Just when I thought things were going so well--when the therapeutic alliance was strengthening and my client and I were truly bonding--I got THE e-mail. The "I need a break" e-mail. Yes, I was dumped by my client a few days ago and, to add insult to injury, she did it over e-mail. Just so you know, I don't normally communicate with clients over e-mail, partly because of the lack of confidentiality on the internet, but mostly because it's too easy to do last-minute cancellations when you don't have to actually speak to someone who can tell that you're lying about your sudden bout of Swine Flu. Usually, when a client switches up how the medium they use to contact you, something's going on. This client, a particularly tech-savvy granny that I had yet to blog about, e-mailed me to re-schedule our previous session. This was the first time she e-mailed me and it raised a red flag in my mind. Alas, in an effort to be efficient, I responded and rescheduled. The other reason I don't communicate with clients over e-mail is that it's too easy for me to forget to write down our re-scheduled sessions when I get their note. That said, I missed our session. Yes, yes...I know that sounds like a totally abhorrent thing to do to a client but before you start hating me, let's discuss some background context, shall we?
This client, let's call her TSG (obviously for Tech-savvy-granny), sought counseling through my program and requested home visits. Ah, yes, home visits. I've done far more home visits than I truly care to do ever again. The only reason why I took this was that she didn't live too far from me and, because I'm no longer taking classes and am on fellowship (read: just getting paid without TAing or RAing), I would be home more, making this a convenient arrangement. Oh, she also requested a therapist with a sense of humor and I was flattered to know that my supervisor, upon hearing this, thought of me. (When you're in grad school, you take whatever positive reinforcement you can get, trust me.) When we met, things went very smoothly. We got along well and I felt that she had really started opening up to me, which suggested that we had developed a strong therapeutic alliance...or, at least it was getting there. As with the best laid plans, I soon realized that this arrangement was far from convenient. TSG did not, in fact, live as close to me as I had thought. The commute to her house became more and more annoying as I competed for road space with Hollywood's finest agents, starlets, and wannabes who tend to drive stupid fast while texting. I found myself thanking my lucky stars for my jungle cat-like reflexes whenever I made it to TSG's place in one, albeit shaky, piece.
One day, I arrive to TSG's condo for our session and, surprisingly, her son answered the intercom and told me he didn't know where his mother was and that he was a little worried. I became worried, too. She's an older woman and who knows what could have happened to her. My worst fear in working with older adults is that they won't make it through therapy. I thought, for sure, this was it, so I became panicked. I hung around for 20 minutes, brainstorming with TSG Jr. about her possible whereabouts and then decided to leave. FIVE HOURS LATER, I get a call from TSG that she had totally forgotten our session--she was absolutely mortified and apologetic. I was so relieved she was alive that I was uncharacteristically accepting of the snafu instead of spending a half hour discussing what her no-showing "means" to her. Another detail that should be noted is that we never had a set weekly meeting time. We scheduled sessions as we went along from week to week. I don't normally do this as it's hard for everyone involved to keep track of our sessions and it makes it too easy to reschedule and move things around. There's something about a weekly set session that communicates a commitment to therapy--that it's a priority and that this time is set aside specifically for our work together. Anyway, we didn't do that and that's my fault. In some way, I thought it would make my schedule-planning more flexible and, therefore, more convenient. (Yes, thinking of myself. Naughty therapist!)
So fast forward to TSG e-mailing me to reschedule. We reschedule. I miss the session. Halfway through what would have been our session, I e-mail her apologizing and offering to rearrange things just to see her. I hit send. I waited. At this point, I do believe I should've called her. Another mistake on my part. Actually, I think I should have called her when she e-mailed me the first time since I thought it was so odd. But, giving into my fear of being seen as reading too much into things, I didn't. God forbid I read too much into things--I'm a therapist, after all. (Note to self: Trust your gut!) Anyway, I get a response from her to the effect that she was so happy we met and thinks I'm a wonderful person but she felt she needed a break from therapy. Also, thrown in there, was something to the effect that this was the result of neither of us sticking to the program. (What program? Ab-hoc therapy isn't a program?)
My heart sunk. I sat back in my chair letting a powerful wave of sadness, fear, and sense of failure swish around me on the inside. I suck, I thought to myself. I missed a session and she dumped me. But wait a minute, she stood me up once before...we were actually even! She sucks! I started reflecting on our past sessions and realized that there wasn't much that was coming out of our supposed work together, anyway. Honestly, I was doing all of the work. She was quite stubborn and was always getting herself into pickles, often by her putting her swollen, arthritic foot in her mouth. But I couldn't find a way to share my feelings about her communication style, which was that her style wasn't working and was usually offensive to others. I guess the therapy wasn't working and, perhaps, the therapeutic alliance I thought was growing in strength wasn't there at all. This was like that period after a breakup when all of the tell-tale signs of a failing relationship become clear upon reflection. Of course she wants a break! How could I have been so blind?!
Losing a client can be a difficult experience for even the most seasoned psychologists. For a one in training, it can be devastating. I don't have years of successful cases to make me feel like I'm a decent therapist and that this one just didn't work out. Losing a client, to me, means that I suck, suck, suck. When I was just starting out in grad school, I used to have this mantra: I suck, I suck, I suck. I would say this quickly, kind of like Jan Brady's "Marsha, Marsha, Marsha!" I used it as sort of negative reinforcement to motivate myself to work harder (not very healthy, I know). Now, in addition to softly repeating that old mantra, I'm holding onto the first few lines of TSG's note for dear life, the ones about her being happy we met and thinking I'm a lovely person (yes, she said that). I feel like that's all I've got until I meet with my supervisor. I know I'll go through the anger phase soon (Who makes home visits anymore anyways? You were so lucky to have me! Lucky, ya hear!?!) and eventually get over her but the wound is too raw right now--the suck-age a bit too great. Now you know breaking up, romantically or professionally, is hard to do. Pass the gelato, please.