Other Side of the Couch

Welcome to a blog that aims to be full of insightful ramblings from a licensed psychotherapist, with a specialty in sex therapy and marriage and family therapy. It is my hope that this blog will be of interest to people in therapy, people contemplating therapy, people contemplating being therapists, people about to be therapists and people who already are therapists!

Tuesday, July 26, 2005

The Fifty Minute Hour and Closure

I received some interesting questions via email about the practice of psychotherapy, and thought I'd respond to some of them.

How many clients do you have and how often do they come and see you?
The number of clients I have tends to fluctuate. At the moment I have 27 clients, and they include couples, families and individuals. This is about as many clients as I can see in any given week. If my practice is full and the potential client is not an emergency, I compile a wait list. If the length of time a client must wait is more than one month, I keep a referral list of other therapists that I recommend to potential clients. In the event of a client needing therapy immediately, I refer to other therapists as soon as I receive the call. Of this 27 clients about half are couples, with one or two families. The remainder are individuals. I generally work Tuesday through Friday. 25-30 hours of my work week is spent with clients face-to-face. I spend 5-10 hours per week attending professional meetings; I have peer supervision with colleagues and paid supervision with other experienced professionals; I conduct research into areas where my education is lacking; I talk with "collateral" agencies (this means other professionals who are involved in clients' lives, such as psychiatrists, other therapists, social workers, teachers, etc.); I market my clinical practice; I do my book-keeping and answer/return phone calls. When I started my private practice, I was determined not to burn myself out and decided that a four day work week was a more humane and reasonable approach to working. I pride myself on being a very conscientious therapist and spend a lot of time reading and researching on different issues that clients raise. This might mean educating myself about other cultures, religions or spiritual practices, learning about the stressors attached to various professions that clients have, consulting with other clinicians with a particular expertise, etc.

Most clients come to see me once each week for a therapy "hour" which is generally, but not always, 50 minutes long. For busy couples, especially those with children and the accompanying headache of finding regular babysitters, I usually suggest that they attend a 2 hour session every other week. Clients in crisis will often request extra sessions during the week, although unless the client is in an emotional crisis or is very depressed I usually suggest that they only come in once a week. While coming to therapy can be very helpful for people, and building a good relationship with your therapist enhances the quality of your therapy, becoming dependent on your therapist is not advisable. Encouraging clients to build supports into their lives in the form of friendships, communities, support groups and/or 12 step programs is a valuable adjunct to working in therapy. It doesn't take a whole village just to raise a child - adults need villages of caring support also.

Why do therapists have a 50 minute hour?
This is a fairly common question. The answer is that therapists, including myself, often need to have ten minutes before the next client. This allows time to jot down any notes that we need to remember, check messages and return any urgent calls and clear our heads before the next client comes in to the office. While a 50 minute hour works best for the therapist, in practical terms I will often allow more time if a client is dealing with a particularly challenging time in their life and would really benefit from an extra 10 minutes on the end of their “hour.”

How long do people stay in therapy?

There are as many reasons for people to attend therapy as there are people on the planet. Some people come and see me with a specific goal in mind: a parenting challenge; the death of a parent; a sexual problem; a miscarriage, etc. These people may spend 3-6 months in therapy and leave. Often they will come back in for a "refresher" later on, or they will return to therapy if another issue comes up that they think I could help them with.

Some people come in with bigger challenges: long-term depression; a marital crisis that has come about as a result of years and years of marital neglect and estrangement; families recovering from the effects of a family member's long-term alcoholism and new sobriety; people with a lifetime of struggle, who are just beginning to realize how much they have been affected by the family they grew up in and want to learn how to make different choices for themselves; men and women with histories of sexual abuse who want to learn different ways of being in the world. These issues are often more long term. I have some clients who have been meeting with me for 4+ years. Others stay for a year or more and then leave, possibly returning later if they feel it would help them.

Sometimes people come in to therapy and are not yet ready to do the work. I always leave the door open for these people to return. I know from personal experience that it can take time to pluck up the courage to sit and face your demons.

How do you know when you are done with therapy? Is it really necessary to have “closure” when finishing therapy?
In the best of all possible worlds, a client’s decision to terminate therapy would be because the problems or issues facing them at the outset of therapy are no longer present in their life. However, in reality a client’s decision to leave therapy may be simple or more complex: they may feel that the piece of work they came into therapy to focus on has been adequately examined and explored; they may not feel that they are benefiting from therapy; they may not feel that they are a “fit” with a particular therapist; they may have come face-to-face with some challenging feelings that they are scared to bring up with the therapist and see abrupt termination as a way out of that fearful place.

