Patients leave for lots of reasons. But now, I'm left wondering if this one will come back

My patient didn't think he was cured—he just wanted to dump me before I could dump him

I worry I didn’t describe the process well enough to him at the beginning, but it’s almost impossible to describe what relative wellness feels like before it has happened
September 12, 2017

“I’ve got nothing to say. I don’t know why I come,” he begins with a big sigh and an eye roll to the polystyrene ceiling. “I mean, how many sessions will it take?” he asks, leaning forward. This is a challenge. He smiles in an “I’ve got you now, huh?” kind of way and folds his arms.

Every week he wonders what the point of this whole therapy business is, when he’ll be better, why I don’t give him a progress report. He wants me to say; “Well done. We have finished Unit A and are now onto Unit B. Only two more units to go until you’re completely cured!”

So, every week I’m under pressure to defend psychotherapy, at least to myself. “Well, you do seem less anxious,” I say, trying to award myself points. “So, have we finished?” he asks.

This man’s mother died when he was five and his father went for a Victorian grit-your-teeth-and-get-on-with-it-lad approach. He wants me to tell him he’s a good boy, doing brilliantly at therapy and that I won’t ever leave him. He, however, is desperate to leave me.

In order to make absolutely sure I know he wasn’t looking forward to his session and didn’t want to come to my party anyway, he always opens with his misgivings and how he wants to stop. He then presents a breathless barrage of material as though he has been saving up every moment of the week to relate to me in our 50 minutes. At the end he tells me how interesting and helpful it has been and I think I am supposed to feel reassured that he did want to come to my party after all.

But then he left. I’d thought all his acting out was a routine we’d repeat until we got to the bottom of it, but I was wrong. I know I’m not supposed to be upset, that patients leave therapy for all kinds of reasons. I stormed out of my own analysis more than once, sure I’d never go back. (I did). There is the “flight into wellness” stage (“Bye. I’m all better.”), but it seems to me that patients more often leave when therapy gets too hard to bear. These probably return—once a chink of self-awareness appears, it’s very hard to shove it away again.

This patient wasn’t doing that though. This patient was dumping me before I could dump him. I worry I didn’t describe the process well enough to him at the beginning, but it’s almost impossible to describe what relative wellness feels like before it has happened. People tend to find that things in their lives start to shift, that they see themselves and others more clearly, that half-thoughts and memories are now fully-formed and understood, that they can sympathise with the disturbance in others.

I remember reading Emily Dickinson’s poem “There is a pain—so utter” and wondering aloud to my psychoanalyst what on earth might have been going on with her. He gave a meaningful “Hmm” of agreement, and I realised properly that disturbance is the result of having being disturbed.

But I won’t share any of those kind of moments with this patient now. Psychotherapy doesn’t have a uniform trajectory, a sales pitch or any promises. It is a long process of thinking and trying to understand and we can’t force anyone to stay. So now he leaves me in the position he has spent his whole life in—of hoping, against hope, that someone will come back. Touché.