Last year Elle and I were talking about when things have gone wrong in my therapies (there’s plenty of content there and we visit it regularly!) and situations where a client might choose to ‘end’ and not come back to therapy but it feels somehow unexpected or not the ‘natural end’. I was in one of those sensible adult places, not activated (!), and so able to express some of what goes on for me when the wheels feel like they are falling off in the therapeutic relationship and how panicked I get. I recognise that sometimes the reasons I bolt for the door (sometimes literally) are often not what appears to be happening on the surface in the moment.

What can seem like a very small trigger can send me totally spiralling…but then that’s hardly surprising when we look at this through a Complex Trauma lens, or the fact that I have tonne of parts who are all processing stuff in their own ways – many of which are not particularly sophisticated! Of course, my four-year-old self and teen parts don’t see things the same way my adult self does, nor have they the skills to manage things in the way that my adult does. You’d think I’d be ok, though, seeing as I have a really fucking competent adult self. The problem is, my system is complicated, has the capacity to hijack me, and I am really really good at dissociating. Adult self is rarely there when I need her when I am freaking out.

Let’s face it – what scares me (all of me) more than anything is broken connection, feeling like the attachment is severed, and that I am on the verge of being abandoned. This is not at all surprising given my history because there was a time when disconnection really was a life-or-death situation. My mother’s PND did nothing for my little baby self or my developing nervous system and I have spent so much of my life in survival because my caregivers have never been reliable.

It’s hardly surprising that when I feel like the relationship with Elle (or A or Em…) is headed towards a cliff edge I am the first to run away. I am the absolute queen of ‘leave before I get left’ which is why I absolutely need my therapist to know this pattern and make sure I don’t bolt and disappear when there is a rupture (even if from their side it might seem small, repairable, or can wait). Ruptures can feel catastrophic to my system these days because … well… there have been ruptures where I have been hurt really badly and basically been abandoned and rejected because of my responses. Think of Em. My reaction to being called a tick, calling her out on it, and running scared didn’t see her try hard to meet me in it, to apologise, to understand why I was terrified, she just saw it as a perfect opportunity to let me go.  

Anita was way better at handling ruptures… until her life collapsed around her ears and she couldn’t hold herself let alone anyone else. The damage from that ending is ongoing and painful. I feel so sad that in the two years since I last saw her, she hasn’t been able to step outside of her struggles and meet to end but that’s not what I am here to talk about today… although it definitely fed into the intensity of the panic I have felt with Elle during our recent rupture. 

So, what’s this post all about?

This is a pre-curser post to help understand a bit of what happened in the most recent rupture with Elle (i.e when I brought it to her attention). Because yes. I got myself in a mess. A big one. And I ended up sending her this message:

I don’t want to see you anymore.

You can only imagine what sort of a state I had got myself into to send that. Eek. Like, I am the person will ALL THE WORDS… not none!

I’m almost done writing that post – and it’ll be up soon. But suffice to say it’s been a wild ride.

I am glad, then, that over the time I have been working with Elle, I have given her pieces of the map of me so that she has been able to understand me better and figure out what I need.

Most of the time I probably appear pretty together when I see her despite the crap that keeps hitting my day-to-day life. I probably seem a bit wounded and in need of support for my little parts but also seem generally functional. Sometimes I am a bit closed off but I am present in the room rather than off in space dissociated. The completely derailed, panicked, reactive, scared stiff self hasn’t really made it to the room (she’s done some emailing though!) – or if she has, she’s not been triggered BY ELLE. Elle has been a witness to the struggle and in support role in the room, not the trigger. It’s only this last month that Elle has had to misfortune of meeting that part of me in person.

Anyway, back to last year. I was testing the water with Elle knowing that it was only ever going to be a matter of time before something triggered my runners and protectors and I needed to know how she would respond if I unexpectedly disappeared. We all know that there are those diehard therapists who will say “I respect client autonomy, and if they choose to leave that’s their choice and I will not contact them thereafter. It’s up to them to contact me should they want to resume therapy.”

Puke.

Honestly, this kind of therapist really annoys me more than anything. If that’s your stance as a therapist then you absolutely should not be working with C-PTSD or people with multi-part systems. This ‘in the service of the client’s autonomy’ is bullshit. I’m not for one minute saying to beg and plead for a client to come back, that’s not realistic. But so often when we start running and slamming doors behind us, it’s not because we want to leave – it’s because we are scared! And we need for the adult, regulated nervous system (therapist) to remind us that we can come back, that we are wanted (even if we are having a tantrum and full of shame), and that they are committed to working through EVERYTHING with us even if it is HARD. Letting a triggered client disappear out the door is abandonment… it’s not kind.

And so, that day I asked Elle if she had ever made a mistake with a client that led to termination and what she did, or what she would do differently. Elle told me the about the biggest regret of her career was a time when she wasn’t as sensitive as she could have been with a client who kept cancelling last minute. She reached the point where she enacted her cancellation policy after several missed sessions – i.e charging for the session by sending an email, and the client left as a result – never came back in. Elle said she had failed to recognise potential wounding around money and still feels terrible to this day.

Mistakes and missteps happen, but what I wanted to know was what she did when the client said they were not coming back. Was she a ‘respect client’s autonomy and let them go’ therapist, or did she do something different?

Elle assured me that she had reached out and suggested that they meet in person but that the client didn’t want to come back, that there were some back and forth communications but that the client ended.

[For the record there was nothing identifying or specific – merely Elle’s feeling that she fucked up and had learnt a lot from that.]

