Saying goodbye to your therapist

One of the very first lessons we were taught in social work school was about termination. The gist is that termination begins the first time you meet with your client. That sounds strange, I realize, but the fact is, therapy is not meant to go on forever. The idea is to graduate at some point; that even if your problem isn’t fully resolved, you will have the tools to learn how to live with it.

In some spaces, termination is very clearcut. For instance, when I worked as a discharge planner in various medical settings, termination was the whole conversation: when are you going home, how, with whom, etc. In therapy though, termination can feel more nebulous.

For so many people, starting therapy is a huge step. The beginning doesn’t feel like an ideal time to address the end. The client is at their most vulnerable, perhaps their lowest or most anxious, and it seems unfair to start an initial session talking about how long it’s going to take for them to feel better. So, although it was drilled into my head all through my undergrad and graduate school learning, I don’t always bring up termination in the beginning.

Often that's not a problem. For some clients, termination comes along naturally. You start feeling better, you don't really have much to talk about, maybe you start seeing your therapist every other week or once a month and then eventually you say your goodbyes. It’s one of the nicest parts of my job, actually, to review with someone how hard they’ve worked and how much has changed for them. I’m often sorry to see people go while also feeling proud and happy for them.

For others, it's trickier. Any therapist can tell you stories of being ghosted. It’s not a great feeling but we get it. After a handful of sessions there isn’t necessarily a solid relationship to say goodbye to; for some people it’s easier to just not return a phone call or an email. We’ll eventually figure out that you’re not coming back.

If we’ve been seeing each other for awhile though, properly terminating is part of the work. Which is not to say it happens every time in a lovely, neat way. It doesn’t happen often, but once in awhile a long-term client just stops responding. Again, we get the hint… but that doesn’t make it feel any better.

This is not meant to scold or condescend but rather to point out that termination doesn’t have to be messy. It doesn’t even have to be a hard conversation! You can say you just need a break or you’re so busy right now. We all know what that means. And for most of us, the door is open if you change your mind.

Say your goodbyes, even if it’s hard. You did the hard work of walking in the proverbial or actual door and you get to decide when to walk out again. Just do your therapist a solid and let them know.

Holiday Disappointment

The prevailing sentiment from my clients after Thanksgiving was a hearty “meh.” The holiday was fine, but not great. It was something to get through, not necessarily something enjoyable or special. It was, all in all, disappointing.

It’s hard to admit that The Holidays can be a disappointing time. After all, we’re told over and over that this is a season of GRATITUDE and JOY and DELIGHT and if you aren’t feeling those things, the problem must be you because it’s THE HOLIDAYS and you have to be HAPPY and ENJOY them. In short, The Holidays are a time of pressure.

Which is not to say you can’t have a lovely holiday season in spite of that. In fact, I hope you do! But I also want to encourage you that in the midst of the sparkle and tinsel and treats, you are allowed to feel lonely, disappointed, angry, etc. In short, you are allowed to have all the feelings, not just the happy ones.

It’s not easy to manage the disappointment or sadness or loneliness that is plaguing you as the radio shouts Christmas carols at you and stores demand you spend all the money you have in the name of MaGiC. But it is doable. As The Holidays march towards us like a smiling but threatening wave, try to focus on what actually brings you peace and joy. Reach out to friends and family while also avoiding people who cause you distress or unease. Indulge in treats without self-recrimination and guilt. Do what you’re capable of doing, whether that be celebrating or gift-giving or visiting or decorating, without thinking it’s not enough. Whatever you’re doing to get through this season is enough. The Holidays do not have to be perfect; they just are and they too shall pass. Hang in.

The loneliness epidemic

I famously hate to be alone. In my adult life, I lived alone for six weeks before convincing an old friend to move from Texas to Baltimore to live with me in my one bedroom apartment. I will insist I need a break from my family, only to wander in to whatever room they’re in a half hour later because I was lonely. All this to say, I know of which I write.

