Psychotherapy: Terminal or Interminable By John Marzillier, PhD on 6/3/12 - 9:01 PM

“I was okay until I met you!” she said and slammed the door of my office as she left. I have never forgotten that moment. I was shocked, not just by the vehemence, her incandescent anger, but by my complete failure to anticipate her reaction. I thought I was a good judge of character and I had got this woman badly wrong. I had invited her husband to attend the previous session and, instead of supporting her jibes and scarcely veiled attacks on him, I had taken a neutral stance. In her eyes, I had let her down. The one certainty was that the therapy had ended. Abruptly, unilaterally, angrily, admittedly, but it had the virtue of being unambiguous. I never saw my client again. 

During my long career as a psychotherapist I rarely experienced such a definitive ending. Fortunately, one might think, but was it? Looking back, I wonder whether I missed a trick, that, basking in my role as the Good Therapist, I colluded with my clients’ fantasies that therapy might go on forever. I would always be there, willing to see them again if they wished, for a few more sessions or a resumption of therapy. There were many clients who returned to me after an apparent ending. Smugly, I thought of myself as good at this job. I was not taken in by the idea that CBT or any other set of techniques was what determined outcome. It was the therapeutic relationship that mattered most and, for many clients, that relationship was the gossamer thread that linked us together. It might be scarcely visible but it was always there in the background even after therapy had ended. Now I wonder if something else was going on and the reason I was prepared to let people return, encouraged it even, was a fantasy of my own. Was it that I thought I was truly important to my clients, indispensable even, and that each time I received a phone call or a letter asking for more help, I felt the warm glow of satisfaction at the confirmation of my self-worth? 

This is not a comfortable thought. It would be easy to dispel it. I could tell myself that therapy rarely works in a straightforward way at first, people need more than one bite at the cherry, and those who returned to me did so because they trusted me and valued what they had received. And they benefited. All that may be true. But perhaps it is not the whole truth. Sometimes, therapist and client are dazzled by the therapy. It becomes a unique, special relationship. They have fallen in love. I do not mean that romantically or sexually but that something of the same specialness delusion operates. Good sense goes by the board and the relationship seems timeless. Until at some point it has to end.

“I have something to tell you,” I say. I am apprehensive, hesitant.

Patricia gives me a hard look. “That’s what people say when they want to end a relationship.”

“Well, that’s partly what I mean.”

Suddenly, her eyes fill with tears.

“In a year’s time I am stopping being a psychotherapist. I thought I should give you a year’s notice.”

She looks down. Tears are falling freely now. “Do you think that makes it any easier?”

I had thought exactly that but I don’t say it. I had wound down most of my clients. And earlier, I had thought that I might just keep Patricia on, to keep my hand in so to speak. When I mentioned this possibility to my supervisor, she looked me straight in the eye and said: “Why would you do that, John?” And I knew immediately that it would be wrong. 

“I’m sorry,” I say, inadequately, deflatedly, although what I am apologising for is only clear to me much later. 
All therapies have to end. When a therapist loses sight of the ending, it is no longer therapy but something very different.


File under: The Art of Psychotherapy, A Day in the Life of a Therapist, Musings and Reflections