Can anyone relate? In a tricky part of therapeutic process

[Stuckandtired]

Grateful for any opinions/experiences of people who've had long term psychodynamic therapy - feel like it's a real 'if you know you know' kind of thing

Am currently 6 years in with same therapist. Highly recommended in their field, strong links with other organisations, clinical supervisor etc

Had some boundary issues last year (me, acting out, nothing major) and I sort of dropped out of it

I got back in touch asking for further sessions and he replied saying no

I replied asking for a final session with some additional context of what was going on for me at the time, apologising etc - feel like it's been 6 years, good to wrap things up. He just hasn't replied

I totally understand it's an ethical decision and he's in no way obligated to work with me, but I'm kind of baffled that a 6 year professional relationship doesn't warrant a reply, albeit a polite one. Bit stuck with this as in my professional role, I would always acknowledge to say 'thanks but it's still not possible' if I couldn't continue

TIA for any opinions/viewpoints!

He’s already given you the reply.
Youre being unreasonable to keep pushing it in the hopes of getting your own way.
You’ve already had boundary issues with him and dropped out of the therapeutic process with him, you don’t get to pretend everything’s okay just because it suits your current wants.
Leave the guy alone.

He did give you a reply. You just didn't like it and are continuing to push to get your way.

Thanks for your responses. Appreciate it. I guess I thought of more of it as a service I could access when I needed it and tried to communicate with him as best I could - I don't feel I'm 'pushing' him or badgering him - he's a grown man!

And he, as a grown man, has don't you that he no longer wants to engage with you.

Yeah I know I get that and he's totally in his rights to not reply to me etc - but he hasn't actually told me. I thought therapy was supposed to model good communication!

In the service I run if we can't meet with clients any longer and if they replied asking for a reconsideration, I would always respond with a 'apologies, not possible, all the best etc'

But he has replied? You ended the therapy relationship without telling him why or asking for wrap ups etc. You then changed your mind and asked for more sessions and he said no. Now you are asking again and the answer is still no so he hasn’t replied. That’s your answer. His response seems entirely appropriate to me, particularly in the context of previous problems in the relationship. (I have had the same therapist for two years but not consistently so not quite the same but if it played as you describe here I would recognise that therapeutic relationship was over and find a new therapist).

Are you really worried about his professionalism or does it just sting that he’s said no in a very blunt way?

The outcome won’t change, he doesn’t want to see you, so I’d think a bit more about why you’re upset by his lack of response.

I can really understand why this would feel painful and confusing after a 6 year therapeutic relationship. Whatever the clinical reasoning, I personally think a brief human response acknowledging the relationship would have been kinder.

I don’t doubt many therapists genuinely believe they are acting ethically or protecting the therapeutic process. Some older therapeutic models place a much greater emphasis on distance, ambiguity and maintaining the frame at all costs.

At the same time, many modern trauma-informed approaches increasingly focus on helping people process and integrate difficult experiences in a way that ultimately brings them back to themselves, their own agency and their own capacity to move forward in life, rather than creating long-term dependence on therapy or the therapist.

I work as an EMDR therapist and one of the things I see repeatedly is that meaningful healing does not always require years and years of ongoing therapy. Sometimes people genuinely do process, grow and move into a different phase of life.

After 6 years together, I think it’s understandable to hope for some acknowledgement of the relationship and also worth reflecting on how much you yourself may already have changed during that time.

Do you mean boundary issues with him did you do something?

Psychodynamic therapy is a peculiar beast in that it tends to be long term, and the ending process is part of the therapy. You took yourself out of the therapy without ending the relationship. I imagine your therapist is viewing your repeated contact with him as a further boundary issue (he’s told you he won’t continue working with you and you’ve gone back asking for more contact).

Deciding you’d now like an ending after effectively ending it in a manner of your choosing is at best a mixed message and he may consider, therapeutically, it’s not something he’s prepared to engage with. He may think that any response from him will keep you hanging on.

Six years is a long time to work with someone and usually there would be an ending process but you chose not to do that at the time. How long ago did you stop attending?

