From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Two Sides of the Coin: When the Therapist Takes a Vacation

A break for the patient, or a struggle?

It is summer, the season of therapist’s vacations. When I was living and working in New York City and had just started therapy with a therapist whose office was on the Upper West Side of Manhattan, I became dependent on her very quickly. Then I learned that Manhattan therapists generally took the entire month of August off to vacation in the Hamptons. For four years, August seemed like it was endless and I think I phoned her just to hear her voice on her voicemail message almost every day.

I was on vacation this past week. Actually a “staycation” while I attended an intensive six-day writing conference held on a local college campus. I had put off on taking a vacation since last October in order to be present at this conference — seven months without a break longer than the four day Thanksgiving weekend. But it was worth it; I immersed myself in the writer’s culture and loved every minute of it.

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Some patients were glad for the time off. "You mean I don't have to come here to see you?" Others were not as thrilled when I told them I would be out for a week. I started telling them a month ahead of time, and continued to remind them until the week before. They had gotten used to having me around and available. “You’re going to be out for a whole week? Where are you going? Are you going away?” They were attempting to get a sense of the situation for themselves, trying to gain as much information as possible in order to lessen their sense of abandonment.

We reviewed a plan should a crisis arise. Since I work in a clinic, during clinic hours someone would always be available to speak with them; they could call the front desk and ask to be connected to the supervisor on duty. If they felt the need to have a session with another therapist, that could be arranged. Off hours arrangements would remain the same as always with the beeper system. If the crisis was an emergency; suicidal or homicidal thoughts; they could call 911 or go to the nearest emergency room.

Still, they seemed uneasy. “I know it’s hard to talk to someone you don’t know about issues we have been discussing for a long time. If you’d like, and it’s not a crisis, you can leave a message on my voicemail and I’ll call you when I get back Monday," I offered. " But,” and this is where I’ve learned to set limits, “our conversation will stay on the short side. How does that sound?”

Some of my patients seemed relieved. They might have just been feeling the need to “check-in” or hear my voice as I had done with my first therapist. Perhaps they had needed permission, which I had just given them.

                          *                                  *                                      *

My therapist is going on vacation this week. She didn’t tell me where she is going nor did I ask. She wouldn’t have told me anyway. I do know that when she takes her two-week vacations around the Jewish holidays of Rosh Hashanah and Passover, she goes home to Europe. I remain fearful that her plane will crash.

I have mixed feelings about this vacation. We’ve been having intense sessions and I feel as though I need a break. She could probably use a break from me as well. And I always like saving a week’s (two sessions) worth of fees since I pay out-of-pocket.

But perhaps it isn’t such a good time for this work to be interrupted. We were on a roll and might lose some momentum. And I will miss the feeling that she is the one person who I can talk to about any issue without risking judgment. Historically, I have had a difficult time when my therapist(s) have gone on vacation, though that has improved. One issue that has persisted from when I carried the diagnosis of borderline personality disorder is a lack of object constancy. I have a difficult time perceiving a sense of continuity and consistency about people and things in my life. I have a hard time experiencing someone who I am fond of and who is absent as a caring presence in my mind.

Regardless of what kind of week I have, and deep down I think I'll be okay, I know that on Tuesday, July 10th I’ll be sitting in Dr. Adena’s* waiting room, she’ll open the door to her office and usher me in. And then we’ll pick up where we left off, getting down to the business of therapy.

* Names have been changed.

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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