If it is the therapist who is driving the termination of therapy, they may suggest termination if the client is either unable or refuses to pay for therapy services; sometimes the therapist decides that the problems facing the client are outside of their particular expertise or competence; sometimes, despite a therapist’s best efforts, they can tell that a client is not benefiting from the treatment; sometimes the reverse is true and the client improves dramatically over time and is no longer in need of therapeutic services, leading the therapist to suggest termination; and there are times when a therapist is unable or unwilling to continue to provide clinical services, either due to illness, need for prolonged absence, or some other appropriate reason. Unless the client’s quality of life has improved to the point where they no longer need services and have decided, after discussion with their therapist, to terminate the therapy relationship, the therapist is at all times responsible for attempting to ensure that clients have access to other clinical referrals.

Therapists often disagree about the benefits of taking time to “close out” a therapy relationship. Some therapists prefer that several sessions be devoted to the termination of therapy. Others don’t see the necessity of a lengthy termination procedure, and still others, like myself, think that it really depends on the client, how long they were in therapy, what kinds of issues they were working on, and how invested they appeared to be in the process. If a client comes to therapy wishing only to work on a short-term goal, the issue of closure is less important. However, in the event of a long-term relationship between therapist and client, the issue of taking time to say goodbye to the relationship takes center stage in the final treatment sessions. Few of us have had the opportunity to say a proper goodbye to a relationship, and that opportunity is enshrined in the closure sessions between client and therapist. This is the chance to “do it right.”

The manner of terminating therapy is one of the most crucial aspects of therapy. All relationships should have a good ending and a good beginning and therapeutic relationships are no different in that respect. While licensed psychotherapists are bound by the ethical standards of their professions to follow appropriate termination procedures with their clients, clients are not bound by the same rules and ethics. I always hope that my clients will terminate therapy with me in an honest and straightforward fashion, but this is not always the case. Some people would rather drink drain cleaner than say goodbye! This shows in the way they terminate the relationships. For example, refusing to answer a therapist’s phone calls is not terminating therapy. That is hiding out from therapy and is not an honest approach to closure. Getting “too busy” in your personal life and not having time to attend therapy is also not closure. That is running off and is not the same as taking time to say goodbye. If a client is furious and/or upset with their therapist and is too scared to tell them, leaving therapy rather than dealing with their feelings that is not closure – that too is running.


On balance, the most effective way to terminate therapy is to talk about it. It is an opportunity to review where you are in your recovery path and to understand, with some perspective, where you have come from, where you stand and where you still might need to go in the coming years. Even a short term therapeutic relationship can benefit from one such session. It is a great opportunity to take stock of strengths and to pat yourself on the back for your hard work (both therapist and client!)

42 Comments:

  • At 7:29 PM, Blogger Bar Bar A said…

    This was very interesting. Thanks for sharing. You sound like a wonderful therapist (I've seen my share). The last one suggested I shop at a clothing store she went to, she said it would make me feel better about myself. Seriously. I never went back.

     
  • At 9:39 AM, Anonymous Anonymous said…

    i'm having an interesting reaction to your blog.afterr reading every single post(sometimes twice) i'm not so obsessed with my therapist.( this is a very good developement for me) nor do i to hate her as much for not being the perfect all knowing mother goddess.what a relief.it was very nice to hear what it is like to be a therapist.i don't know how the whole shift happened but i hope i can maintain it.thanks

     
  • At 2:20 PM, Anonymous victoria said…

    I have a very different issue -- i went for therapy after some kind of trauma, (suspended my own psychology master's for some time)and stopped therapy after 7 months. However I was so in love with my therapist by that time, that I went back and asked him to supervise my research. That was another 6 months...and now that's over, I feel absolutely lost..... I feel I don't even have the energy or will to continue my studies myself, without him. We had a special connection, he told me that and said we would be friends after everything was over for good. However, I never pushed for anything, because I am aware of the ethical side of things and have alot of self control; and he knows how i feel, I had to tell him that.... he too told me he was attracted to me. It was a mutually enriching experience. I can't believe I'll never see him again...
    I kind of grew up in his office and he was my support when no one else was. If only he knew how special he is to me...
    My problem now is I don't know how to deal with never seeing him again... I have no reason to... but he was such a constant part of my life for one year through my crisis and the only source of comfort and happiness that i can't seem to let go... I miss him all the time and if anything gets ugly, I just miss him more because I can't run to him anymore... I feel I am slipping into my depression again...
    what's your opinion?!!!!

     
  • At 4:13 PM, Blogger Jassy said…

    Victoria:

    You said that you went into therapy for "some kind of trauma" and spent 7 months in therapy. That probably isn't long enough to deal with any kind of trauma and now you're slipping into depression. Please...find another therapist. If you let me know the area you live in I will try and find a referral for you.

