When the Therapist Leaves: A Personal Account of an Unusual Termination

When the Therapist Leaves: A Personal Account of an Unusual Termination

by Amy Urdang
A psychotherapist explores client-therapist boundaries and termination issues in a particularly intensive course of therapy.

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Often when we present a case, we present only the best of ourselves, or only those aspects that we feel confident will not be questioned. And sometimes we hide in the theoretical aspects of a case, rather than exposing ourselves more. I have always found our work to be more engaging, richer and more useful when we share not only the content of our cases, but what goes on inside ourselves. And so I have tried to be very open and honest about my own process, rather than hiding it, and hope that the material will generate valuable thought and reflection.

Several years ago, after years of building a psychotherapy practice on the West Coast, I closed my practice and moved to the East Coast. It was a very hard decision, one I made in support of my husband rather than one I initiated. Sometimes, I call that period my practice interruptus, a feeble joke, but it does hold some of the sense of what happened between my client, Louise1, and myself—an act of communion between two people, which is all too hastily cut off. Our therapy had been unusually intense and uniquely rewarding; it had tested my clinical skills and pushed me beyond what anyone had prepared me for in graduate school or in my post-graduate training. The process of our termination would prove to be just as challenging, as Louise would soon make three very extraordinary requests.

Anticipating the move

Before telling of the unexpected turns our therapeutic relationship took, I want to give some context to our work by outlining my own mixed reactions to my impending move even as my clients flailed about with their own reactions.

I was devastated. I was terrified of moving, of moving back to the East Coast, and being close to my childhood terrain. I was terrified of coming into the orbit of the depression I had grown up around, of drowning in it again.
I was scared at the idea of new beginnings, of losing my friends and my work, of having to start over; of losing my center, my ground.
I was scared at the idea of new beginnings, of losing my friends and my work, of having to start over; of losing my center, my ground. I had trained for 10 years in the Bay Area with Jim Bugental, an existential-humanistic psychotherapist, and colleague of Rollo May and Irvin Yalom, and I had developed a broad referral base and a close-knit therapeutic community. My friends were almost all either therapists or involved in some sort of spiritual work. I was terrified of not being able to speak the language we shared with anyone on the East Coast.

Some part of me was also excited. I relished the idea of putting away my practice for a period of time, of not having to carry so many psyches with me day out and day in. The previous few years had been emotionally exhausting as I tried to balance the needs of a family, clients, and a mother with Alzheimer's. As I began to think about not working for a while, the sense of daily obligation began to feel heaver and heavier, the constant checking of phone messages, the hours of reflection and consultation, the concerns for my clients. I began to feel them like sucking entities, forever tied to my breast, weighing me down, eating me alive. Sometimes I didn't think I could last through the next few months. Then I would shift and feel my equally real concern for them, how tied I was to their lives, how much I learned from and valued their bravery and their struggles, how much I stabilized myself by learning to stay stable with them, and how much my life was enriched by my work.

I began to anticipate the loss of not knowing how my clients were, what they were doing, how they were struggling. I would feel the loss of connection deeply. I had seen most of my clients for several years. Some of them left for a while, and then returned. Some of course, I never really made contact with, or our relationship floundered early on and ended. But it was the long deep relationships that I both cherished and felt burdened by. I was often scared to tell them, not wanting to add pain or disappointment to their already difficult lives, and not wanting to field their reactions and add pain and disappointment to mine. I had only three months between the time of the decision and the move, three short months to process what should have come as a mutual and gradual decision and instead had come so abruptly.

I struggled to understand the best ways to handle these endings. I sought additional consultation, talked about it in my peer group, read what I could find. Most of the research material that I located focused on how to deal effectively with normal termination issues in the clinical hour: how to handle client anger or denial, the difference in termination of brief and long-term therapy, and the need for supervision. These terminations were all instigated by the client, planned for, prepared for. Very little focused on premature termination, except in the context of a year-long training rotation, and premature termination was what I had initiated with my clients. There was even less material on countertransference issues and the therapist's own reaction to termination, particularly, again, when the therapist initiated the termination and the therapy was not finished.

I had expected to experience tremendous sadness myself, but I was struck by how often my grief was tinged with a sudden sense of relief, and toned with a measure of numbness.
I had expected to experience tremendous sadness myself, but I was struck by how often my grief was tinged with a sudden sense of relief, and toned with a measure of numbness. My reactions were more complicated and confusing than I expected, and I had to monitor myself constantly. The most consistently challenging part lay in addressing both the reality of the nature of the relationship, the roles of therapist and client, and the more interpersonal aspect or mutuality of the situation. I wanted to acknowledge the real losses that we both faced while watching for what the client needed. This premature termination seemed to require more self-disclosure than I had anticipated, and I had to be watchful to contain my personal material so that any self-disclosure was always in the service of the client. Not any different than at any other point in the therapy, obviously . . . yet now the drama that was being played out and the intensity of the transference and countertransference made the entire process thrilling, exhausting, and overwhelming.

