When therapy is over and you are healed to the best of your ability, is it time to mourn or celebrate the end of the therapeutic relationship?

Dear XXXXX,

I thought it was safe to let you know how I was doing. I thought it was safe to email you about what my thoughts were regarding brief psychosis –v- depression (which is something I have finally made sense of and wanted your opinion on because I trusted you). I told you what my current working life was like and I felt as though I got a rubber stamp response because nothing in your email referred specifically to what I had actually said or achieved.

In therapy once, you asked me to always let you know how I was doing because you didn’t want me to move on and disappear out of your therapy life. You also once told me you loved me and trusted me deeply and that you would never abandon me.

With those bold statements comes a considerable amount of post-therapy responsibility to clients, even to the most adjusted but vulnerable client who has left your therapy and your rooms. With that comes a duty of care to accept that sometimes the client who wants to move on feels much dissonance, ambivalence and an overwhelmingly disproportionate sense of obligation and responsibility to her former therapist to keep her informed lest she feels abandoned by her.

At what point in therapy should an experienced therapist tell a long-term client with a Borderline Personality Disorder diagnosis, in an unsolicited manner, that they love them?

This is what my therapist said at the last session I had with her.  I do love you.

It was a major catalyst, amongst other things, for my decision to leave therapy back in April.  Our email relationship limped along for few months until I finally pulled the pin.  That occurred this morning.

The overwhelming sense of freedom, relief and empowerment is tinged with much sadness, grief, loss and longing.  I loved her dearly and she said she loved me, but only in the context of a therapy client within her four walls.  It was not a marriage proposal and we are not going to walk off into the sunset and live happily ever after in a house with a white picket fence.

I can live with that.  Finally.

When I listen to the eerie, haunting music of Sigur Ros, an Icelandic band, it takes me to a place of yearning, grief and loss and longing that I cannot identify and don’t understand. This is what my children would call Mum’s sad, weird, drunk music.  I used to listen to it in 2004 when I was not a well person.

How can you yearn for something that you don’t know exists?

How can you identify something when you are unaware of its existence?

How do you grasp onto something when it appears to have no substance?

If I discover and hold onto what it is will I be happy?

Do I really want to find out what it is that I am looking for?

Emailing and texting your therapist can be (for some) more addictive than cigarettes, alcohol and drugs.  The reward neurotransmitter dopamine floods your brain and motivates you to do more of the same. This is the same neurotransmitter secreted when you snort cocaine.  Even a simple email exchange can do this for some.  It’s not what drug you take, it’s the effect that drug has on your brain.

Until recently I had full email privileges with my therapist which led to gross feelings of narcissistic entitlement.  I haven’t seen her in therapy since April and I still expected her to be available electronically 24/7.  I would get upset when she didn’t reply within 12 hours.  If she did not reply immediately, I would get rude and hostile and she would apologize.

This relationship was not healthy for either of us.  We were merged and sometimes not in a healthy, nurturing, supportive, way.  Partly because of her availability, I would lurch from one crisis to another expecting her to resolve my life with a few words on an electronic form of communication.  Eventually she emailed that this had to stop and that I could email her, not every day, but every once in a while, and not to expect an immediate reply because quite frankly she was feeling overwhelmed.  She also said I was welcome to come back to therapy any time I wanted to.

For someone was has been diagnosed with Borderline Personality Disorder, it can take a long time to recover from the anaphylactic shock of raging, damaging emotions that are coursing through our blood when we experience an attack on ourselves.  During this time many physical symptoms of post-rage illness are experienced and this I like to call “mental influenza.”

Even though one can have much insight into the “who, what, where, when, why and how” of the scope, breadth and dimension of these rageful feelings and/or attacks you can still be left with the shocking after effects of the toxic flooding of your system; the blackness and physical feelings that leave you with a sense of vertigo, numbness, breathlessness and weakness, the sensation of lightheadedness and giddiness where you think you are going to pass out.  These feelings simply don’t diminish as quickly as they should and days later they can still be hanging around at the same intensity level as when they first happened. 

Six years ago I was officially diagnosed by a psychiatrist in a psychiatric hospital as having…drum roll please…BORDERLINE PERSONALITY DISORDER.  He said it to me in the same way he would announce he had a plague of rats infest his kitchen, discovered I had a sexually transmitted disease or that he had just found out I supported Tea Party candidate Sarah Palin.  It was delivered with revulsion, disgust and contempt.

Today I proudly come out of the BPD closet and out myself as having one of the most reviled and hated personality disorders ever constructed by the most esteemed and eminent fundamentalist gentlemen writers of the Psychiatric Bible the DSM – Diagnostic and Statistical Manual.

Eight years ago, after many months of frantic searching, I finally found a photo of my therapist with her family on the internet.  I cut her face out and stuck it on her business card and carried it in my handbag.  Every so often, when I was feeling insecurely dependent, I would take it out and look at it until it became rather worn around the edges.  It was a great source of comfort to me and kept me connected with her through some very dark times.  She never knew about this.

Perhaps it would be a good idea, especially for therapists who conduct Dialectical Behaviour Therapy to have a business card with a photo – a professional one not a personal family photo.  This way clients do not have to ask, beg or grovel and debase themselves asking for a photo from their beloved but reluctant therapist, nor spend hours furtively searching on the internet for an illicit image of someone they are perhaps pathologically attached to.  When you have a legitimate source of something private the guilt and shame of dependency, something which regressed clients seem to feel a lot of, can disappear or at least lessen in intensity.

Death of a spouse, divorce, moving house and losing a job are four of some of the major most stressful incidents that could happen to you.  I’d like to add a fifth one; and that’s making the decision, or having the decision made for you, to leave your long-term therapist.

I don’t need my therapist anymore for therapy – or survival.  I am able to look after myself and be my own therapist.  I can survive in the big, wide world with all the tools and devices I have learned over the years, yet to move on from my therapist would leave a huge hole in my heart.

The more child-like and dependent I was the more I needed her to stay alive, but the more I grew up and matured in therapy the more I relied on myself and less on her.  It’s not about the therapy itself.  That is the giddy part, growing up and away and moving on.  One can only move on in therapy as one gets stronger and eventually that dependence is replaced with independence.  And as one gets stronger one naturally starts to separate, first at an unconscious level and then one becomes aware that the nature of your feelings are changing.

Letting go of the fantasy of a post-therapy relationship with your beloved therapist means you are ready to move on from the transference.  When your mind starts to shift from an enmeshed relationship with another to a singular meaningful relationship with yourself where the focus is now “me” and not “we” it signals a profound shift in cognitive thinking.

There is much self-examination and reflection and untold pain that comes with this.  Socrates said that the unexamined life is not worth living and I have explored every possible nook and cranny of my inner life.  Letting go of someone you love is the hardest part and this creates a vacuum which needs to be filled with something that is just as meaningful.  Never take a crippled person’s crutch away from them unless you have a replacement that is equally as effective.  But before you do that, you need to reach into all corners of transference options and the therapist who is willing to explore every aspect of your attachment to him/her and their own considerable counter-transference issues and/or attachment to you is doing themselves and their client a huge favour.