What happens when your therapist goes on August Holidays...
I'm back at work, but many of my professional colleagues are on holiday....what does this mean for those we leave behind.....
I took my summer holidays in July this year and I'm back at work. But many therapists go off in August. Everyone needs a break, but how does this affect our clients? The journalist Sarah Croft reflects on her own experience in this piece for the the Evening Standard....
We're on a break... when psychiatrists go on holiday
For those in therapy, August is the worst month of the year, when the shrink you've come to depend on jets off for an extended summer holiday, leaving you with the baggage. By Sarah Croft
When you’re in therapy, it’s hard not to flinch when people start talking about the August ‘silly season’. August is the month that shrinks traditionally take off, leaving their patients — people like me — to fend for themselves.
The convention of the August break dates back to the origins of psychoanalysis itself: many of the early analysts (Freud included) were either Austrian or Swiss and were simply used to taking a month off during the summer. However, as psychotherapist Julia Bueno explains, the break also has a purpose: ‘Therapeutic work, which may have lasted years, will eventually come to an end. The patient will ultimately have to tolerate his or her own distress alone with the skills learned, and breaks in the therapy allow for a chance to practise this.’
Not all therapists take an extended break: it’s typically the preserve of psychoanalysts — who, in strict analysis, will see their patients up to five times a week — and psychoanalytic psychotherapists, who also work intensively with patients over a much more extended period than is the norm in other forms of counselling (essential in order to develop the therapist/patient relationship that is at the heart of this kind of therapy). But given that there are nearly 200 psychoanalysts working in London, my situation is far from unique; even if the capital’s streets are unlikely to succumb to a sudden surge of madness.
‘It’s funny, isn’t it?’ mused a friend. ‘I mean, the idea of all those crazy people, suddenly let loose simultaneously.’ I wasn’t sure whether he was including me in the ‘crazy people’ cate-gory: I like to think I’ve graduated to at least semi-sanity since I started seeing my Harley Street-based therapist, Jane, five years ago. But I also know that it’s because of her I’m able to lead an increasingly uncrazy life, which makes the thought of a month without our three-times-weekly sessions somewhat alarming.
I began psychoanalytic psychotherapy soon after the death of my mother from cancer. She was my best friend and died when I was 28, but I was already familiar with counsellors and psychiatrists as a result of my anorexia, which began when I was 12. As a 24-year-old I spent several months in an eating disorders clinic when my weight slipped to five-and-a-half stone: I discharged myself just as soon as I’d gained 10lbs and without addressing any of the issues that had led me there. When my mother died I knew that it was make or break, psychologically. Fortunately, after a few false starts, I found Jane.
I’m better now than I was at coping without Jane. I’m approaching this August without the same sense of intense dread that I did during the first years of therapy and am fully committed to my eating plan of small, regular, balanced meals — this week, I’ve even started to get my head round full-fat yoghurts. I’ve also developed a range of coping mechanisms, the most effective of which has proved to be writing a diary: it’s both an instant emotional release and, in retrospect, a reminder of the fact that I’ve survived tough times before.
However, experience has also taught me that the next month won’t be fun. As a single, self-employed journalist I find it all too easy to go days without talking to anybody, especially now that the person I could always pick up the phone to speak to, my mother, is no longer there. August for me can feel like a double bereavement — plenty of opportunities to practise those ‘skills’, then.
Three-times-a-week therapy provides a structure to my life and there’s nothing anorexics love more than structure: we don’t really do spontaneity. NB: never throw an anorexic a surprise birthday party; it’s bad enough without the cake. Trying to resist substituting the framework provided by therapy with the framework provided by rigid calorie-counting is hard, even after five years.
That doesn’t mean that there aren’t upsides to the summer break. For one thing, I actually find myself feeling flush in August. Private psychotherapy isn’t cheap: Jane operates a sliding scale and while I’m firmly at the bottom of it, a 50-minute session still costs £50. Moreover, I never take a holiday in August, although that’s mostly down to superstition: if Jane and I both head off to the beach at the same time, a nagging voice insists, disaster will follow. We can’t both stop concentrating on holding my life together: that would be like both pilots on a plane taking a nap at the same time. Not that I really regret staying at home: because holidays, like surprise parties, involve eating and spontaneity. Anorexics tend not to be as enamoured of them as the rest of the world. Besides, I know that the money I’m saving is vital if I’m to pay for another year in therapy.
