Ramble #8: Therapy interminable

I have a client who cannot believe that therapy should have an endpoint. It never occurred to him, in his forty-three years, that therapy is to try to solve a problem, or improve oneself to a place of greater independence or self-esteem or happiness, or help to eliminate destructive anger or seriously mitigate depression or anxiety. It never occurred to him that he could or should change. One always needs to talk about one’s feelings and pains, he would say.

 

This might be an interesting challenge if the person were new in therapy, sitting on the couch for the first time. I’d ask: Why do you think nothing changes for the better, where you feel you can't be on your own without a listener or “leaning person”? The sordid fact, though, is that I’ve been working with this person for over two years and it never occurred to me that he is not trying to get better, or to see himself as an improvable person. How was this possible? How did I not see his failure to care about the theory of dysfunction, his failure to explore any of his feelings present and past, his failure to request any input from me, as a therapy game-ender?

 

I can only say: Ask my toilet training. Plus, my general aversion to turning a client’s psyche into very specific goals. And there was his serious presentation: always talking about his pains and frustrations.

Quite an oversight. Finally being remedied.

 

Why would this client feel that therapy is just to vent? Some years ago a psychiatrist told him that he would “probably have to be in therapy for the rest of my life.” And he believed it. Did that doctor, saying that, instantly extinguish my client’s sense of personal empowerment? There’s no way to know. But I know he was startled, somewhat shaken to the core, when I informed him that people want to change. They want to reach a place of happiness or serenity or “coping” – and independence. This was not him. It wasn’t that he was dependent on me. Several times when confronted with a scheduling or insurance glitch, he remarked that he’d have to find a different therapist who charged nothing (beyond the copay). He needed and was entitled to therapy, forever and mostly free.

 

Many months earlier, I had begun to suspect an unspecified personality disorder, difficult to grasp and describe. He loves his pleasures: gourmet meals, social gatherings, gambling, alcohol, and would recount his epicurean episodes with delight. He could dismiss me easily but was suitably pleased with me. He both tolerated and rejected his father’s mental abuse when they would meet occasionally. His problems – anxiety and depression – were ego-syntonic: He named them but did not challenge them. He sometimes felt suicidal but did not act on it. What was the nature of his regressive dependency, which he was fully unaware of, that I felt but could not identify?

 

He had left home under extremely adverse conditions at age fifteen, staying with a girlfriend, with an aunt, with men. At fifteen, he must still be ten years old, and eight, and five, and probably two, because he was unparented. His father was a shaming narcissist. His mother was a religious hypocrite. I wondered: Is this Borderline Personality without the abandonment pain, the dramatic acting out, the temper?

 

A younger Borderline I've seen also seems to feel that therapy is akin to a once-weekly sedative and a lifelong prescription. In her case, I can come close to accepting her open-ended necessity even though she has been mostly stable for a few years. And what about all the clients without a personality disorder? Might their therapy continue long-term for good reasons and end, by treatment plan, for bad reasons? Do the deepest pains and existential undertows end? Do the clients stop being “psychological,” where after months or a couple years of attendance in sessions they have now retired their emotionally introspective mind and returned refreshed, renewed, reborn, cleanly opaque in the here-and-now world?

 

I believe it is easy to see it both ways: Therapy can't end because there are no “independent” persons. We can’t refuel ourselves. And therapy should end when something – anything – changes: resigning from a bad job, writing that granite-hard letter to one’s parents, growing the balls to file for child support garnishment – because the person is no longer stuck. They have solved a problem and now feel different in the adult way: superficially. Or they’ve had enough of self-knowledge.

 

I seem to go along with both philosophies. Because some people want to be adults, some want to be children.