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Feeling Abandoned by a Therapist She Can No Longer Afford....

06 Sep

Question:  
I have a question. Obviously I made up a name because it is possible that a particular person could figure out who I am by reading my question [Ed. Note: We always change the name unless specifically asked not to].

My question: what suggestions do you have for a person in crisis who is diagnosed with PTSD and depression/anxiety, and now possibly RAD (reactive attachment disorder) and has to end therapy w/ my first and only therapist after almost two and a half years of meeting twice a week, due to financial issues.

I have started once a week therapy w/ a therapist from a crisis center, and these sessions are limited, so they will end quickly.  I have a plan a B for therapy w/ a local county clinic after that therapy ends.

I actually met you and went to one of your workshops on PTSD on the advice of my first therapist about 2 yrs ago. I purchased a few CD's on PTSD  and Sleeping issues, and listened to them regularly.

I am now feeling completely abandoned and rejected. I guess I don't understand the role of the therapist, the purpose of therapy and I feel like I should never be as open and trusting again w/ any mental health professional, because I don't get it and I become overly dependant on them.

Any suggestions or ideas on how I can learn to accept this tremendous loss and not be overwhelmed with this fear of being attacked and manipulated again?

Sarah

Answer:

Dear Sarah,

I’m sorry you’re suffering from the loss of your first therapist.  On the plus side, it sounds like you made good progress with him or her; and also that you’ve done a good job of following through with alternate back-up coverage to get you through this difficult time.  

I know you must feel like you’re back to where you started or worse – less trusting than ever – but real progress and learning does stick, and when you get past your grief and anger at having to part with this therapist, I think you’ll be able to continue to build and grow from your work together.  

I don’t know what led to your having to stop, or if you had ample warning and support with follow through.  (It sounds like you may have, given your careful plans for back-up resources.)

But I do know in a general way that therapists have genuine feelings for their clients; and sometimes this leads them to let a client build up a tab that eventually becomes untenable for both the therapist and the therapeutic relationship. (I’ve always cautioned my supervisees that we tend to make our biggest mistakes with the clients we care about the most.) I don’t know if this happened here or not. Or if you tried negotiating a lower rate, and that failed as well.

But when all is said and done, the therapist has to make a living, and the integrity of the work is predicated on the fair exchange of service for pay.  Once that exchange breaks down, the work can get pretty messy, too.

And I know it can be confusing, but this is a professional relationship that makes therapeutic use of the caring, affection and concern that happens between you…. and every other feeling too, like anger, betrayal, fear, jealousy, and the utter longing to be taken care of completely.

You want to say, “If you really cared about me, you’d see me for nothing!”. But that’s the distressed, abandoned, irrational kid inside of you talking.  The truth is, an uneven exchange in a professional context always breaks down the work, sooner or later, and makes for lousy therapy.  

So keep seeking and using the good, alternative care you can afford.  Keep listening to the imagery CDs – that’s a good fill-in “blankie” for this difficult time.  (The Grief imagery might be particularly helpful).  Try to remember the learning and growth you’ve already experienced with this therapist - that sits somewhere inside you, yours to keep, with her or without her (or him) - and draw on that.

This too shall pass. Your abandonment story is one you’ll naturally fall back into – how could you not?  Just don’t stay there!

Wishing you all the best,
Belleruth

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award