She watched herself watching me

I needed to terminate my work with Louise O, but it was not as simple as what the readings and consultations on termination suggested. Six years previously I had begun work with Louise. She was referred to me by a colleague who lived in a small town about 40 minutes away and it was clear she wanted to see someone who was not connected to her community. The safety I afforded was worth the inconvenience of the commute.

Louise was 32 and a single parent of an eight-year-old boy. She was well educated and worked at a demanding job. She initially came in because of feelings that had arisen as a result of her parents' recent separation and conversations with her father. She wasn't sure if she wanted to open up what might be a bottomless pit of feelings, but she wondered if there could be more pleasure in her life than just work. She spoke flatly and quite matter-of-factly about her life, about being a good teacher, and good at taking care of others and how she had no one bigger to lean on. Someone whom she had considered a friend had just turned on her after she had confided in her. I have to do it all myself, she said, and I am tired.

The second session she arrived with a very small puppy with a broken leg. She looked at me and with dry irony said, "Hmm, seems appropriate, don't you think?" There were hints of what was to come in these first hours together.
She was scared to look at me. Her eyes roamed the room, trying to familiarize herself with the details, trying to get comfortable. She watched herself watching me.
She was scared to look at me. Her eyes roamed the room, trying to familiarize herself with the details, trying to get comfortable. She watched herself watching me. It was hard for her to self-initiate, and there was much silence.

A few months into our sessions, our work took a sharp turn. I had seen hints of her terror, but now we had built enough safety and trust in the room that she could fall headlong into it. Louise began every session the same way. She would spend several minutes looking silently around the room. Often within a few minutes, she had curled into a ball in the corner of the sofa, hiding her head. When the terror was most extreme, she hid altogether, pulling the cushions or the blanket over her. Sometimes, I would trigger it, by asking a question. Sometimes, it came with no obvious trigger. She would walk into the room, take off her shoes, and without a word collapse into the pillows.

I tried different strategies. Nothing could pull her out of it and I could coax no words. I was scared, impatient, angry, confused.
I began to dread our sessions. Was I being manipulated? What did she want from me? What was she re-enacting?
I began to dread our sessions. Was I being manipulated? What did she want from me? What was she re-enacting?

I was a young intern when I began seeing Louise, just out of grad school. Fifty minutes of silence like this was difficult, and nothing in my training thus far had prepared me for what I came to realize was an unimpeded regression. My anxiety was enormous. What concerned me first was that my own discomfort as I sat in the room with her could become so great that I wanted to crawl out of my skin, or refer her out. Was I feeling some of what she felt inside, I wondered. How could I find my way through this unless I could tolerate it myself?

Tolerating my fears, entering hers

So what I began to do was to work first with my own anxiety. I would ground myself, imaging my body as a pyramid with a wide and stable base, dropping my attention into my belly. It was a kind of meditation, dropping the thoughts and simply working with the sensations in my body, until what felt unbearable softened and melted into a spacious quiet. I would gather my attention in the hara, or belly point (in Chinese and Japanese traditions, the hara is considered the seat of one's spiritual energy and the vital center of the self) and as I relaxed I could tolerate my fear and anxiety and enter into hers.

I had to completely enter her internal world while staying firmly rooted in mine. It was the hardest work I had ever done.
I had to completely enter her internal world while staying firmly rooted in mine. It was the hardest work I had ever done. I was reading some of Winnicott's papers to help me with this case and I came across Margaret Little's book, Psychotic Anxieties and Containment: A Personal Record of an Analysis With Winnicott, which is an account of her own analysis with Winnicott. She had herself worked through what she termed a psychotic regression, while still functioning as an analyst. I was struck upon reading her description of the work of sitting with a patient in this state: The analyst has to be able to give up his defenses against the same anxiety, the dread of annihilation, of loss of identity, both for himself and for his patient. At the same time his own identity must remain distinct and his reality sense unimpaired, keeping awareness on two extreme levels. He is in the position of a mother vis-a-vis her infant, but where neither he nor his patient is in fact in that situation. This calls for the same qualities as those of a good-enough mother: empathy with the infant on his level, and an ability to see him as a separate person. Not relying on his "professional" attitude to accept a direct relationship with him as distinct from the mirror image; psychically to merge with him, accepting the delusion of oneness with him; to tolerate his hate without retaliating when the original traumata are relived and to stand his own feelings when they are aroused.2

It was a confirming experience to read her work. It gave me courage and it expanded my understanding of the nature of the beast.