As we get older, our lives tend to get smaller. Children grow up and move away; spouses get sick or die; same with friends. The prevailing issue I hear from my clients, especially those who are widowed, is that they’re simply lonely.

Loneliness, in fact, was cited by the US Surgeon General last year as one of the biggest issue to face older adults, especially post-pandemic. We were already fairly disconnected from each other before the spring of 2020. Those weeks and months before we could safely gather were devastating for most of us but particularly difficult for older people who lived alone or with little informal support. We’re still recovering from those months (years?) and some things have changed permanently. Some people have never recovered from being alone so much.

After all, it’s really hard to have a robust social life when you’re older: you’re retired, the kids are grown and flown, sometimes even the grandchildren have launched into the world. Some folks don’t drive anymore or only drive during the day when there’s no weather. Friends and family have their own health issues that prevent them from visiting. The list goes on.

However! It is not impossible to remedy some of the loneliness. What I mostly hear from people is that “no one calls, no one invites me,” but when we look a little deeper, my client hasn’t made any calls or extended any invitations. Or they got turned down once and gave up. It feels bad to be rejected, even kindly, but what feels worse is to wait around for people to read your mind and know that you want to hear from them.

So: pick up the phone. Send a text or an email or a card (getting actual mail is the best feeling!). The odds are, the person you’re reaching out to is also lonely and will be thrilled to hear from you. It takes a little vulnerability and risk, but you don’t have to be lonely if you don’t want to be. Give it a try.

Hello, intrusive thoughts!

Have you ever been minding your own business, living your life, and your brain suddenly asks you, “what if we drove into oncoming traffic?” Or, “what if you threw your phone in the ocean?” (Tempting, actually–maybe not the best example). These thoughts are completely normal, although they can feel extremely distressing. They’re called intrusive thoughts, a charming symptom of anxiety or OCD.

For some people, they’re just random and fleeting. Of course you aren’t going to swerve into oncoming traffic; silly brain! For others, intrusive thoughts aren’t fleeting at all. They stick around; they repeat; they destabilize. Worst, they feel incredibly shameful, which only makes them louder.

One “cure” for anxiety–inasmuch as there is one–is talking about it out loud. Everything sounds worse in the echo chamber of your brain. When you share your scary, shameful thoughts aloud, they lose some of their power over you. An example: I used to have a terrible intrusive thought about accidentally throwing my dog out the car window. I would never actually do this, as I love my dog. But the thought would come every time we drove somewhere with the dog and it was, as you can imagine, incredibly distressing. When I finally screwed up my courage and told my best friend about it, she laughed out loud. She immediately apologized but actually her laughing was helpful! It was a ridiculous thought! The second I named it and she laughed, it became just silly instead of frightening. And now I have it rarely, if at all.

The point of this self-disclosure is that sharing our fears is actually one way to diminish them. Intrusive thoughts trick our brains into thinking there is danger when there is none. Checking those thoughts by telling them to someone else takes away their power and allows us to accept emotionally what we may know rationally: our thoughts cannot hurt us unless we let them.

I don’t mean you should minimize or diminish your thoughts, intrusive or otherwise. Rather, try meeting them with curiosity instead of fear. Try sharing them with others instead of letting them echo in your brain. You might find you can let them go. And if you can’t, that’s ok too; that just means it’s time to talk to a therapist.

You know where to find me.

Setting up therapy for someone else

One of the worst parts of feeling depressed or anxious or grieving is that it’s really hard to do stuff. When you’re not feeling well or like yourself, everything is a chore. Finding a therapist to help you may feel like the last task you could possibly manage. Sometimes, enlisting the help of a trusted friend or family member to do the leg work is exactly what’s needed to get you connected with someone who can help.

At least a third of my referrals come from the friend/adult child/partner of the potential client. I’m grateful when clients have that kind of support and are open to using it. That being said, would this be a blog post if I didn’t add a huge caveat??