    If you started therapy with this particular therapist and had NO other supports or sources of comfort and love, it was/should have been a primary part of your therapist's job to make sure that these get put in place as soon as possible. People facing depression and trauma need loved ones around them...friends, lovers, family members and, failing that support groups to help keep you centered and connected. It's not enough to rely on a therapist for 50 minutes worth of support a week. I'm not doubting that you had a special connection. But his place in your life was as therapist to you...your life should have INCREASED in connection, joy, confidence in many areas of your life as a result of his work with you. Please, find somebody to talk to about this. I wish you luck, Victoria.

     
  • At 4:05 PM, Anonymous Anonymous said…

    I have been seeing my therapist for a little over four years. I'm perpetually depressed and he has been there for me always - our connection is solid. I know he is attracted to me, he told me so, and I also know nothing could ever come of it. I feel like I've met my soul mate, and its painful to say goodbye to him when my hour (or sometimes two hours are up). I know I have to leave and forget about him, because all I do is think of him. He never leaves my mind. i can't live my life like this anymore, but I don't know if I'm strong enough to say goodbye.

     
  • At 1:27 PM, Anonymous Anonymous said…

    How about in your own practice? Of the last 50 or so clients who are no longer your clients, how many of those endings were prompted by the client, and in how many cases were you the one who said "I think we need to talk about terminating." (For the sake of ease, let's not count the ones where the client couldn't or wouldn't pay.)

    Thanks! I'm just trying to get a sense of how this plays out in real life.

     
  • At 2:30 PM, Blogger Jassy said…

    Anonymous: Good question!

    I looked over the last 50 clients who were no longer clients - and I count a couple as one client. 40 of them left because the work we had set out to do had been accomplished. Of the ten that were left, two lost their jobs and could no longer afford to come; one client had been a long-term, face-to-face client who worked with me via phone and Skype after I closed my Boston practice, but has depression and it was my clinical judgment that she needed more of a relationship in situ with a therapist than I could offer virtually - I made a good referral to a colleague in the Boston area; I referred one partner from each of two other couples out for Trauma therapy with other clinicians because they weren't ready/able to do sex therapy due to high reactivity (they agreed they would come back and finish their couples work with me when they had more of a handle on their trauma); one man decided not to do the erectile dysfunction work with me, preferring to use the Little Blue Pill and keep his ED secret from his partners; one couple left because the work "felt too hard"; one couple consistently no-showed or "forgot" their session so I suggested that they come back and see me when they were ready to make time to do the work together; one client left because he and his wife had a second baby, and he couldn't afford the co-pays, but felt good about the place we got to in our work together and the last client got referred out to another clinician because I had to change my work hours and could no longer see him at his usual late evening appointment time.

    Does this help, Anon?

    Jassy

     
  • At 8:57 PM, Anonymous Anonymous said…

    Jassy --

    Yes! It helps hugely. But what would really be helpful would be know who INITIATED the "time to stop" conversations, particularly with the 40 who concluded because the work was done. Can I take what you wrote to mean that they were the ones who said, "Work's over, I'm moving on?" Or did you say, "Work's over, it's time for you to move on?"

    Thanks so much for your quick response. I guess I'm trying to figure out, roughly the percentage of time that the client initiates termination, and the percentage that the therapist does.

     
  • At 9:47 PM, Blogger Jassy said…

    Anonymous:

    Usually, I begin a first session by asking a client what they need help with and we identify my "job description." As each piece of work is done - and sometimes I point out that a goal was achieved and sometimes the client does - I ask the client if they are satisfied with where they are or if there is something else they would like help with. It's hard to say percentage wise how this plays out - but as most of my work with clients is sex therapy, there are often physical/sexual markers. For example, if a man was coming in because he had erectile dysfunction (ED) and he starts being able to either (a) get and sustain erections or (b) learns to feel good about himself and his sexual relationship regardless of what's happening with his erection, he isn't usually in a hurry to stay around in therapy. I may suggest having a follow-up session after four weeks just to check that everything's going fine, but otherwise these men tend to leave. I would say it's primarily me who initiates the conversation about whether they've met their goals, and I have confidence in my clients being able to make the decision about whether they will continue or not.

     
  • At 9:57 AM, Anonymous Anonymous said…

    Would that other kinds of therapy had the same kind of objective markers for success and failure as sex therapy!

    Thanks so much. This has been a really helpful exchange. With the research showing that 60% of therapy clients are dissatisfied with the timing of their terminations, you shed important light on a crucial subject.

     
  • At 12:09 PM, Blogger Jassy said…

    Anonymous: I'm wondering how many of the dissatisfied clients were "forced out" of therapy because their benefit limits were reached....just a thought. More than half of my clients are self-pay where their own pockets determine their ability to continue - the decision is not being made by an outside body.