I told her that I would always want her to reach out to me because it made me think about all the times I ran out of Anita’s and how when I am upset I can pull the plug (or parts of me can) and how it is really important to me that my therapist recognises when I am truly wanting to end and when I feel backed into a corner and feel like I need to leave because I can’t tolerate the feelings of disconnect etc.

Even though Elle was clear that she would always contact me in a rupture situation – my brain was whirring after the session and so I wrote her this letter at the time:

I was thinking about what you said yesterday, about the client that never came back – because of course that’s what my brain does at 3am when I can’t sleep and the anxiety is doing its thing. I actually had a lot of thoughts, like I can think of hundreds of reasons of why that all happened, but I am sure there’s nothing you haven’t thought about over the years so it’s not relevant.

However, what it did make me really think about was what would happen if something similar happened with us. You’ve probably figured out by now that I am not someone who cancels last minute and, generally speaking, if I did it would be because something was out of my control with the kids or something. But, actually, there are times when I get completely hijacked by my system and the “I don’t want to go” (it’s much bigger and more complicated than that) is really hard to get around.

Tbh it’s rarely an “I don’t want to go” because there is lots of me that absolutely does but it’s sometimes more of a “things feel very wrong, something is up, I’m scared that it’s all going to blow up, I don’t feel safe, I feel hurt, abandoned, rejected, maybe even angry… [on and on and on]…and so I need to protect myself from that and stay away – and she doesn’t care anyway so what’s the point?! It’s better to leave before I get left…”

I mean I totally get what happens, where it comes from, what parts of me are involved, and yet when it’s happening it is not always easy to sidestep it. It would be funny if it wasn’t so tragic but I guess at least there’s a really clear trajectory on how it all runs which I guess at least I am aware of now. And I see it a lot. Clients, for whatever reason, find it difficult to go to their therapy, maybe don’t show up, and might seem to be ghosting but actually it’s not because they don’t want to be there it’s because there is some kind of a rupture (that maybe the therapist has absolutely no clue about) and they, for whatever reason, can’t bring it to the room.

So many of us are conflict avoidant and even though bringing ‘big feelings’ shouldn’t be a problem, I guess most of our experiences have been that when we have, we’ve been mocked, or shamed, or abandoned, or gaslit…you know the deal… and so we’d rather not risk that repeating. I think sometimes, too, part of us knows that our reaction to whatever has been triggered is MUCH BIGGER than it ‘should’ be and so there’s shame and embarrassment there too because we feel completely derailed and it’s not even that big a deal (only it is a massive deal!).

I think it can be all the more unsettling for people that don’t really spend much time contemplating the therapeutic relationship and so when something between the therapist and client happens it’s hard to know what to do with it. Like it’s much easier to say, “I’m sorry, I’m sick” rather than, “I feel really anxious and something you said has really upset me” when they thought they were there to talk about their work stress and all of a sudden all this other shit is stirred up.

Sometimes it feels like a toddler or a teenager having a tantrum but actually I think that’s exactly what is happening – whatever is being triggered isn’t necessarily conscious and, in that moment, the adult self isn’t available enough to navigate the situation and all we know is that it just feels huge and insurmountable and overwhelming and completely in our bodies – and so the instinct is to run away and hide.

In some ways I think this can be really hard to manage because whatever is happening to stop a person turning up to therapy feels massive to them, and acting out can bring on all the massive feelings of shame and embarrassment afterwards and basically like you just want to crawl into a hole and die. It takes a lot to feel brave enough to come back and talk it through, and there has to be a strong enough sense that the person opposite you isn’t going to confirm everything that you fear is happening. It really is like with toddlers and teens. They need an adult to help them out of their meltdowns sometimes and an invitation back to work things out.

It is really complicated (but also not). I think when people don’t show up, rather than being flaky or disrespectful (I mean I guess there must be some people like that), is about testing whether the therapeutic relationship is strong or not. Like do you care enough to come find me if I disappear or will you just let me go? And I really get that this is complicated because all the training is like, ‘therapists should respect client autonomy’ and all the shit about not creating a dynamic that encourages ‘game playing’… only that is really pathologising and really makes it seem like everything that happens is down to us. It’s not game playing, it’s trying to protect ourselves.

As I said, lots of us have been hurt over the years and haven’t had the experience of managing conflict in a way that doesn’t somehow burn the house down and so rather than face a situation that potentially will hurt us more on top of whatever hurt feelings we are already feeling, we disappear. I think, for me at least, if I experience something as being abandoning or rejecting then it absolutely triggers the need to run away.

I’m not explaining this brilliantly well, and this is looooonnnggg, but I guess what I am trying to say is, if I cancelled last minute, or didn’t show up it’s not because I am rude, or don’t respect boundaries or whatever else – it’s because something is really wrong (from my side) and it feels too hard to come. If you just let me go and never contacted me to find out what was up or didn’t reach out and invite me to come and try and figure out what’s going on with you in person, actually what it confirms to me is probably everything I was running away from in the first place which is the feeling that you don’t care…

I’d like to think that a situation like this would never happen – but I also live in my head and experience often enough my runner ducks bolting. Just usually I have enough time to gather them back together before I see you.

Having a therapy go south in this way is sooooo common and causes such a lot of hurt to those involved. I have way too many stories – not just my own! – and I was wondering whether after the event a therapist reaching out would make any difference. And I think it would. An opportunity to talk through what happened when it’s not live would probably be really helpful because I think we tend to carry this shit around for a long time. 

Anyway, that’s… a lot. I’ll try not to run away, but if I do, please come and find me. X

And so… I guess it was helpful that I sent that last year, because Elle did come and find me…and the session when we did get to meet was HUGE. I’ll get the ‘what happened next’ post up asap.