Occasionally—though not always—the friend or family member in question wants the client to have a therapist more than the client does. The client may be willing to call me themselves or even set up an initial visit, but their heart really isn’t in it. Sometimes it’s because they honestly don’t need to talk to a therapist; their loved ones are trying to help (or trying to manage their own anxiety) and they want to check the box of THERAPY. This is most often the case with adult children, who have a totally different experience and understanding of therapy than their parents. There’s much less stigma around mental health support for younger generations, which is wonderful! It also can lead people to think that everyone needs a therapist at some point and that just isn’t always the case.

Another good indication that therapy isn’t going to work out when someone besides the client has suggested or arranged it is because said client simply isn’t ready. As I’ve written before, therapy is work. If you aren’t ready to dive deep into some stuff, or being emotionally vulnerable sounds horrific to you, you probably won’t benefit from therapy at this moment. Which is ok! You wouldn’t take an antibiotic if you weren’t sick; you don’t need to go to therapy if you aren’t ready to explore or make a change.

All of that being said—caveat upon caveat!—if someone you love wants you to see a therapist, they usually have a good reason. You may want to give the therapist a call, just to see what they say. Sometimes we need a little push in the right direction. And if it doesn’t work out or you don’t like the therapist or whatever, you don’t have to go back. It’s your choice, even if someone else is doing the administrative work for you.

Holiday creep

A colleague of mine recently referred to this time of year as the therapist Olympics. Most of our clients are a little more… unhinged than usual. Rightly so! Days are shorter and colder. Families of origin repeat patterns that range from frustrating to harmful. Sobriety is tested. Finances are tight. Grief is magnified. Caregiving is harder than usual. Basically The Holidays amplifies whatever was already difficult to navigate. While the culture at large insists upon sparkle and glamor and gratitude and consumerism and food and booze in excess, some of us are struggling. 

There are any number of lists out there about how to combat the holiday blues. Of course I agree with most of them: be mindful of how much you're drinking; keep moving your body; make time for yourself, etc. But I also want to add my usual caveat: it's ok to be struggling. In fact, many people are at this time of year. I bet if you admit to someone close to you (or even someone in line at the grocery store honestly) that you aren't filled with joy right now, they would agree. You’re not alone if you’re not feeling sparkly.

If you feel like you are alone in those feelings, it's tempting to self isolate. People are often afraid of spreading their anxiety or sadness to others and instead opt to keep it to themselves. Sometimes time alone does help, and if that helps you, go nuts. But also remember that distress and grief and anxiety are better shared with others. It lightens the load to let someone else know that you aren't filled with the Spirit of the Season. It's ok if holidays are a tough time for you; they’re tough for a lot of us. Take a chance and let someone know you need support. 

(Also make sure you keep your appointment with your therapist).

Parenting your adult children

My clients sometimes offer me this glimpse of the future: "your kids are little now, just wait." This is true; my children are still little enough that I’m a huge part of their day to day life and decision-making. Read: I have control over much of their lives. My clients’ kids are usually grown-ups. These grown-up children get to make their own decisions (and their own mistakes) without the very hands-on guidance of their parents. 

That’s how it’s supposed to be, right? Those of us who choose to raise children do so with the idea of launching them into the world as independent human beings. Once they’re launched though, they don’t stop being someone’s children. Parents of adult children generally don’t wish their kids good luck and stop being interested in their lives. When interest turns into interference, problems can arise.

Now listen: I’m not suggesting you can never again have an opinion about your adult child. I am, however, suggesting that the relationship between adult children and parents is different than the relationship with young kids or teens. Boundaries shift over time; not allowing those shifts to happen can lead to trouble.

So what is a parent of an adult child to do? Often a parent’s first instinct is to jump in and fix the problem. But if you’ve done your job and launched said kid into the world, you have to trust that they will figure out their own stuff. And if you really cannot stand idly by and not get involved, you can ask your kid what they need. This can look like, “I see you’re struggling; how can I help?” or “I want to help you but I want to make sure you want that from me.” The answer might be no but it might also be yes. We all need our parents sometimes, even when we’re grownups. But we also need to be given the grace and space to ask for help, rather than having it thrust upon us.