I began to imagine what her experience was and to try to articulate it for her, the one with no words. I was at sea here, moving into my own uncharted waters. My words did not come from my intellect but from some deeper place within, the same place from which I focused inwardly and from which I stabilized my attention. It is hard to describe . . . a type of merger state, which I could only sustain by deep relaxation and steady attention. I spoke very simply, as if to a child, making the implicit explicit. I put words to her black hole of experience: "You are frightened, your terror is so big, and you are so tiny." Sometimes I would try to describe her feeling in more detail, the sense of falling in space, of not being able to find her body, and to feel that even to move an inch or blink her eyes might result in complete annihilation:
"This experience is very old—it goes way back before you could talk, before you could put sense or words onto feeling."
"This experience is very old—it goes way back before you could talk, before you could put sense or words onto feeling." Sometimes she looked at me blankly, and sometimes the glimmer of understanding would cross her face. As Margaret Little aptly puts it:

Such things arise from anxieties earlier than those of psychoneurosis; they concern survival and identity (Freud 1917), and for those who suffer from them the sound of words spoken may be important but not their meaning, so that verbal interpretation is of little use and other means of dealing with the anxiety need be found.3

I did not try to interpret with my words, but to translate. If my articulation matched her wordless experience, she might slowly raise her eyes, and look at me with terror and a just a whisper of trust. If I was inaccurate, she would shrink further into the sofa. If she was able to speak at all, they were simple phrases, a child's image of a bad thing, a bad thing waiting to grab her, to hurt her, but she could only whisper so softly that I could not hear her in my chair. She could not dare to speak up for fear that the bad thing would get her. I struggled fruitlessly to catch the phrases and so ultimately I began to sit beside her so I could hear her tiny words.
Sometimes I asked her to try to make contact with me through the terror, so she could begin to keep one foot in each reality, even if at first it was not a foot but maybe just a little toe.
Sometimes I asked her to try to make contact with me through the terror, so she could begin to keep one foot in each reality, even if at first it was not a foot but maybe just a little toe.

Holding Louise . . . the metaphorical and the literal

She could not make contact unless I initiated first. I would have to articulate some portion of her experience before she would chance a look at me. Sometimes I would ask, "Can you peek out?" Eventually she used her gaze to indicate a particular need, looking at my fingers and then away, sneaking a quick glance at my face for a clue if I had understood her desire for my finger, this link to another reality; at times she was unable to see through her internal darkness to even know where my finger was. We might sit through half a session with our little fingers interlocked. Margaret Little comments on this aspect of literal holding:

I feel it is appropriate to speak of the two things about which there has been the most misunderstanding—holding and regression to dependence. Winnicott used the word holding both metaphorically and literally. Metaphorically he was holding the situation, giving support, keeping contact in every level with whatever was going on, in and around the patient and in the relationship to him. Literally, through the long hours he held my two hands clasped between his, almost like an umbilical cord, while I lay, often hidden beneath the blanket, silent, inert, withdrawn, in panic, rage, or tears, asleep, and sometimes dreaming. . . . "Holding" of which "management" was always a part meant taking full responsibility, supplying whatever ego strength a patient could not find in himself, and withdrawing it gradually as the patient could take over his own. In other words, providing the "facilitating environment" where it was safe to be.4

I hardly fashion myself a Winnicott with his remarkable insight and skill, but breaking the boundary of no physical contact seemed not only appropriate, it seemed essential. To leave her alone in there would have been monstrous, and a replication of her original trauma. It was not a step I took lightly, however, and the responsibility of it weighed on me. Indeed, I also made use of consultation and supervision which I sought throughout this case.

There were of course other factors that made this work frightening. Louise had cut and burned herself for several years. At home, when her terror overwhelmed her, she would hide in her bed under the covers or lie for hours in the bath. She frequently felt suicidal. I worried for her son, though Louise was a responsible parent and careful to protect him from these patches of madness. Louise's job gave her summers off, and so summers were our most intense months, as Louise could devote more time to her healing. She kept a journal and wrote poetry. When the terror began to have form and she could not yet name it, I gave her paper and color and she drew the images. She wrote me letters on the days we did not meet, alternating between the voice of the exhausted Ms. O, that part of her that was capable of work and that drove to my office twice a week, and the voice of the child.

