To anyone at all) – “I’m feeling about ready to leave therapy. It’s been a challenge/good experience/disappointment/real puzzle to me/a life changing experience (pick one or more). I’m ready for a rest.”

(To yourself) – “I feel about ready to stop. I want to respect that. I can come back if I want to, or go elsewhere, later. I will always have many options.”

(To your spouse) – “I’m graduating soon from therapy. I hope you’ve been keeping up, because your life is about to get really interesting!”

(To your therapist) – “Thanks for the challenges, for the patience, for information, for the compassions and caring. I’m not who I was when I came here. I know I’ll keep growing after I leave, and what’s happened here will help to make that good growth. I’m grateful. I hope you think of me from time to time. I know I’ll think of you. Maybe I’ll send you a postcard.” (I always like to hear these sorts of statements. Expressing gratitude is something I very much value. I will often express a lot of it back – I do admire the courage and humanity of my clients. I always am inspired by it. Rarely, I think, do they realize how much they enrich my life. I want them to have some small sense of that. And I always respond positively to the idea of that “postcard”.)

CONCLUSION

I wrote this originally in one sitting, while thinking particularly of one client of mine (who reported finding it useful), but always had in mind a more general problem, involving many more individuals. What I have written seems incomplete, and unfinished, and I hope to revisit the topic and revise it further, but for now it’s time to go. This, too, is a work in progress.

(revised 2008.06.03)

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