And if you really can’t keep your opinion to yourself, that’s what friends and therapists are for: vent away! Then you can maintain the healthy and happy relationship with your kids we all strive to have.

When to say, "that's not helpful"

The people who love us are (generally) well meaning. They want us to feel well, as a rule, and they often have a good idea of what that looks like. Or, they think they have a good idea. Often when you’re grieving, someone who loves you wants to help you by telling you what they think is a great idea. For instance, “[your loved one] would want you to be happy/live your life/not dwell on the past.” Or, “it’s been six months/a year/so long, it’s time to move on with your life.” They make these pronouncements as if they’ll magically snap you out of your grief and back into the world.

I don’t think I need to tell you, that’s not how grief works.

What I do need to tell you is this: it is ok to tell someone they aren’t helping. You don’t have to be unkind or snappish or rude. You can, however, set a boundary and tell them the truth: “that’s not helpful.”

In a previous post about boundaries, I noted that it can be hard to say something we know the other person doesn’t want to hear. People don’t like to be criticized, especially when they’re sure they’re right. That doesn’t mean that your emotional needs have to go ignored in service of not making someone briefly uncomfortable. In fact, someone who loves you and wants you to be well should be able to hear you tell them “that’s not helpful” without losing their shit about it.

It doesn’t matter how long it’s been since your bereavement or what the deceased would or would not say about how you’re handling it. What matters is that you’re getting real, actual support from the people around you. Sometimes that means telling them what you need–and what you don’t.

You don't have to tell your therapist everything

It’s an often-told joke amongst people in my life that I provide way too much context when I tell a story. To explain how I know someone to a mutual friend, for instance, I go all the way back to before we met and the circumstances which led us to one another. I’m apparently not capable of saying, “we used to work together” and leaving it at that. So I truly understand the desire that sometimes comes up in therapy to tell your therapist every single thing that has ever happened in your life. But I’m here to release you from that.

This is not to say you have to censor yourself; on the contrary, you can say anything in therapy. My argument is that you don’t have to. There are some things you can keep to yourself. Everything that has ever happened in your life or throughout the week in between sessions does not have to be hauled out and mined for content. If your therapist asks you about something that doesn’t feel relevant, you can say so. You decide what to talk about; you can also decide what to leave alone.

A lot of people who are new to therapy believe that they have to begin at the beginning and carefully examine everything in their lives. Sometimes that’s helpful. But just as often, it’s necessary to start at today and visit other details as you go along. In doing that, you may find that certain subjects don’t bear revisiting. Being in therapy doesn’t mean watching reruns of your life and trying to figure out what went wrong. Instead, you get to decide what’s important to you now, right this minute, and see where the conversation goes. You’re in charge. Which means, ultimately, that some stuff can stay out of the therapy space. Nothing is off limits but that doesn’t meant that everything is up for grabs.

Should you forgive or stay angry?

When I first started as a hospice social worker, I had this vision in my head of the deathbed. In this fantasy of mine, the soon-to-be bereaved are with the dying and everyone is saying whatever needs to be said. It was a very pretty picture. But it didn’t take too long in real life practice to see that vision vanish.

Don’t get me wrong, it does happen sometimes, that everyone says the Four Things: I love you, I’m sorry, I forgive you, thank you. I’ve facilitated those conversations, I’ve witnessed them, and they are truly beautiful. But more often than that, a lot goes unsaid and unresolved. Maybe it’s because everyone thinks there will be more time; or there’s a fear of upsetting each other; or it’s just too hard to start the conversation. Then the person dies and the bereaved are left with whatever went unsaid or unresolved or unforgiven.