I read her children's story books as she lay curled on the sofa next to me. We called this fragile creature "the little one," in contrast to Ms. O who was so competent and so completely numb. It was like lifting veils of reality, so tenuous, so palpable.
I held her hands in my lap at the end of each session for several years, talking to the little one who lay mute and terrified, wanting to be seen but terrified of the exposure.
I held her hands in my lap at the end of each session for several years, talking to the little one who lay mute and terrified, wanting to be seen but terrified of the exposure. She told me in our final weeks that more than anything else, it had been my willingness to hold the little one that had given her a tenuous thread to life.

Many years later, the day I told Louise that I was moving, I shook before I saw her. I was terrified. I was afraid of her fear, of going back to those sessions in the first few years when I had sat with her in silence. That would be the best, the silence. I was more afraid of what the worst might be. She had made tremendous progress in the last year, choosing life, she said, for the first time. "There are birds outside my windows singing," she said in that droll way of hers, "and birds are a good thing." Her episodes of regression were less frequent, though she could still be catapulted back into them, and it became easier to move in and out of them. She still wanted her hand-holding at the end of each session, though by now it had became a few minutes rather than half the session.

But as life would have it, her own situation that spring was very difficult. There were power plays in the administration at work, and her relationship was ending. She came in several weeks in a row in that completely retracted state, mute and unresponsive, and I knew from experience that I could not thaw her or draw her out any more quickly than she wanted. Pushing her in such a state previously had had consequences that had taken us weeks to unravel. So I had to postpone telling her my news for several weeks. This only heightened my own anxiety. Was I postponing telling her because I was afraid, or because it was too much for her to take at that moment? Each week I was torn between my fear of her overwhelm, the reality of her overwhelm, and my fear of shortchanging our time to process the termination.

Telling Louise

When I felt she was stable enough, I told her I had something difficult to tell her, and that I had had to make a very hard decision about my life that impacted her. I could feel her terror rising with my opening words. Before she even knew the content, she had pulled deep inside herself to receive it. Her eyes had lowered: she shrank into the sofa. From many years of being with her this way, I knew that as dissociated as she was, she could still hear my words. She could not respond in the moment, but she could listen. My voice was still the thread that tied us together.

So I talked. I told her that I would be moving and that I would be closing my practice. I told her why, and that I had not anticipated this when we began our work together. I spoke of the unexpected, the promise I had made to her so long ago that, barring the unforeseen, I would stay with her as long as she wanted me to; and now the unforeseen had come to pass.

I talked about the tie that we had, that had brought us this far. I brought up what was different now than when she had first come to see me. But mostly I talked about what I imagined she was experiencing, and tried to breathe through my own desperate fear that this would decimate her, that I would lose her, that she would begin cutting again, threaten suicide, and succeed.
I sat quietly with her in my silences, anchoring myself for both of us. She was shaking under her cushion cave, eyes like stone.
I sat quietly with her in my silences, anchoring myself for both of us. She was shaking under her cushion cave, eyes like stone. As the hour came to a close, Louise was still silent. I reminded her that we still had many weeks to deal with this. I stood up and went to the door. She picked up her bag without looking at me and moved heavily out of the room.

An extraordinary final request

Louise returned three days later, sat on the sofa, looked at me and said, "

I want three things, and I don't want you to say anything until I'm done. You know this is devastating for me.
I want three things, and I don't want you to say anything until I'm done. You know this is devastating for me. We have always met in this room and I am not sure that you exist outside of this room. The only way that it will be okay for me to have you to leave is if I can know that you exist in the rest of the world as well. If I know that you are out there in the world, then you can still be with me in some way. I will have seen you out there, so that when I walk in the hills or come here, I can remember you in that surrounding and remember us together out there, and know that you still exist." She paused, gazed at me for a second then continued. "So I want to take a walk with you outside of this office. You can decide where; that really doesn't matter. Second, I want you to come to my house and see my room and my garden, and third, I want to see your garden."

She had completely taken control of the session, and taken me by surprise.
She had completely taken control of the session, and taken me by surprise. I never had a client ask anything like this, nor would I anticipate anything like it again. What she was asking was further boundary-breaking and I needed to think it through. We spent the hour exploring her requests, and I told her I needed to think it through myself.

My gut response was to do it, but my intellect balked. I was afraid here, the same fear as when I was holding her. Was I doing more harm than good? Was I destroying the integrity of the container we had created? Was I gratifying her unnecessarily instead of working through her resistance to losing me? I talked about it in consultation, and in my own therapy.

From our conversations, I knew that she was not trying to change the nature of our relationship, or to turn me into a friend. She was trying to let go of me as her therapist, but internalize me at the same time. The natural process had been shortchanged, and she was, I think quite creatively, trying to effect what would have normally taken more years. The walk would bring us out into the real world, the place she had the most difficulty traversing. Walking was also a way she stabilized herself, even on the worst of days.

