Why Therapists Break Up With Their Patients

6 minute read
Gottlieb is a psychotherapist, writes a weekly column for The Atlantic called 'Dear Therapist' and is a New York Times bestselling author. Her latest book comes out April 2, 2019 and is titled Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed.

Most people come to therapy to talk about relationships — with their partners, parents, children, and, of course, themselves — only to discover how significant their relationship with their therapist will become. In fact, studies show that the most important factor in the success of therapy is your connection with your therapist, the experience of “feeling felt.” This matters more than the therapist’s training, the kind of therapy being done, or the type of problem you have. It makes sense, then, that patients who don’t feel felt might cut things off.

The reverse, however, is also true: Sometimes therapists break up with their patients.

You may not consider this when you first step into a therapist’s office, but our goal is to stop seeing you. In the bittersweet way that parents raise their kids not to need them anymore, therapists work to lose patients, not retain them, because the successful outcome is that you feel better and leave. (Can you imagine a worse business model?) But occasionally we have to say goodbye sooner.

Nearly every therapist has initiated a breakup at some point, though knowing that didn’t make it easier the first time I had to do it myself.

I’ll call the patient Becca. At 30 years old, she came to me because she struggled in her social life. She did well at work but felt confused and hurt when her peers excluded her. Meanwhile, she’d dated a string of men who seemed excited at first but broke it off after two months. What, she came to me to figure out, was going on?

But no matter how I tried to help Becca, we both felt stuck. Generally what happens between patients and people in their life in the outside world gets replicated in the therapy room, and it’s in this safe space that the patient can begin to understand why. But Becca would either reject what I said, or when I began to touch on something that might shed light on her situation, she’d deflect. Sometimes she’d cry, but if I asked what her tears might be about, she’d shoot back with “If I knew that, I wouldn’t need to be here.” If I tried to talk about what was going on between us, she’d insist I misunderstood her, and if I asked for clarification, she’d concede that I had partly understood, but insist that I was still missing something important about her experience — and then become frustrated anew. Later, when I’d bring up her dissatisfaction and ask why she chose to keep seeing me, she’d say I was abandoning her, despite my reassurances to the contrary. And when I’d try to explore her feelings of abandonment not just with me, but others in her life, she’d deny them, shutting down the conversation. Week after week, I felt useless, and I started to wonder if the problem was me.

Because therapists work alone, most of us seek outside feedback about challenging cases from trusted colleagues. So I brought up Becca several times with my consultation group: Was I missing anything? How might I reach her? What else should I try? But when all of their suggestions fell flat, they asked me why I was still seeing Becca. Maybe someone else would find a way in, they suggested, or maybe another therapist would be as stuck as I was, but why waste her time? In other words, why didn’t I break up with her?

“I don’t want her to feel emotionally stranded,” I said.

“She already feels emotionally stranded,” one colleague said. “By everyone in her life, including you.”

I knew this was true, but I also knew something else from having been a patient myself: therapy is hard work — and not just for the therapist. What makes therapy challenging is that it requires people to see themselves in ways they normally choose not to. A therapist will hold up the mirror in the most compassionate way possible, but it’s up to the patient to take a good look at that reflection.

Of course, therapists aim to be supportive, but our support is for your growth, not for your low opinion of your partner. Our role is to understand your perspective but not necessarily to endorse it. “I don’t do, ‘You go, girl!’ therapy,” a colleague once said, adding that patients can get that temporary salve from their friends. My own therapist put it more bluntly: If I just wanted to feel good in the short term, he told me, I could eat a piece of cake or have an orgasm.

The late reporter Alex Tizon believed that every person has an epic story that resides “somewhere in the tangle of the subject’s burden and the subject’s desire” and I couldn’t seem to get there with Becca. So finally, reluctantly, I decided to end our sessions.

Sometimes people wonder if they bore us with what feels to them like their unremarkable lives, but they’re not boring at all. The patients who are boring are the ones who won’t share their lives, who smile through their sessions or launch into seemingly pointless and repetitive stories every time. Why are they telling me this? we wonder. What significance does this have for them? People who are aggressively boring want to keep you at bay.

What patients need from us is compassion, yes, but also objectivity — a light shined on their blind spots. What we need from them is trust that we care about their progress as much as they do, and a curiosity about the ways they may be unwittingly perpetuating their difficulties. If I seem to be more curious about you than you are about yourself, something’s not working.

The relationship only works if we’re both doing our part.

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