Of course, I have no idea if Jane really spends her August on a beach: as anyone who has ever watched an episode of In Treatment will know, therapists don’t answer questions about their personal lives. Jane is a New Yorker, so I tend to picture her in the Hamptons, the holiday destination of all New York therapists in American author Judith Rossner’s 1983 novel August. Rossner’s plot focuses on the relationship between a young woman, Dawn, and her analyst. But while Dawn’s experience of the summer break rings true to me, I prefer to think that Jane’s vacations involve considerably less familial angst than those of her fictional counterpart. No, in my mind Jane spends the month on a picturesque New England verandah, the sea breeze tousling her hair as Chopin plays in the background. Being at least a little in love with your therapist is obligatory; the idea that they might have issues, too, is inconceivable. Also, obviously, a bit worrying.
Wherever Jane is, I’m reassured by the thought that she’ll respond to my emails if I have a crisis. Many therapists are stricter and, as Bueno explains, this means that it’s important to discuss in advance what might happen in an emergency. ‘It depends on the therapist and the client, and indeed how an “emergency” is defined. Some therapists may take the view that it will be therapeutic to encourage self-reliance, others may work out a back-up plan. If it becomes clear the client may struggle during the break, contingency plans will be discussed: for example, contacting the therapist at set times, visiting a GP, or contacting support lines.’
As I write, September seems impossibly far off, yet I know I’ll be surprised by how quickly it arrives. Going ‘back to school’ is always a bit of an odd experience in therapy: it’s hard not to feel shy pouring your heart out to someone at the best of times, but it’s much worse when you’re not even allowed to ask how their holiday was first. There’s also the fact that the start of the new school year is all about clean sheets, literal and figurative; in therapy, however, you’re stuck with the same old grimy, tatty duvet you’ve spent a lifetime trying to get away from.
This is part of what I think of as the ‘Tristram Shandy problem’: in therapy, the more you talk, the more you realise there is a lot to talk about (which is why taking a month off can feel so frustrating). That said, much as I flinch from the thought of never seeing Jane again, the idea of spending the rest of my life picking over my unhappy past truly appals me. Even I can imagine getting sick of myself.
And maybe this is the biggest indication of the progress I’ve made in the past five years, a change even more significant than my slowly increasing weight. When I first began therapy, I clung to each appointment for dear life; now there are weeks when my sessions with Jane can seem like mildly irritating interruptions. Which doesn’t mean that I can yet look forward to August without seeing knots of tumbleweed blowing across a desolate prairie, but maybe by next year… ES
'I missed my therapist more than my sister who had just died.'
A lot can happen in a therapist's absence, as one writer (who wished to remain anonymous) recently discovered
‘I’d been seeing my therapist twice a week for six months, when he announced he would be going on holiday for three weeks. It couldn’t have come at a worse time. My sister had just died and my relationship with an emotionally abusive partner was getting progressively more horrible. Of course, my therapist and I talked about and prepared for this “loss” (one of the issues that got me into therapy in the first place) and how I could experience absence without getting totally freaked out about it. I thought I’d be fine, although the recurring dreams I was having about being trapped in a giant building, trying to shout for help but no noise would come out, were a pretty textbook example of the fact that actually I wasn’t all that OK.
So off he went on his jollies. I tried to find some trace of him on Facebook, Twitter, anything that could tell me more about him and his family and where he’d be holidaying while I was suffering, as though that would somehow make me feel closer to him. But obviously his social media profile was as locked down as an MI5 spy’s attaché case. He didn’t exist, except on his website. At home in my private misery (he was the only person who knew I wasn’t OK as I hadn’t even told anyone I was in therapy), I would pour myself a glass or two of wine and just stare at the little passport-sized photo of him on the homepage.
I don’t know if it was because he was away that things started to feel worse, or if they would have got worse anyway, but without those two sessions punctuating my week, I wasn’t in a good place. It was strange to feel so dark at the height of summer when everyone else was skipping happily around in flip-flops. It sounds stupid but I found myself missing my therapist more than I missed my sister who had recently died, or maybe I was bundling up all the “missing” in one. To get through, I kept up a therapeutic dialogue with myself. I’d ask myself the sort of questions I knew he’d ask and guess what? I had an epiphany! After ten years of being in a miserable relationship with someone who called me names and put me down every day, I realised I had to leave. So a few days before my therapy sessions were due to resume, I packed my bags, told my ex it was over and went to stay with a friend. When I told my therapist what had happened, he seemed genuinely sorry to have missed being a part of this breakthrough. But maybe it was his intention all along?'