The second request was to see her garden. Our gardens were symbolic energies for both of us. Over the years she had described to me her garden's progress from a soil-less, rocky and barren lot. It was a pretty good metaphor, yes? Many of her colleagues had given her seedlings and cuttings, and several years before she had wanted cuttings from my garden as well. We had talked about what that meant to her, about alchemy, the magic and transformation of soil and plants and water, and the alchemy of what we were doing together in our little room, the internal garden. The symbolic and the real, the metaphors that made the future a viable possibility rather than an unbearable sentence. The mystery of the bulb that lies dormant all winter, hidden and unseen, no way to verify its existence except through faith, and then the magic of its growth and beauty each spring. It had been important to have some of the same plants that I had in my garden, the same flowers I had brought into my office every week, and important that I had been willing to share them with her.

For me to see her garden now, I knew, would be a verification of all she had gained. It was also, she said, a chance for her to show me what was calm and normal and settled in her, rather than the dissociated and broken self she most often brought to the office. And when she sat in her garden, she said, she would remember me there, too.

What she wanted from seeing my garden encompassed her first two requests. She could see me in my real world without impinging into my privacy. She did not want to see my house, which would be too real and scary. It was my garden, my creation, that held my essence for her. It was the third leg of the tripod.

The next session Louise asked me what I had decided. I told her that I thought it was a good plan and reiterated that we needed to keep talking more about each aspect as the time got closer. Again, I expressed my concern about not being finished.
She cut me off quickly and impatiently, as she did when she felt I was stating the too-obvious. "I know we aren't finished and that I have to find someone else," she professed boldly.
She cut me off quickly and impatiently, as she did when she felt I was stating the too-obvious. "I know we aren't finished and that I have to find someone else," she professed boldly. "I already called the woman whose workshop I went to last year and I have an appointment tomorrow to meet with her, but she isn't sure that she will have room for me in her schedule. If you will give the names of some therapists you think I could work with, that would be good, too. I know that I can't replace YOU and I also know that I am not ready to do this on my own. So I have to find someone who somehow I can continue with, and I want to have all of it, or as much as I can, in place before you leave."

It was astonishing to see the shift in her in a few days' time. Was this a resistance, a flight into health? It was what we called the Ms. O face of Louise: capable, high functioning, and often quite wise, but as cut-off from her true self as the little one. Ms. O could usually rally when needed and state her truth in a flat and practical way, but without much affect. I wondered if I should tag the resistance. Yes, she was finding a way to protect and minimize her loss, but she was also honoring our work by acknowledging her need to continue, by immediately looking for a something, without having to denigrate me in any way. She knew the depth of her grief, and knew that she could only let it trickle through or she would decompensate.

When we discussed her feelings over the next few weeks, she expressed sadness, disappointment, envy, fear, and numbness, but not anger. Anger she had shown me before when I truly misunderstood something important, or tried to impose my will on hers, as when I had strongly pushed her to be evaluated for medication when her escalating cutting and burning had been most frightening for me and most physically perilous for her. Yet anger at my leaving was too dangerous and too threatening for her to consider directly. Although I was quite sure that she did, indeed, feel anger towards me, I was also quite sure it was currently inaccessible, and I chose not to pursue it. It would be up to Louise and her new therapist to address such feelings down the road if and when it made sense to do so. On a more practical level, it did seem that Louise was constructively making use of her anger and intense feelings by taking action, suggesting plans about our endings, and taking active steps to find another therapist.

I was actually quite impressed by how she had taken charge of the situation. Yes, she relieved me of some of my burden, and I was wary of this. I was sometimes afraid she was taking care of me, protecting me from her terror and her anger, and from some of my own. Because of the strong psychic bond that we had, she, of all my clients, perceived the intense fear and ambivalence I had about my move. She asked me many direct questions about my decision and my feelings. I acknowledged my fears about the move, but presented them as something that I had to struggle with, as the challenge that they were (and still are), as the call into the unknown.

Louise was taking a sabbatical year, with the hope of not returning to her work at the end of it. It was a year we had both looked forward to, as a time of great healing and renewal for her, and I had drastically changed the look of that year. What I tried to do, without minimizing the extent of her loss, was to equalize to some degree the challenge we both faced with the unknown beckoning, so that I could model a way of standing next to, if not embracing, that which we feared. Louise had often said that she felt I was the first face she had imprinted on, and that she sometimes watched me to see what it was that humans did or were supposed to do, just the way a baby bird will imprint on its mother, surrogate or real. So I walked carefully between my self-disclosure and deflecting her questions back to her.