Also, not everyone who dies is saintly, or unconditionally lovable. Difficult people die too. They have loved ones who are left with complicated feelings. They have loved ones who are angry or hurt and now there can’t be a resolution. Maybe there couldn’t be a resolution when the person was alive either but once they’re dead, there’s really no way. In that case, what do we do? Should we forgive or stay angry?

I’ll answer this question with one of my own (just call me Socrates): who is forgiveness for? Is it for the person who’s wronged you? They don’t always want your forgiveness, and when they’re dead they certainly don’t care anymore (I imagine; I guess I’ll find out for sure one day). If it’s not for them, can it be for you?

You’re allowed to hold on to your anger for as long as you want. Even if the person you’re angry at can’t fight with you about it anymore, you are allowed to keep being mad. But everything has its tipping point. One day your anger won’t serve you anymore. Then you can consider forgiveness, if not for someone else, then for yourself.

When trauma shows up

I am not a trauma therapist. My training is in grief; in life-limiting and chronic physical illness; in medical social work; in aging; but not in trauma. And yet, because many of my clients are new to therapy, I hear a lot of trauma confessions.

I don’t call them confessions because trauma is something to be ashamed of or hidden away. But it often is hidden from view. Often I’ve been the first or second person to hear about a traumatic event from decades prior. The next thought from my client, after they share this awful, horrible thing that happened to them that they’ve hidden away for all these years is: “why is it still bothering me now?”

I’m not a trauma therapist but I have an understanding about why we avoid dealing with traumatic events in their aftermath. The reasons are many: there’s a sense of shame, a fear that what happened was your fault; there are expectations of our family and friends, a fear that they won’t respond helpfully; there’s a self-protection our brains do, to minimize, to block out, to ignore what has happened in order to keep going, to survive. The list goes on; there are many, many reasons not to disclose a traumatic event.

Valid as those reasons may be, they will not make the trauma go away. 

Since I am not a trauma therapist, there will be a limit to what I can offer if I see someone with a trauma history. There may be a point where my client and I decide they’re ready to move on to someone who is trained to work with their particular trauma. Or we may decide to consult with an EMDR therapist (a magical therapy I know very little about; but luckily I have a wonderful network of colleagues who are both skilled and trained in it). 

All that comes later, though. What comes first is this: thank you for telling me. And: of course it’s still bothering you, that’s normal. It won’t bother you forever. Starting therapy is the first step to figuring out how to move forward. 

So if you’re ready to start and you’ve found someone you like, just start. If it turns out you can only go so far together, that’s ok. You’re only taking a first step.

When your therapist makes a mistake

Therapists mess up. We are only human, and so sometimes we make mistakes. Unfortunately those mistakes can cause harm to our clients, a thing we try very hard to avoid. That being said, it does happen. I'll spare you a bunch of academic language about therapeutic rupture and repair. And I'll spare you the times that I've messed up as a therapist–that's for my own supervision. What I really want to explore is what to do when your therapist messes up in session. Therapists are entitled to have bad days or bad moments. The question is, when it happens to you, as the client, what can you do?

There are a few options here. First, you might choose to not return. If it’s someone you’ve only seen once or twice, for instance, and they’ve already made a misstep, you might just want to find someone else. In that case, consider that whatever mistake they’ve made as a gift; you know they’re not the right fit for you.

But if your therapist is one you’ve been seeing for a long time and you don’t want to leave, you can—and should—address the issue.

I know that’s easy for me to say, sitting here at my dining room table and not in the therapy room (virtual or in person). That space is sacred and heavy and sometimes fraught. A power dynamic exists. Therapists are trained to be aware of that dynamic and try to make it an equal partnership but it still exists. So it can be frightening say to your therapist, “I am upset with you. You said something that hurt me. I’m frustrated,” etc. It takes an enormous amount of vulnerability and a little bit of risk.

Let me assure you though, if you have a good therapist, they want to hear it. They don’t want you to silently resent them or just disappear and not return. It can be scary, sure, but ultimately it will make things better and allow you to do the work you came to do. Your therapist is going to mess up sometimes; give them the opportunity to apologize so you can both move on, together.

The Good, Medium, and Bad days checklist

One truth about both grief and chronic pain (my two areas of expertise) is that some days are good, some days are bad, and some days are neither. Categorizing the days that way isn’t my attempt to judge them, though that’s what it sounds like. Instead, it’s my way of helping my clients figure out how to manage based on what kind of day (or moment) they’re having.

I hear a lot from my clients about whether or not they’re being “productive.” This is a word I hate. You are not a factory that has to churn out a certain amount of parts every day in order to keep functioning. You are a person who sometimes has easy days and sometimes has hard ones. If you are living with chronic pain or suffering a bereavement, you are allowed to not “accomplish” something every minute of every day, or even once every day. Sometimes it’s a struggle to wash your hair or make an important phone call or exercise. It’s ok for even “easy” things to be hard. 

Easy for me to say, right? We get a lot of messages about our worth from a lot of different sources and for most of us, it boils down to this idea of productivity. I can’t undo any of that just by telling you it’s ok to have a bad day. What I can do is offer an alternative to the self-berating some people do when their pain or their grief prevents them from being productive. 

Instead of starting with judgment (“I didn’t do anything today, I’m useless, I wish I had…” etc.), start with making a list. Actually, make three lists: what can I do on a good day? What can I do on a bad day? What can I do on a medium day? A bad day might consist only of eating and drinking and brushing your teeth. A good day might be an endless list of possibilities. There’s no right or wrong, only what you are capable of doing depending on what kind of day you’re having.

This might sound kind of silly but let me explain how it can help. If the only things on the list on a bad day are tasks you’re able to complete, you cannot berate yourself for not doing more. You did the things you were able to do on this particular day. On the flip side, the list of good day activities doesn’t have to be wholly completed on a good day. It can be filled with options: a good day might mean taking a walk with a friend or sitting down to pay bills but it doesn’t have to be both of those. There will be more good days to do more things on the list. 

Changing the way we view ourselves and our worth is not a quick fix; it’s an ongoing practice made of many small habits and tasks. Instead of the usual cycle of self-recrimination, try something new. Make a list. Give yourself grace. Better days will come.

Decision fatigue and grief

One of the perks of being married is that you don’t have to make all the decisions yourself. For most couples, the labor is divided, either out loud or by silent agreement and habit building over the years. It goes beyond who does the dishes and who mows the lawn. It’s also who knows what to do when an appliance needs to be serviced or replaced; who keeps track of the appointments and the birthdays and the finances; who does what in the household. 

When someone is widowed or divorced, they become the sole responsible party in their household. I can’t tell you the number of times I’ve heard, “I don’t know where all the accounts are” or “I don’t know who the electrician is” from my bereaved clients. If you’ve built a life with someone else, chances are you’ve shared the responsibilities. Therefore, finding yourself alone, having to make all the decisions without someone else’s guidance or input, can feel exhausting.  

This is a kind of decision fatigue. Decision fatigue isn’t unique to grief but it is part of it. When the furnace breaks or you’ve forgotten to schedule an annual physical because the other person used to do that stuff, it’s a reminder of who is missing. The bereaved expect the bigger grief landmines: holidays and birthdays, for example. The other moments—the smaller ones, like “my husband always” or “my partner used to”—are less expected. In those moments, your loss may be more keenly felt. When they pile up, one after another, the idea of making yet another decision can feel absolutely paralyzing.

If you find that you’re struggling with decision making during your grief, you’re not alone. Decision fatigue is a normal part of the process but you don’t have to just live with it. This is your gentle reminder to ask for help when you feel overwhelmed. You can’t replace the person who did the things you don’t know how to do (or just don’t want to do); but at least you can tell someone else that you’re struggling and ask them to help you. You will not be stuck here forever; but while you are, let someone lead you out, at least a little.