     
  • At 1:04 PM, Anonymous Anonymous said…

    Thanks for sharing this post. I recently just terminated therapy after one and a half years, and I'm starting to think I may not have gotten the closure I needed. This was my first time in therapy so the whole termination process was really foreign to me. My main purpose of starting therapy was to deal with anxiety, depression and coming out to my parents. After a year or so, I was able to re-frame a lot of my negative thought patterns and gain confidence and esteem in myself I never thought was possible. A few months ago I finally came out to my parents and it was probably worse than I had imagined it to be. The hard thing was, my therapist wasn't as available as she usually was during my coming out process. I probably only saw her two or three times during that whole process (which spanned almost 2 months). Fortunately, I was able to deal with my parents' reaction in a healthy way on my own and even though I'm still dealing with it and it hurts, it's not ruining or hindering my life.

    After I realized I was able to deal with something that big by myself I thought it would be time to mention termination to my therapist. So when we were able to meet again I spent some time recapping everything that had happened and brought up termination. Unfortunately, there was only 10 min left of the session. I was a bit awkward since I had never gone through the termination process before (and I expressed this to her). I told her my reasons, she wished me well, said she was confident i was self-aware enough to reach out to her again if need be and was proud of my growth. And then I left.

    Part of me feels like that 10 min. wasn't enough. It didn't do justice to the year and a half we spent as therapist and client. And I left that session feeling weird, awkward and sad. I thought that was just how termination happened, but after reading some articles and blogs it seems like most people have at least one last session to wrap things up. So, I emailed my therapist and expressed that I wish we had had more time and basically laid down my gratitude and thoughts on our time together to her in an e-mail. It's been a week and I haven't gotten a response. So now I'm questioning if that was the best thing to do. Did I cross a boundary by e-mailing her? I just wanted some closure, I guess.

     
  • At 4:09 PM, Blogger Jassy said…

    Hi there:

    Thanks for your recent comment and congratulations on coming out to your parents. That's quite an accomplishment. And, I'm also sorry that it was harder than you thought it would be - it sounds like you're pleased with how you were able to handle the situation and are dealing well.

    I can understand, however, why ten minutes tacked onto the end of a session did not feel like enough of a termination. It's not. It doesn't honor the work you did, doesn't give a re-cap of what you learned, achieved, and how you rose to the challenge of facing your life in a different way. I'm sorry that it's taking your therapist a while to get back to you. My two cents? Emails go astray. Try calling her and leaving her a message telling her that you had emailed her and were concerned in case she hadn't received it. Tell her that you want to honor the relationship you had and the work you did and ask, in person on the phone, for a termination session. Put together a list of questions you want to ask her. What does she think were your primary challenges? What does she think might be places to focus on in the coming years/ months? Coming out to parents is a big, damn deal - there are more hurdles. Does she think your support system is adequate to handle them? What would she recommend? What does SHE think of the work you did? What do YOU think of the work you did? If you think about three big things you learned, what would be the three most important ones? How was the work you did with her helpful? What was ONE thing that she said that really stood out for you? (I'm often surprised when clients tell me the answer to this question - it's never what you, as a therapist, think it will be! :-) )

    And no, you didn't cross a boundary by emailing her - not in the slightest.

    Good luck...let me know what happens :)

    Best,

    Jassy

     
  • At 9:19 AM, Anonymous Anonymous said…

    Thanks so much for your response and advice. And you're right, I at least owe it to myself to honor all the work I did this past year and a half. I'll keep you posted on what happens!

     
  • At 9:22 AM, Blogger Jassy said…

    You're welcome and I look forward to hearing your follow-up:)

    Jassy

     
  • At 2:05 PM, Anonymous Anonymous said…

    Hi Jassy,

    I just realized I never followed up on this. I got a response from my therapist about two weeks after I had e-mailed her. It was a pretty short response. She thanked me for e-mailing her and ended it somewhat generically ("every day is a gift and embrace the possibilities.")

    It wasn't quite the closure I had expected, but I ended up processing the whole thing on my own. I've been doing well sans therapy, but I do miss it and have already started looking for a new therapist. I miss having that space.

    I think, in the end, I made a lot of progress with my former therapist and I'm grateful for the sessions we had, but I think it was time to move on.

    Anyway, thanks again for the advice.

     
  • At 9:44 PM, Blogger Jassy said…

    Hi there once again - and thank you so much for checking back and letting us know how things went with your therapist. Despite the fact that it wasn't the response you wanted, you appear to have done a good job of taking care of yourself and moving on. If there's anything I can do to help find a new therapist, I'm happy to help. If you let me know where you live, I can talk to colleagues and get some recommendations. Feel free to email me at dearjassy@jassytimberlake.com.

     
  • At 12:30 AM, Anonymous Bongo said…

    Thanx for the opportunity to ask questions here...I'm not sure what my question is exactly...I have been with a therapist for 7 years...he has been much more then a therapist for me.. buthas always kept the "session room" safe for me... in 3 weeks he is leaving the profession and leaving the country...I have been seeing him to deal with childhood trauma issues..I have come a long way... but losing him feels like I'm losing all.. my safeness, my trust..myself...this is the only safe relationship i have ever known...trust, caring... the purest form..and I feel it's all going away.. i even blog about it,,, it started out as a personal HEALING journal.. and has turned very dark...i don't remember what my question was ...thank you for the opportunity ....As always...grace and peace..Bongo

     
  • At 10:22 PM, Anonymous Anonymous said…

    Hi Jassy,
    Ok, basically I just dont know what to do or how to tell my therapist how im feeling... I have become extremely dependant on him. i see him twice a week and i talk to him on the phone probably every other day. i know i get on his nerves, but he knows that i literally do not have anyone else to go to for anything and most likely feels obligated to be my entire support system. but he is the only person who knows my secrets. and i cannot be open with anyone else yet. i count on him for so much. and hes been great about it all. he is always there for me and talks to me no matter what. but im a little concerned about him potentially ending our relationship. he promises he wont, but he cant possibly want to deal with me almost every day of the week, most of which im not being charged for. so, i guess all i want to know is, do we have a weird therapist, patient relationship and if so, is that a really bad thing? what can happen when a patient is too dependant on their therapist? i cant bring myself to bring up the course our relationship has taken with him. i like having him there alot. i feel like i need him. im scared if i mentioned something he might put a stop to it. i wouldnt be able to handle losing him at all.what do you think?

     
  • At 7:45 PM, Blogger Jassy said…

    Anonymous:

    My suggestion is that you write him a letter telling him everything that you've written here. He needs to know what is going on for you otherwise he can't be of help. And I very much doubt that he feels "obligated" to be your entire support system. But I would try asking him what his recommendations are for building a more comprehensive support system for you. It's never a good idea to have only one person to rely on, particularly just a therapist. You appear to be an intelligent, thoughtful, insightful person - just the kind of person that people like to be close to. Ask your therapists help how you can use those wonderful qualities to create more of a circle of caring and support around yourself.

    But first, tell him what you just told this blog...he needs to know your concerns so that he can offer insights and help.

    Best of luck
    Jassy

     
  • At 6:44 AM, Blogger Annon said…

    Please could you let me know if it is common practice with some phycotherapists to make or encourage a client to become dependent and if so, what would be the common signs of this happening in therapy. and is it normal for a therapist to become and show anger towards a client? Many thanks annon.

     
  • At 8:00 AM, Blogger Jassy said…

    Annon:

    I sincerely hope that it is not common practice for psychotherapists to encourage dependence on their therapist - however, this does sometimes happen. It is not, however, an ethical stance for a therapist to maintain. We should always be encouraging our clients to take what they learn in therapy and use it to improve their relationships outside of therapy. There are many things that we depend on our therapists for - clarity of thought, insights that we may not have thought of, a different lens - but emotional dependence is not a good thing to foster in a client, and speaks more to a therapist's need than that of their client. Common signs might be the therapist telling the client that they are the only person the client can rely on, fostering the idea of the client as isolated and alone in the world, not encouraging the client to build supports for themselves, not helping the client to strengthen existing relationships, and treating the relationship as if it is a "friendship" or two-way relationship. I'm sure there are others, but those are the ones that come immediately to mind.

    As for anger, no...it is not commonplace for therapists to show anger towards their client. Has this happened to you? And if so, under what circumstances?

    Jassy

     
  • At 12:47 PM, Blogger Annon said…

    Hi Jassy, I have tried twice to send you 2 answers. They do not seem to have gone through to you? The last one seemed to go through, i saw it printed on your page and then it disappeared again? Have you received the reply someother way?

     
  • At 12:53 PM, Blogger Jassy said…

    Hi Annon:

    The above two comments are the only ones I've received from you. However, I had trouble posting my response (above) to you earlier on today. I receive all comments as they are posted and these are the only two I've received from you today.

    I say re-load your browser and try again.

    Jassy

     
  • At 1:20 PM, Blogger Annon said…

    Hi Jassy. I shall try again. Thanks for your quick reply. I started therapy because i was having maritial problems and because a very special and dear friend was dying of which i could not cope with. My therapist was very kind, supportive and understanding. During the 1st 8mths of therapy, i would txt her occassionaly when in distress and she would always reply in a very supportive and kind way. About a month before my beautiful friend died, i became very distressed and my texting did increase considerably. My therapist stopped replying to any txts and told me that it was not therapy and that i would have to deal with my distress in sessions only. (I will send this in 2 sessions, just in case my reply is too long!)

     
  • At 1:36 PM, Blogger Annon said…

    I understood this, but felt terribly embarrassed, alone and hurt. My husband and i had moved to this foreign land with very few friends and no support unit to talk of. I felt that she must have known that this was not therapy prior to this. When my friend died, i fell to pieces.. i wanted to crawl into a very dark and small place and just have anything take away the pain. I don't mean that metaphorically, i truly wanted to be in a small dark place, curled up in a fetal position. In one session, i was in tears and i approached the subject about how i felt she had let me down during that awful time, when before she was so supportive. She became really angry and told me that she did not have to justify her therapy methods to me. I never expected that response from her. Again, i felt ashamed, hurt, angry etc. In the next session, i avoided climbing that tree again, and just spoke of other things..at the end of the session, she asked me a very pointed and deliberate question... did i get upset when she became angry..when i said yes, her reply was "good". I had a session with her about 3 days after my friend died and i spent the whole hour crying on her shoulder. In the next session she told me that if i needed her to comfort me in this way again, i would have to ask, because she felt i needed to learn to ask for the things i needed. This has been the most confusing, painful, therapy. Anyway, there have been many confusing, hurtful things done and said, but i hope what i have said above gives you enough info. Thanks for spending the time to read this Jassy. Annon.

     
  • At 2:36 PM, Anonymous Anonymous said…

    Hi
    I'm not sure if this blog is still active or checked. I'm very confussed and angry with mysel fat the moment, i can't stop thinking about the therapist that helped me this year. I feel the need to be close to her and even though I have a partner, family and lots of friends, there's noone i want to talk to but her, I trust her and she can always help. I dont want to keep thinking about her, how do i fix this infacutation ?????

     
  • At 6:15 AM, Blogger Jassy said…

    Anonymous:

    It sounds like you are in a tough place at the moment - and I can't tell if you're still working with the therapist or not. If you are still working with her, I strong suggest that you tell her about your feelings and process them with her. This can be remarkably helpful to clients. If you are no longer her patient, then I'm afraid the old adage "Time heals all wounds" applies. I would suggest that you try talking to friends and family about your feelings and, if that doesn't help, you may need to address your feelings with another therapist if your old therapist isn't available.

    In the meantime, focus on what is good and wonderful about your current relationships with friends, family and loved ones. Throw yourself into activities that you love and enjoy and pay attention to the things that make you grateful for the life you have.

    Good luck with whatever you choose to do.

    Jassy

     
  • At 8:38 PM, Anonymous Anonymous said…

    I saw a woman psychotherapist for five visits. On the sixth session, she said I was obsessed with her and it wasn't transference. She sounded either frustrated or angry. As part of her diagnosis, she uses the MPPI and she said my results were inconclusive. She told me she consulted with colleagues and then gave me a list of referrals and I left. I felt in shock because it was so abrupt. I feel blamed for the termination of therapy. I got a new therapist from my insurance company and he is trying to get a phone interview with her. Can I anticipate that she will probably blame me for the termination? Thanks

     
  • At 12:07 AM, Anonymous Anonymous said…

    Hi. I have been in therapy for a little over 5 years with the same therapist. For the first 4 years I saw her twice a week and this past year once a week. We are very close. We exchange gifts for birthdays and christmas, she has visited me in the hospital when i've been sick, and when i've had a particularly difficult session she says, you know i love you right? And I tell her i love her too. We have a big/little sister type bond. WIth all of that said, I do not have her personal phone number, we never see each other outside of the office and she has never promised to have a relationship with me after therapy (which i would never expect.) However, I am now moving 1800 miles away. I don't know exactly how to approach telling her goodbye. It makes me tear up just thinking about it. I understand the importance of moving on, and I am excited to. But I feel like telling her goodbye is going to be very painful and I am just not sure what to do.

     
  • At 12:12 PM, Anonymous Anonymous said…

    I was in therapy for almost 4 yrs with the same woman, our last session was as recent as last month. I had other appts and she started cancelling them. After the 2nd cancellation, I started taking it personal. We are on cancellation #4 at this point. She did call and say she was retiring at the end of next month. I was just shocked,and now I'm feeling completely lost and sad.I trusted her with everything,and I'm thinking that after this amount of time, I at least deserve some sort of closure on this relationship. I swear it's worse than divorce! It seems to hurt more. I have raked my brain trying to figure out if I have done something wrong, and I can't figure out what I've done. I can't believe how this feels, and it really has taken me about 50 steps back. It's really painful - I can't even sleep. I am just not sure what to do now.
    Thanks.

