(UN)PLANNED OBSOLESCENCE

 

“Therapy is not meant to last forever,” I tell my kid clients during our first visit. After inviting them to express their feelings about being brought to counseling, I ask them to think about how they’ll know when the work of therapy is done. What will have changed for them?

In asking this, I hope to empower them and shape our work according to their priorities, not necessarily, or only, those of their caregivers. After all, change requires buy-in. Simultaneously, it is my way of planting a seed for one of therapy’s most important flowerings: the good goodbye.

Everyone can expect to experience loss over the fullness of a lifetime; but childhood, for the clients we see in community mental health, can already be replete with losses both clear and ambiguous. Parents especially seem to disappear, in the county where I currently work—into jail, substance use, other towns and states, other relationships and families, mental illness, accidents, suicide, and even death by homicide.

Such loss is complicated in untold ways, with impacts on identity and self-esteem, attachment, concentration, decision-making, moods, stress, coping style, and the immune system. A positive therapeutic relationship, while not “fixing” all that’s gone before, can be a corrective experience, providing safety, reliability, tolerance and adaptability, support and regard, healthy boundaries, respect, and (crucially) warmth. I would contend that when therapy “works,” that corrective quality is the main reason why.

Bringing closure to all the relating that’s come before, the good goodbye is one that is anticipated, planned for, and—though there’s room for sad feelings as well—celebrated together as an accomplishment. I like to provide client-specific “transitional objects,” small items that can carry forward the memory and meaning of our time together. I’ve given skeleton keys, worry stones, figurines, feathers, memory books, and (so far) one mixed CD, all accompanied by notes or letters of congratulations. One spunky little girl I see has already requested brownies, though the end is not yet in sight; for a teen with a love of savory sweets, I made rosemary shortbread.

Needless perhaps to say, all this preparation is as much for me as for the client. I, too, experience some attachment in my work with clients, to varying degrees, and the good goodbye helps me to find closure for work that has impacted me as well. (In The Body Keeps the Score, Bessel van der Kolk espouses the belief that clients can’t grow and change if they can’t see their impact on their worker; I’m hopeful that my clients can see theirs on me.)

The good goodbye is also a corrective experience for me for other losses, both personal and professional—those goodbyes that never resolve. When denied it—when, as happened late this spring, a favorite client simply drops off the map, our work together feels as open-ended and prone to fraying as an unfinished hem. Though coached by colleagues to trust and let go, it is hard not to comb over my memories of our last visit, for possible clues. Did an errant remark cause pain or offense that the client or caregiver wasn’t comfortable addressing?

It’s impossible to know. Some clients aren’t good about calling under any circumstances, let alone the momentous ones that announce the end. My lost client had made radical progress—was he just doing well enough that he felt he was done? Although I give all credit to him and his mom, did disappearing feel necessary to him, in order to own his gains? Or could it be that a lack of experience with healthy endings might have caused him and/or his mother to dread the emotions of closure? When people protect their emotions, it is often (and often unwittingly, though not always) at others’ expense.

In any case, I send my best wishes to him.

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Out of respect for client privacy, names here are always changed or omitted. Text and image copyrights held by me. If you enjoyed this piece, I hope you’ll consider sharing it. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017) will be continued in a future post, when I have more stamina for the topic. Thank you for reading!

5 thoughts on “(UN)PLANNED OBSOLESCENCE

  1. It’s a startling synchronicity to read your post! I’ve been wondering if late about my therapist “She has impacted me so much, have I made any impact on her?” No doubt my quiet nagging sadness of “No…I haven’t seen if I’ve made any impact. I must have made no impact – neither positive or negative” is rooted in the very issues I’m in therapy for. Hence,it’s such a startling (and really delightful!) thing to learn that you feel attachment to clients in varying degrees, that good goodbyes matter to you as well, and that being ghosted impacts you. 🙂

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    • Okay, the postponed reply! You have expressed this feeling here once before, as I recall, wondering about the other side of the therapeutic relationship and whether it matters or is meaningful to the therapist. I can only speak for myself (an emotional person), the point I’m at in my career (just beginning), and my current work environment (community mental health). From my perspective, yes, the work and relationship is meaningful and impactful for me, usually in proportion to the level of connection (interpersonal affinity) and/or engagement (involvement in the work) that exists. This is important to say, I think – I can have almost nothing in common with a client, either temperamentally or in terms of background or interests, but if that client is actively involved in therapy, an alliance is created, the relationship feels meaningful, and the good goodbye is extra-important. This is in contrast to my personal life, where without numerous common interests, ideals, and/or points of connection, I don’t feel strongly compelled to engage; and I love that my work can, in some ways, be “bigger” than my life, although I also still enjoy my own private interests and intensities. Of course, in community mental health, the rate of attrition is so high that to some extent one has to steel oneself against disappearance and lost opportunities, or be in an almost continual grieving, self-questioning state – not so helpful or productive. I also don’t know what it will be like to have worked in the field for five, ten, twenty years – how that will or won’t impact my experience of client relationships; or, for that matter, how changes in my personal life might impact what I bring to them and receive from them. What I can say for sure is that I encounter clinicians in almost every work environment, whose work I don’t respect, and those people, perhaps not coincidentally, don’t seem to take their clinical relationships too much to heart; whereas people I do respect, who’ve been in the field for some time, tend to have fond and vivid memories of clients past. I hope you’ve had a nice weekend!

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      • I had s great weekend 🙂 I appreciate your reply! It’s giving me lots to think about – a friend of mine (also new and in community mental health 🙂 ) definitely takes his clinical relationships to heart but he seems so alone in his current setting…where sometimes it seems to be an outsider that he’s the only one caring deeply, wanting to make a difference. Then of course there’s me and my personal desire to matter to my own therapist 🙂

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        • I sincerely hope your friend will soon find a like-minded colleague or two. It can be tough work, and support matters a great deal. It helps one cope and recharge. I’m glad you had a good weekend, and I hope a good week lies ahead. 🙂

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