I wish there were some way to know if we did it right or not. One clue helped calm some of my fears. Louise came to see me soon after her meeting with her new potential therapist. The night before she had a dream. She was in the new therapist's office and there were two closets on opposite sides of the same wall, covered by lovely iridescent lavender satin scrims. Though she couldn't see inside them, she knew that the closets were huge and connected inside, so that in reality it was one large closet. And just in the doorway of one side of the closet, she could see a large ball of thread sitting on the floor . . .

When I asked her to tell me more about the dream, she looked at me as if I was completely dense and stupid.
When I asked her to tell me more about the dream, she looked at me as if I was completely dense and stupid.

When I asked her to tell me more about the dream, she looked at me as if I was completely dense and stupid. Louise taught using story and myth and she knew the story of Ariadne and the thread that she had given to Theseus to escape the labyrinth. She did not want to talk more about the dream, and there are of course many ways to understand and explore it. Most important was that it had profound meaning for her; it was her thread out of the labyrinth, and that there was no separation behind the lavender scrim, between any of the many dualities that we might consider. It was the end of our session, and we left it at that.

Entering the garden

During our last session, we met at my office, and she drove me to my house a few blocks away. We avoided the house and entered the garden gate, and she walked through the garden, noting the plants. I briefly told her the story of my garden's growth, from an empty plot of weeds to the lush Mediterranean retreat it was now. She recognized some of the irises that I had divided and given her. We didn't talk much. She soaked the garden in and after 10 minutes or so, she nodded she was ready to leave. We drove next to the marina.

We walked the trail that edges the water. We were not friends, not companions, but we were comrades. We had fought together.
We walked the trail that edges the water. We were not friends, not companions, but we were comrades. We had fought together.

I was not comfortable. Many voices chattered in my head, many questions, many doubts. Again we did not talk much, but continued to walk along the path. There was no pretense of friendship. We were still therapist and client. A parafoil-propelled cart raced by on the path and we laughed in astonishment. We had no script for any of this.

The following Saturday I drove 40 minutes to her house. She made me coffee and took me through her garden. It was wilder than mine, with tall grasses and tumbling masses of hardy perennials, with rock-lined paths and a mosaic bird bath. I could imagine the slow transformation from scrabble soil and a weedy lot to this most imaginative garden spot. We meandered our way through her backyard, periodically stopping to listen to the birds. I was hyper-aware, as I had been in my garden and on our walk, of every second ticking away. She pointed out the plants I had given her, and showed me others that had been given by friends or started from seed. A mockingbird flicked its tail as it rested on the branch of a tree and a hummingbird swooped past on its way to feed at a scarlet Mexican sage. As I stood with her I realized that I had never listened so intently to the sound of buzzing bees.

We re-entered the house and she took me into her room. Part bedroom, part study, part cocoon, her room was draped with dyed swaths of silk scarves, the walls hung with her artwork, overflowing bookshelves. She had created a true retreat, a nest of safety, filled with color and form and whimsy. Look, she said and pointed behind me. I turned to see what she was pointing to: a statue. In my office, I have always had a small statue of Kwan Yin, a representation of the Chinese goddess of compassion. There on the floor next to her bed was a larger version of the same statue. "The parents of my students got together and gave her to me," she said. "And they didn't know anything about the one in your office." Her eyes were wide as she said, "They gave you to me."

As I left her house and walked to my car, I was struck by how in fact I was doing the final leaving, not her. The enormousness of our ending hung on me in the way that time seems to stop for a moment. My own mother had died that winter and I had been blessed with the grace and good fortune to be with her as she took her last breath. As I left Louise's house, I had the same sense of leaving the hospital after my mother's death: grief, gratitude, and an appreciation of the infinite mystery of life.

The client's side: Louise responds

Prior to publishing this article, I sent it to Louise, asking for her permission to tell the story of our work together. It has been eight years since we had our last session in the garden. This is Louise's response, which she also gave permission to publish here:

I've read your paper through twice now and have many thoughts. Yesterday, after the first time I read it through, my first response was one or two tears. Very basically, I was sad I had caused you pain (anger). And then I woke up in the night and asked myself all-important questions: What else were those tears about? They were definitely the little one's tears. She still exists, of course, tucked in very safe within myself. And then, also, I began to go through the times you talk about and ask, "How did that coin look from my side?"
I remember why I started therapy, the absolute clarity that I was not willing to live without feeling.
I remember why I started therapy, the absolute clarity that I was not willing to live without feeling. That the feelings were there somewhere and must be gotten to if I was going to be alive.

