When Your Therapist Leaves for Summer Vacation
I hate August. The month marks the onset of the dreaded shrink drought as psychiatrists clear their appointment books and patients like me are left to stare at their iPhones searching their calendars for relief that is certainly weeks, if not a full month, away.
Along with wilting herbs, the juiciest tomatoes of the year and flimsy floral sundresses, August is the patient’s month of doom. It’s when psychiatrists take their precious families to suck in the cursed cool air, buttery lobster, and inky wild blueberries of Maine or the glossy, fashionable pleasures of glittering Martha’s Vineyard, Nantucket, Hyannis, Newport, Narragansett, Montauk, East Hampton, or Southhampton.
I can pretty well bear these annual absences now, with my current Upper-West Side psychiatrist, but in 1990 I was 25 years old, post-college, and living in Burlington, Vermont. I’d been in therapy for a year, passing rapidly from taking keen intellectual pleasure in my bi-weekly appointments with my psychiatrist—I’ll call him Dr. Kohl—to finding myself nearly asphyxiated by him. The way I felt in his presence reminded me of the sickening excitement the first time a boy held my hand in the dark. Before the kiss.
This is both exactly how you’re supposed to connect to your shrink—if you’re old school—and precisely not—if you’re considerably more than post-Freudian. I was on the wrong end of what Anne Sexton called “the big cheat.” I was in love with my doctor but he wasn’t in love with me. This imbalance is therapeutically productive but it doesn’t feel very good when you’re in it.
What’s worse is that when your shrink goes on vacation in August you can be sure they’re off with their family. These are the very people whom you envy, the privileged few who have what you want but won’t ever get from your doctor: unpaid time and attention strewn carelessly out over hours and days; not time metered in excruciatingly brief 50-minute intervals. When your shrink is on vacation he or she is with truly important people, the ones who are loved and cared for in a way you may experience in fleeting bursts as a patient all the while knowing the experience is a cheap—or not so cheap—facsimile of the real thing.
That’s the trouble with therapy. As good as it is—and trust me, when it’s right it’s as unambiguously pleasurable as plunging into chill blue ocean water after 15 minutes on a sweltering A-train platform—the rub of therapy’s half-measures is difficult to harmonize. As a patient, every time I hear “Time is up” or “I’ll be away the week of the . . . ” or “I have a bill for you,” I am forced up against the stinging reality that I have so much more invested than my doctor. Even when I was painfully in love with Dr. Kohl, I grasped his relief in leaving his practice, and me, behind. What has always felt amiss is that the better the shrink, the more of what passes between the two of you presents as unmediated and real—the very opposite of a professional transaction. And yet all the signs, including money, the denuded office, the uncompromising “hour,” and the professional boundaries splinter this meticulously constructed delusion.
The centrality of therapy in one’s life pivots on who you are and why you’re there. I ground myself in session, using the most truthful exchanges I have anywhere to take myself for an airing as I unfold the disparate parts of my actions and thoughts, more often than not the ones that matter most, their significance shaded until spoken. I’ve always indulged the illusion that I’m my doctor’s only patient. Since I can’t sustain this fiction as I pass other patients emerging luminous from behind my doctor’s door or sitting in self-contained suspension in the waiting room, I console myself with the fantasy that I’m the only one who matters—the only one my doctor truly cares about. Special. Different. