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Mona Ackerman

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Breaking Up With A Therapist Is Hard To Do

Posted: 06/19/08 10:01 AM ET

Q: My shrink just fired me! Can he do that?

I have been seeing my psychologist for about two years. I thought we were advancing well in therapy. I felt comfortable in his office. I was working through a lot of issues about my parents -- mostly anger, of course. I felt like I could tell him whatever I was thinking. There were times I disagreed with his analysis of a situation and told him so. But then I went on to interpret the situation in a way that was helpful to me. So I believed that it was a successful treatment. I thought that my comfort and my choices were the only ones that counted. Aren't I supposed to be able to act out in any way that I need? I didn't think my therapist needed to like me, I thought only I needed to like the therapist.

But, several months ago, I stormed out of the office and slammed the door. I didn't believe the therapist was listening to me and did not understand exactly what I was going through. When I returned the next week, the therapist wanted to show me how I overreacted to the situation. He also talked about my misinterpreting what he was saying or thinking. I, on the other hand, was hoping that the therapist would have realized that he indeed had not been empathic. So, I tried to show him what he had missed in the story I had told and that clearly he had not been listening to me then or indeed in many other previous sessions. In fact, he had even gotten one of the names wrong.

Even after I had made my case, the therapist would not concede the point and actually started talking about how he was distressed and angered. I couldn't believe it and told him so. The next couple of sessions did not involve the contentious topic. I thought he probably had just wanted to avoid the whole issue and not admit his fault in the blow-up. Avoidance is a mechanism he often accused me of when I didn't want to face my own mistakes or shame. So, I was sure he'd understand when he was doing something similar. After all, he is not infallible.

What we did talk about was what I had learned in therapy -- where I had started from, and where I had ended up. We came to the conclusion that I was certainly more independent than I had been when I started. I should have guessed that he was preparing me for a break-up. But I thought it was just his way of getting back to our sure footing in our therapeutic alliance. By accentuating the positive, we could both return to good feelings. I could accept, even though it was never again mentioned, his missteps and his lapses in attention. And he could accept that I have a tendency to blow up, but that it doesn't affect our relationship.

Boy was I wrong! Last week, I came in and he handed me a list of new therapists. He had even already spoken to them about me! He said our time was finished and that I should move on. When I protested, he firmly said all things must end. It was his decision as the therapist that the effectiveness of our sessions was over.

Frankly, I think he just didn't like to be confronted weekly with his incompetence.

A: Can he do it? Yes, he can!

I am often asked what I do if I don't like a patient. My answer is that usually likeability doesn't matter to me. I just focus on the reason for the therapy, the pain that the patient is in and my desire to help. But if there is some button that is being pushed in me -- what we therapists call counter-transference issues -- then I have to be both honest with myself (and fair to the patient) and refer the patient to someone else. Still, that doesn't ever take two years -- the time you were in therapy -- to come to that conclusion. But even if your therapist should have recognized the problem earlier, he still has the right to leave the relationship. One patient once told me how a therapist had told her after three sessions, if you don't start working and stop telling stories, you'll have to leave. So they agreed she should leave and she did.

Did your therapist want to avoid facing his own mistakes? That's not so clear and, anyway, it's not something we'll ever know. Of course, a therapist should be able to deal with a patient's anger. In fact, a good deal of the time, I am the repository of deep-seated and resentments and anger. I get abused. It hurts, but I take it. During training, in fact, we are told that if a patient makes your stomach churn and makes you feel bad about yourself, you're probably dealing with a borderline, a particularly difficult disorder. You can diagnose borderlines, but you still will have to deal with their anger -- and your distress.

The freedom to act almost any way you want with your therapist is critical. It is only through the ability to totally be yourself with your therapist that you learn about yourself. So, it is unclear if your therapist just felt you didn't trust him enough to listen to alternative explanations or if he just didn't want to take your anger anymore.

Did he terminate your therapy correctly? Yes and no. He did not end your sessions when you were in the middle of a crisis -- and he did prepare you for your next step in therapy, albeit not as well as he could have. Termination is the rather horrendous term of finishing a therapy. It should not be done abruptly. It is a process in itself and the patient should be aware of what's happening. In your case, you were oblivious to what your therapist intended. That, on occasion, two people don't mix well or that in order to move on you need to go to another therapist. Sometimes, if a patient has used me as a substitute parent, when they move on to adult issues about jobs or relationships, they may continue to want only unconditional support from me, not a clear and unbiased analysis of their response to a situation. A therapist should be able to take on several roles, but sometimes the patient only wants one.

Was your therapist justified in cutting you loose? Again, I cannot make a definitive statement, because it is not clear if the tension in your sessions was present from the start. What does seem evident is that your therapist felt that for some reason he could not get you to work through your anger or learn how to respond better to people so as to have better relationships. And yet, it does not appear that from your perspective that was one of the issues you wanted to work on. In fact, it seems that you feel that it is the responsibility of others to accept your explosive and probably impulsive nature. There is nothing necessarily wrong with that, and in fact if that is the case, your shrink should be adjusting to that and not requiring you to be aware of your overreaction or your misinterpretations. It is not the therapist's role to judge you or to mold you into some ideal of the perfect personality. If you are happy with who you are and you are not a danger to others, then it is not a topic for discussion.

If however, you have entered therapy to improve your quality of life, and your therapist sees that your interactions with others might be what distresses you, then hopefully, you will have both developed enough trust to deal with the issue -and work through your disagreements. It appears that in your case, this trust was never fully developed. Your therapist probably did not feel you ever listened to him. On your part, you seemed not to feel that his observations -- even though you might not have agreed with them -- were worthy of consideration. That hardly bodes well for a good therapeutic relationship. In fact, when my patients tell me they disagree with my interpretations, I remind them that I am the PhD, the doctor in the room. We all have a good laugh, but it does remind them that they have come to me for a reason. I might be wrong, but what I am saying deserves some thought on their part. This is not how you see your therapist.

But most importantly, is termination painful? YES!!!! It feels like abandonment, like rejection. Anyone, no matter what their issues, will have these feelings. If, however, you still have these strong feelings after about 6 months, you may want to seek additional therapy in order to determine precisely what button termination pushed in you. It is possible that you had never before been aware that a relationship was ending -or, more likely, cared enough about a relationship to be troubled by its termination. In that case, you will have to look at your own fears and your own ways of interacting in relationships. It is possible that your old ways of interaction don't work anymore. You will need to trust someone enough to be able to learn how you act or overreact in a relationship and how you control the interaction. So, maybe out of the pain of this break-up, you will learn something valuable about yourself - a path to improving your life and attaining what you really want.

Yes, the song is right: Breaking up is hard to do.