I also know that I had a picture of what therapy would be like that was not in any way what happened. What I expected was something involving talking . . . out loud. You would ask I would answer. The work would go somewhere. All would be revealed. All would be healed. Uh-huh. And at the same time, yep, that's true.

When I teach adults I often work through with them pictures of the twelve senses. The first of the senses is touch. "Touch" is not tactile. It is a sense located in the organ of the skin, an awareness of the skin as a boundary, a boundary that gives you certainty that you exist and are an entity, something real. The place your spirit can exist on the earth. "Touch" is what allows you to take in and perceive the world and form memories. Memories that you can access and name. Without a sense of touch a soul has no boundary, no container. Memories have no place to live and the feelings cannot coalesce into something cognizant and meaningful. They are just pure emotion swirling around, nameless, overwhelming, annihilating.

To live without a functioning sense of touch is to live in constant fear. Fear of imminent annihilation, fear you are not real. I know about this. You know about this.
To live without a functioning sense of touch is to live in constant fear. Fear of imminent annihilation, fear you are not real. I know about this. You know about this. I know about this. You know about this. This is where I used to go. There were lots of feelings. Huge feelings. None of them nameable. None of them in context. All of them outside of me, surrounding me, bigger than me. If I could describe it at all it would be a feeling of all encompassing destruction by terror. Blown apart by terror.

I wanted to talk to you about my feelings. I assumed it would be in words an ear could hear. What happened was as soon as I began to access the feelings they were so big and so unnameable and so much outside of me that to even try to move around in them would have shattered me. Or at least that's how I felt. I had to freeze in them to make it through them. You know this.

The immobile silence I fell into in your office was the only way I could describe how I felt. I had no names and so could find no words, but! That silence, that frozenness, is still the most eloquent communication I have ever had with anyone about my experience. I never doubted you heard me. I have never been able to say it so clearly to anyone else. It was the language of gesture, but it was language. I would make it to your office, kick off my shoes and fall into that place because after a week of being emotionally silent I needed to talk. It felt like talk. It felt like rivers of words. Words in the normal sense had no connection to feeling for me. I did not have names for them, for the feelings, and so they did not exist. They were not a means to communicate.

What you did was give me names. Each time you named a feeling for me it became a letter, something that could be worked into words, written inside, where I could at least make some jumbled start at sorting things out, forming a narrative. Holding it and not being overwhelmed by it. You gave me a vocabulary. You taught me "fear," "sad," "angry."

In what you wrote about that time, where is the part where you acknowledge what you did? You speak of feeling frustrated, fearful, angry. The reason for the little one's tears. But then when I think on it, I think about your face, and the being of you that you brought to therapy, and I cannot find a scrap of frustrated, fearful, angry in it. I don't mean you did not feel those things. But I can smell those things coming for miles away. I can hear them in the tones of someone's voice. If you had brought them with you the little one would have seen that coming a long way off. And you would not have known her. My point is that
while your intellect may have been sifting through lint, your heart was always as smart as they come.
while your intellect may have been sifting through lint, your heart was always as smart as they come. You might say, "Ah yes, but I needed to project such perfection on you." Maybe.

Maybe not. When you were not perfect, I believe I mentioned it. You did not need to be perfect. You loved me. You saw me. You trusted your heart and so you saved me, because you gave me the vocabulary to begin to make for myself a skin. A container. A place I could live and do live. That simple. Whatever you felt outside the room, however much you might have doubted yourself, the greatest part of what you did bring was strong and true. If it was not so, the little one would have known it. I would have known it. And I trust my instinct.

And then about the leaving. We worked together for six years. It's been eight years now that you have been gone. When you left we were not done. And yet we had to be. Whether or not I had reached bottom it became bottom because there was no more time. Yes, it was terrible. Yes, it was devastating. Yes, it broke my heart. But at least I could feel it. And because it had to, something began to happen at just that moment. I did not know it then, but I know it now when I look back and try to trace something. This is my side of that coin.

Have no doubt that I was protecting you when you left. I remember that very clearly, committing myself to not letting you in to all that I felt about it so that you would not feel worse than you already did and I knew you did. This was a very clear choice made because it was the only way I knew to honor what you did for me. But something else happened too.

The day you told me and I picked up and left without a word, I knew there was a choice. I could give up or go on.
The day you told me and I picked up and left without a word, I knew there was a choice. I could give up or go on. And I went on. I picked going on. Partly for you and partly for me. I couldn't or didn't ask you what to do, but inwardly I looked around for someone to ask and someone showed up. In retrospect, that was the first time Ms. O showed up for me. Not in Ms. O teacher drag, but in PJs. Cozy so I didn't recognize her then.

