Psychotherapy "Terminations" and Beyond By Victor Yalom, PhD on 6/29/17 - 3:39 PM

Often when I “terminate” with a client (what a horrendous term for the conclusion of a meaningful human encounter) I let them know that I don’t see therapy as some kind of permanent cure to the concerns that brought them in to see me. At best it offers some meaningful relief, and some expanded awareness and resources that they may draw on when they inevitably face future challenges.

I usually tell them I’d be happy to be of help in the future, whether seeing them again, or referring them to a colleague, often adding that I’d be delighted to hear from them with any update on how things are going for them. 95% of the time I never hear back, but of course certain clients run through my mind at various time. I may walk by a building that a client had done the architectural plans for. Or I am riding my bike, and I remember their joy in a bike tour they once took in New Mexico. Or a client springs into my mind for no apparent reason at all, and I wonder whether their marriage—that I had some role shepherding them into—gave them the love and sense of safety they craved.

And then there are those clients that I mark down on my inner scorecard as failures. Yes, I might have given them some support, maybe I helped marginally change the trajectory of their lives, but I felt that somehow I just couldn’t help them break through to achieve the types of changes that they desired—or I desired for them. How were they doing? Were they still as depressed as when we parted ways? Or worse…had they given up entirely? Committed suicide?

I notice that I hesitate before I type the word “suicide” as if somehow that reflects poorly on me that I’d even have this worry. Why the hesitation? Is it that I should be omnipotent, and never have clients, or even former clients that might commit suicide? Or is it that I shouldn’t admit that clients occupy my thoughts even years after I stop seeing them? Has the pernicious concept of therapeutic “neutrality”—one that we thought started and ended with psychoanalysis—become so rooted in our profession that we carry it with us without awareness? As if it’s wrong to care about our clients as actual human beings, as individuals!

There is one specific client that I do worry about from time to time—yes, worry whether he did decide to put an end to his tormented life—but I was somewhat reassured recently when I ran into a colleague at a conference whom I had entirely forgotten was the original referral source. She knew the client personally, and related to me that he was still alive, although still very much struggling day to day, but that she was grateful for the help I provided her friend. Given my feeling of failure with him, I was pleasantly surprised that my efforts were appreciated.

Just a few days ago I got an email out of the blue from a client I’ll call Penelope whom I saw several years ago. She said she just wanted to say hi, thank me for the help I had provided, and let me know that things were going well for her. She was a classical musician who was starting to achieve some success in her highly competitive field, and for the first time in a stable relationship.

I recall that the course of therapy was not an easy one—for the client, as well as for me. We all have our own tricks of the trade, some we like to think of as our own, or at least ones we’ve customized to fit our own personality. I like to work in the “here-and-now” when I can, drawing attention to how the two of us are engaging, with the idea that this will shed light on the client’s interpersonal relationships. Of course this is not a proprietary technique—I learned a great deal about this from my father—but I like to think that I have achieved some mastery in this.

In this case it failed repeatedly: Every time I asked Penelope how she was feeling towards me, she bristled, got angry, and didn’t see how this was relevant to her issues. I recall various responses on my part. One time I made an impassioned plea, relating her difficulty in trusting me to problems she was experiencing with a friend or co-worker. Or I would try to push back, again in the here-and-now, saying something like “I really sense that when I ask you how you feel towards me, it hits some sort of nerve for you. Can you tell me what is triggered?” Again, this got nowhere fast. Finally, I took this prized technique and stuffed it back in my toolbox where it belonged. Was that a failure? Or a brilliant realization that there is no one-size-fits-all in this work?

My memory is a bit hazy, but I recall we worked on and off for a year or so. I don't remember exactly how things ended, but it certainly wasn't one of those Hollywood therapy endings where her neurotic puzzle was solved, and I was left with a warm glow that I had performed my craft with precision. So thank you Penelope for being one of the 5% who let me know what has happened in your life. I go on faith that most of those I work with have some lasting benefits from our work, but it’s sure nice to hear it from you.

* * * * *

That was going to be the end of my musings, so I sent this piece to Penelope to make sure she felt comfortable with me publishing this (even though identifying details are changed). She wrote the following:

“I think that even though it made me pretty mad when you asked me how I was feeling towards you, I realize now that I was mad because that’s what I needed to work on. It took me a few more years to not get mad when people asked me stuff like that, but once I got more comfortable having conversations like that it was a lot easier for me to have close relationships.”

Wow! If I had known at the time that my apparent misfires would ultimately yield results, it would certainly have reduced my anxiety during the therapy. Would that have made me a better therapist? Perhaps not. Uncertainty is inherent to the process, and something we need to learn to live with. But how heartwarming it is to know now that my efforts with Penelope planted some seeds that are now blooming.

File under: The Art of Psychotherapy, Musings and Reflections