You don’t understand psychodynamic therapy then. Some models of therapy you can access it when you need it and dip in an out, by psychodynamic isn’t like that at all.

ETA Sorry, have reread your post — you’d already ‘dropped out’ after ‘boundary issues’ last year. He doesn’t want to resume seeing you , and told you so, presumably because of whatever went on last time. He’s within his rights to choose who he sees as a client.

I think you have to accept the answer is No. Would it really be useful to have an other session to go over it all? Maybe it would be better to just leave it. I think another polite reply saying no would be better than just ignoring though.

Thank you all. I really do appreciate all of your perspectives and opinions.

To answer some previous questions, I dropped out last year as it became too overwhelming and wasn't able to communicate this with him at the time.

In hindsight I should have found a way to explain this but didn't have the words.

I think I have been (very naively) hoping he would understand that as a therapist and given how long we have reliably worked together, there could be some space for that and by reaching out over email he might reconsider. Appreciate I have probably misunderstood this modality though.

Thanks so much again for your thoughts. Really do appreciate them

It’s highly likely he’s filled your slot with another client so doesn’t have space, boundary issues aside. Yes ideally he would understand you feeling overwhelmed - did you tell him you were stopping, or just not turn up?

He cancelled my last appt as I missed a payment (totally my fault - hadn't realised and apologised and paid straightaway) but I didn't email him to reschedule.

I think heart of hearts I feel slightly miffed that he couldn't cut me some slack after 6 years

Which is it? You acted out and crossed a boundary? You just stopped going without explanation? He cancelled you as a client?

I suppose all of them really. I feel I acted out by not engaging fully and not explaining I needed a break, I crossed a boundary by not paying promptly which was my responsibility, and he has seemingly cancelled me as a client by not replying to me.

Appreciate that sounds confusing but it feels like there are multiple layers at play which happens in any long-term professional relationship

Again really appreciate your responses, it's been very tricky to navigate

I think you have to accept that it's over and find a new therapist

And at the time, if you had rescheduled immediately after paying and apologising, he may well have. But now, a year on, he will have filled your slot with another client. He replied to you once. He's not going to keep doing it when he's already said no to taking you back as a client.

Psychodynamic therapy isn’t a “cut folk some slack” kind of modality, it relies on a strong therapeutic frame including regular scheduled sessions, and clear strongly held boundaries. I’ve seen folk not being admitted to a session because they were 5 minutes late, because the time boundaries are part of the therapy.

I’m surprised though that having worked with him for 6 years you didn’t understand the role that tight boundaries hold in psychodynamic therapy.

I can empathise with you. 6 years is a long time to work with someone in that way. You will have shared your deepest and most painful inner world with him and although the therapy relationship is always contained in professional boundaries, in that time you expect a mutual caring on a human level to develop. I think him ignoring you may feel like he just didn’t care and the 6 years of hard work on both your parts has gone unacknowledged.

You may have acted out, but as therapists, they should understand that clients don’t always act in the most emotionally healthy ways and some compassion and kindness doesn’t hurt.

If he couldn’t offer a closing session, a final acknowledgement and wishing you the best doesn’t seem too much to ask.

How was your relationship with him when you worked with him? Did you feel like he genuinely cared?

Yeah I didn't understand it to be honest

He seemed very laid back about some other things

I suppose I just stuck with it as I was happy to give it some proper time to see through the whole process

It was a bit hit and miss to be honest

I found it useful and productive enough to overlook some things, but his responses and lack of care to me more recently suggest I may have misjudged how much he valued me as a client on an individual level

Thanks so much for your thoughts - the bit about mutual caring stuck out to me, and it's what I feel has been missing

I think you are getting some really harsh responses OP apartly because you are in the CHAT forum rather than the Mental Health one.
I totally understand what you mean and I would have expected your therapist to have tried to arrange a final session especially after 6 years. Did he do that at the time or just didn’t make any contact with you when you didn’t schedule another session?
My psychiatrist and therapist have both chased up when I have cancelled sessions in the past. I agree that a therapist should be able to interpret the clients behaviour based on what they know about your issues but I guess we don’t know the full story of the issues between you.