“I know we only have a few minutes left in our session,” Martha says interrupting her complaints about her work and her marriage, “But I wanted to tell you I’m planning on taking a break from therapy.”
Feeling immediately angry at this sudden pronouncement with almost no time to discuss it, I ask, “What led you to that decision?”
“I’ve been thinking about it for a while. We just don’t seem to be getting anywhere. I come in every week and complain about either Mitchell or my boss, my boss or Mitchell. It doesn’t change anything.”
I happen to concur with Martha’s assessment, but my sense is that my attempts to engage Martha in greater self-reflection, as opposed to her litany of complaints, has been mostly unsuccessful.
“Martha, could you at least come for one more session to talk about what you think hasn’t worked and why, as well as giving us a chance to say good-bye should you decide to end.”
“I’m not ending. Just taking a break. Besides, I’m on vacation the next two weeks.”
Another surprise. Martha obviously had planned her leave-taking for a while, even neglecting to mention her upcoming vacation.
Aware we have no time left this hour I say, “Well, what if you come in three weeks from today so that we have a chance to talk and in the meantime maybe we can both think about why you chose to tell me about your break at the very end of a session right before you were going on vacation?”
Martha sighs. “I guess. This seemed like a natural break point, but if you want me to come in once more I guess I can do that.”
“Thank you. I’ll see you in three weeks and have a good vacation.”
I am definitely annoyed, feeling dismissed and discarded. I have no idea whether Martha will show for her session in three weeks and whether or not she’ll continue. I feel obliged to keep Martha’s time available even though she’s made no commitment to the continuation of our relationship.
Martha does show in three weeks. She is, however, uncharacteristically late, leaving me again off-balance and unsure of her intentions.
“Well, I’m here,” she says. “What do you want to talk about?”
“Maybe we should start by talking about your anger at me,” I suggest.
“I’m not angry at you. I just don’t think we’re getting anywhere.”
“You tell me the last few minutes of an hour that you’re leaving, you’re late to this session and you seem annoyed about being here.”
Here I am again, angry. My anger. Her anger. My anger. Her anger. Maybe that’s what’s going on.
“You know, Martha, I think what you’ve been trying to do – unconsciously of course – is help me to feel your level of anger, dissatisfaction, and powerlessness, whether those feelings are directed towards me, your husband, or your boss. Things aren’t going the way you want them to in any aspect of your life and you feel powerless to change them.”
“That’s exactly right!” Martha says brightening.
“But I wonder if you’re really as powerless as you feel,” I continue. “Or if you don’t know how to ask for what you want or don’t know how to make it happen. For example, I want you to stay in treatment. I do understand that simply complaining about what’s not working in your life isn’t helpful; that we have to figure out ways in which you can get what you need here as well as in other parts of your life.”
“But how am I supposed to know what I need? You’re the doctor, you’re supposed to know.”
“There’s an awful lot in what you just said, Martha. First, there’s a request to be taken care of and anger at not being taken care of. But there’s also a lot of passivity in your statement which only increases your feelings of powerlessness and makes you less likely to get what you want.”
“But I don’t know what I want! I just know I’m not getting it.”
“That’s a great insight, Martha. And it makes a lot of sense. When you were a kid, no one cared what you wanted. They were too busy with what they wanted. You don’t know what you want. But you do know you feel dissatisfied. And when you’re dissatisfied you complain or leave. I’d say we know what we need to work on, assuming you’re willing to stay and work on it.”
“I was sure I was going to take a break. But, yeah, I’m willing to give it another try.”
“Good,” I say smiling.
Excellent work! This is one tricky customer and you got hold of her in a clear, kind and firm way. You have passed the first test. Trust, or the lack of it, is surely a big issue for her.
Thanks a lot, Josefine, I appreciate your feedback and your encouragement.
Very good post. Thank you for sharing
You are helping me think about an on again off again client of mine.... Thank you!
Thanks so much for commenting. I'm glad I could be of help.
linda: as always the clarity of your thinking & your keen awareness of your own affective state combine to make a lively & effective lesson for any psychotherapist, beginning or veteran. We have all been there. I hope I handle it as deftly as you next time. Thank you!
Thanks so much for your feedback, Sylvia, and for taking the time to comment. It's always good to hear from you.
Don't understand the manipulation that occurred by the therapist in the session. Martha's symptom was used to the therapists advantage.
I'm afraid I don't know what manipulation you're referring to. From my perspective it is never in the patient's best interest to terminate therapy abruptly, especially when the ending is an expression of feelings the patient is having difficulty expressing in words.
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Thanks for your feedback, Anonymous. I hope you stumble upon my blog again.
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