     
  • At 12:44 PM, Blogger Jassy said…

    Anonymous:

    That is such a painful story. And yes, you do deserve some closure. I suggest calling her and asking for two closure sessions so that you can talk about the ending of this relationship of some duration. Even therapists sometimes don't know how to handle goodbyes, apparently. I'm sorry - and yes, you deserve a better explanation.

     
  • At 6:21 PM, Anonymous Anonymous said…

    Oh honey I completely understand. I was in therapy for a year and a half. We connected with so much chemistry and special bond. I went weekly and one session he ended it. I was very devastated for a long time. I do turn to him at times for help and he kindly replies. The thing is I'm completely in love with him like I've never loved before. I've never told him I'm in love but I think he recognizes my love for him. You may want to contact him. If he's good he will want to help you. Good luck..hugs and blessings to you....I so understand how you feel. Do u ever wonder if its difficult for him also? I'm sure he misses you very much.♥

     
  • At 6:33 PM, Anonymous Anonymous said…

    Its extremely difficult. Although trust me if u need him he will b glad to help you. A good therapist who shares a bond cares about you forever . I've had to turn to my therapist after ending it and he's there. I was very misserable and my heart ached when it ended. I felt so depressed and cried but when I realized he's never left I just got better and if I need him I contact him. Go a few weeks catching up on your growth and if than u want to contact him...I promise he will be pleased you still have faith in him. Good luck...be strong..you will connect again. Your growth shows him he is very good and that's a compliment to him. Send him a letter of thanks. Good luck honey but remember he's not gone he just healed u. Find positive in that and don't write him off. U will connect sometime down the road. I promise.

     
  • At 5:22 PM, Anonymous Anonymous said…

    Hi Jassy,

    I appreciate your kindness answering all client side questions. I'm in a situation and I really need advise! Im feeling embarrased about :( ....

    I m having therapy since three months, I think I have made some great advances and I think my therapist is a great doctor! The thing is that somehow Im obssessed with him and researched about him in google... I kind of found who his wife is and researched about her also ... I feel very bad about having done that... I promessed to myself never do that again. I dont want him to know I did that!!!! But this is affecting therapy! Should I left him and find another one?

    Thanks for any advise!!!

    Bye,

    Joana, DC

     
  • At 7:45 AM, Blogger Jassy said…

    Hi Joana:

    Believe it or not, therapists are used to clients googling them with curiosity about their lives and who they are outside the therapy office. My suggestion? Right now the keeping of secrets is impacting your therapy with him - and maybe secret keeping is part of the work you've been doing with him? - so I suggest that you tell him that you were so curious about him and his life that you googled him. Most therapists with any kind of internet savvy are mindful about what information is out there about him and are used to clients having curiosity about their lives. This information is sidelining your therapy so he needs to know. If he's as good a therapist as you say, he will not be thrown by your interest in him. And he can use it in clinical ways to help your therapy with him. Don't leave and find another one - just tell him what you've been feeling. Good luck and let us know what happens :)

     
  • At 5:31 PM, Anonymous Anonymous said…

    Dear Jassy,

    Many thanks for your answer. Is a miracle your answer! I have to tell you that when I read your advise I started to cry, I don't know why... I think I didn't want him to know that... or to feel dissapointed about me... I had two more sessions after that and couldn't tell him that directly, although I mentioned I'm obssessed in researching about my ex-boyfriend, which is true...
    In my today's session I just told him I'm researching in google about him. It required a lot of courage! Now I feel better... he has not mentioned anything about it or made a reply... But I feel
    like I want to reduce my researches, now it makes less sense. Hopefully he will
    use that to further help me. I will let you know!!

    :)

    Joana

     
  • At 6:34 PM, Blogger Jassy said…

    Joana:

    Great! Keep me posted as to how it's going. I'm glad you feel better :)

    Jassy

     
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  • At 2:39 AM, Anonymous Spirit said…