I know I used to hate Ms. O, I know I raged at her for appearing to have no needs, so that my needs never got met. I know she was not real to me or for me. Not there for me. You used to try to interest her in me, in the little one. It didn't fly then. I remember feeling this. I have not thought of myself in these terms for a very long time, but if asked I would say now that I am Ms. O. I like her. The little one has a nice little home very deep but not hidden in her heart. Ms. O became my inner mother. Maybe she always was, but she and the little one had a horrible mother-daughter relationship. There's lots of talk about inner child; somewhere around forty-two or so I stumbled across my inner adult. A mother who would always figure out what to do. That's Ms. O for me now. The same one who takes care of many, and the one I can always ask and she has the answer. So in the night after I read your paper I started to think, when did this begin? How?

But I asked myself what I needed and that part of me showed up with an answer about how to bring Amy outside the room.
But I asked myself what I needed and that part of me showed up with an answer about how to bring Amy outside the room. When she's gone, no one's going to let you in this office any more. There won't be an office that is Amy's office, but there will be times you need her to be tangible. You will need to find her. Where can she go? And the answer was into the things that I love. I remember very clearly asking myself what I needed and myself answered.

What I remember about that walk was the light and the sparkle on the water. The wind. A friendly wind. Enough was let loose into that wind that I never did lose you. And by letting you see my room, my garden, enough of my strength was let loose, made visible, made real that I never did lose that either. Ms. O became for me an Amy. Not THE Amy, but something like one. An answerer of questions. I trust her as I trusted you then. I can ask her anything and she knows and it's the truth. My next therapist became somehow the witness to this. How strong I was got repeated in her office until it didn't need to be said again.

Were we done? No. Was there more we could have done? Yes. Could the bottom point have been deeper? Most likely. But it was enough.

Was I angry? In the sense that anger for me in those days was immediately directed inward, yep. But something else happened too. The only way to explain it is to tell you a parallel story. One year ago last summer I saw my father again. We emailed and then finally met face to face. First alone and then briefly with my therapist. I had plenty to say and I said it. I was angry. He knew it. He took it. He listened. He cried. And then he wrote me an email and he apologized. That was good. He said he took responsibility for all the bad that happened to me. That was better. And in that moment something happened. Call it alchemy. Or forgiveness. It happened in an instant, but it was real. I see my father now, quite often. My mother died and my father remarried and I like his wife. We talk on the phone several times a week.

There's still a part of me that holds stiff, that doesn't trust all the way through, but I'm sticking around to work that out. Was I angry at you for leaving? Yes. Hugely but briefly.

I knew your weren't choosing to leave me. I knew you were sorry. I have to say it was hard to read that you were relieved as well, but in all honesty there are days in my work to where I think, "Oh, to hell with this, I'm going to quit and write cheap novels." The point is the part of you that was sorry to leave me, to cause me pain, made it possible for me to be angry intensely and then get over it. In that sense there was a forgiveness. Long long ago. If I was angry through these years or still was I would know it because part of me would go "blah" inside (imagine tongue sticking out) when I thought of you.

If we had continued to work together eventually you would have been there for the meeting of Ms. O and the little one. Two things brought them together. Desperation precipitated by your leaving and the start of work where I could use my experience to heal others. A few years after you left I learned a new word: "happy." You weren't there to tell me the name of that feeling, but without "sad," "fearful," "angry," I would have never got to "happy." You weren't there but someone was in here who I could ask and she let me know.


Notes

1 "Louise" is a psuedoynm.
2 Little, Margaret I. Psychotic Anxieties and Containment: A Personal Record of an Analysis With Winnicott (NY: Jason Aronson, 1990), pp. 88-89.
3 Little, p. 86.
4 Little, pp. 44-45.

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Amy Urdang Amy Urdang, MA, LCPC made a hard choice between pursuing horticulture or becoming a therapist and figured her back would give out before her mind would. She is a Licensed Professional Counselor currently working in Baltimore, Maryland and formerly practiced as a Licensed Marriage and Family Therapist in California. After Graduate School at John F. Kennedy University, she devoted herself for many years to the Existential-Humanistic work of Jim Bugental, as well as to in an intense study of the Enneagram with Helen Palmer and has a deep trust in the relationship between meditation and therapy. She is currently a candidate at the Baltimore Washington Center for Psychoanalysis. She can be reached at 410-889-0800 or through her website in the therapist section www.psychologytoday.com.

CE credits: 1

Learning Objectives:

  • Increase awareness of how therapy affects the psychotherapist.
  • Explore the value of using therapist countertransference and self-reflection in relation to termination.
  • Stimulate creative thought about what it means to connect and provide therapeutic safety in psychotherapy.