Tuesday, October 28, 2008

Where'd Ya Go?


I'm going to tell you that I haven't found that treatment termination goes quite the way they say it should go in the textbooks. By and large, my patients haven't had a pre-defined end date where we process the meaning for months beforehand then stop, never to see each other again. Psychotherapy, I've found, ends in a more fluid and phased-out way without a whole lot of talk about the meaning of ending.

So people come in pain and distress. I usually suggest they come weekly, at least until they feel better, and we continue with that until they say they'd like to come less often, then we go to every other week, then monthly, then "call me when you want to come in." It's hard for me to figure out my schedule more than a month ahead, so there are people who call when they do and everything isn't planned out, and there are people who finish with regular therapy session who still need medications and they come in for a session every few months.

Sometimes, I realize that I just haven't heard from someone in a long time--I think more about the people I'm seeing and not so much about the people I'm not seeing, so sometimes I realize after quite a long time that I haven't seen someone (sometimes the pharmacy calls for a refill and this jogs my memory). If I realize someone's fallen off my radar, and it hasn't been so long that I'm embarrassed to call, I call. Often this prompts someone to ask for an appointment. Sometimes I hear that all is well and they're fine. Once in a while, I don't reach a real person and I never get a call back. If it's someone I only saw briefly, I don't worry about it-- people know how to find me. Patients sometimes reappear years later, some only come when they're in active distress and the rest of the time they don't want to talk. Whatever.

So every now and again, someone I've been meeting with regularly and for a long time simply disappears. They don't return calls and I have to let it go-- no one wants to be hounded or stalked by their old shrink. A couple of times, I've had the sense that the disappearance is more meaningful than "I'm done"...either they've canceled a regular weekly therapy session to fade into the sunset, or they've disappeared more benignly, but after years of treatment and no response to my "I've been thinking about you" phone calls. It's unsettling to me; I wonder how they are and I'm usually left with the nagging sense that something must have been said in the last session that was upsetting, but now can never be addressed. Oh, and I guess I can also wonder if they disappeared because of something on the blog.....