    The level of thinking about therapy-obsession of sorts, drastically changed when I started working closely with a woman therapist. One in particular when my D.I.D. issues were being (unknowingly) addressed via PTSD/borderline personality. I think the obsession started because, not only was I looking at my past for the first time, I was in a horrible, relationship. I was trapped, psychologically and therefore, physically-I had no idea how to get out. Eventually, this therapist "ran out of tools" she wasn't the first. Soon after, I met another therapist and started the whole process over again.I went from "just let the feelings be there" to the feelings becoming a freaking monolith that I could not get out from under. But my feelings for my therapist and a sense of knowing about her and our work was the only thing keeping me going...but it was also the one thing driving me mad...my partner hated my feelings and closeness I had with my therapist. Sometime later, I really do not know how many years, this therapist ended sessions with me as well...I never have gotten a straight answer about why...but she too did say "i'm out of tools". Then about a year later, I started working with another therapist, and obsessed of sorts, again. A good year or so free from that nasty partnership I was trapped in, but, I still had not moved through the trauma that had kept me stuck in the first place, and I was dealing with a broken heart and broken trust from the one therapist who I thought I could really count on. After about 2-3 years of work (still not directly addressing D.I.D.), everything else, but not that...although I tried . I grew a lot or at least grew another me, one that could stand up and live in the world-mostly...but this therapist ended her practice to do alternative healing....again...lost and devastated...trust broken, but not in the same way...just more in general. Soon after I started working with a woman I knew from years ago, whom I'd met once or twice, and knew a lot about me, via circumstances too long to go into here...but she was also connected, if only loosely, to the one therapist who broke my heart. I still had so much work to do...I just had no idea how much. So 11 years later, (my current therapist) recognizes D.I.D. I must say, I feel pretty freaking let down and embraced at the same time, by the mental health field. Now again, I'm working on trauma D.I.D., stuck in an 8 year complex and often tumultuous relationship, it has it's good parts too..but one of me hates it..so..again..psychologically trapped in a relationship that I don't know what to do with, a 7 year old child too (whom I love dearly and who deserves only the best), and now 2 therapists..the one I've worked with for 11 years and a re-uniting with the one who initially broke my heart and my trust...I've been locked in that obsession (though there's much more to it than that) for 16 years...trying to heal from that loss and sense of total injustice. Yes-I think about therapy and my therapist all the time...especially the one I've worked with for 11 years, although now I am starting to think about the other one too, in between sessions...I only see her every 2 weeks and the other one I see twice a week now. My world has been an obsession with myself, therapy, and therapist since February/March of 2014-not counting the years past. I don't think it will matter who I work with, the obsession will be there...thinking about therapist and therapy and process...self obsessed in a way...but I just want to heal....I just want deep intimate authentic relationships with people in the world and to be free of feeling trapped because I love somebody intimately.
    Please help.

     
  • At 12:34 PM, Anonymous Anonymous said…

    I wonder about the need for contacting a therapist and discussing closure. After many (many many) good years, my therapist (who also sees my spouse) suddenly became snippy with me and told me I need to stop being "selfish." He also said my mentally ill spouse went off all meds and was being obnoxious because I didn't "show that I care enough." I do every -100% - all - chores and tiptoe around trying not to set off my spouse. I simply have no need to go back to my therpist for more scoldings. It's hard enough putting up from emotional abuse from my mentally ill spouse, who can't help it. I dont feel the need to go in and actually pay good money for abuse from someone who can help it. Everyone is selfish sometimes and I am not perfect. but I'm never going in for closure w/ that therapist. I am just done.

     
  • At 1:12 PM, Anonymous Anonymous said…

    no idea if this blog is still reviewed: I was in a 2-4 year weekly counseling relationship with a wonderful female therapist. Our private sessions ended rather suddenly due to needs in her personal life. I can't recall if there was any closure sessions...though she likley offered it but I was in such shock I would have most likley shut-down and not have actively participated. I continued for another year or so in a weekly group in which she was a co=therapist but I never siad a word in the group...ever. I was just afriad to be out in the world all alone so I went to the groups so I could still see her...since in my eyes she was my safety net...she was one of only a couple people who fought hard enough to break down my walls. I am not certain if she dropped out of the group sessions first or if I did but either way we did so, and we each went our separate ways. For a couple years I would see her on occassion thru business connections and she was always pleasant and seemed truly glad to see me and see that I was doing well. We had been close enough during my private sessions that I knew almost immediatley when she was facing divorce and I would have loved it if we could have continued a relationship as friends after therapy ended but I never approached the subject because I knew how dedicated she was and would have never asked her to take any action against her ethics. Problem: now 20 years later she has recenlty come back to my mind on a daily basis and I cannot get her off my mind. With the internet everyone we ever knew is only a touch away and she is friends with a couple of my FB friends so ever so often her profile comes up as someone I may know. I would very much like to reach out to her and let her know what an impact she had on my life and on the lives of my family who would have been seriously impacted had I not held on and fought thru my depression all those years ago. In all likelhood had she not enetered my life and taken the action she did I would not be alive today. I was fortunate enough to sit and talk with my former psychiatrist about my gratitude before he died and I will be forever grateful I could let him know the impact he had on my life. I am not sure how to make an approach as she now lives several states distant and I would never wish to intrude into someone's life. Would it be inappropriate to attempt some form of contact after all these years? If not would it be best to ask a friend to contact her for her ok to write a letter or would another m=approach be best?

     

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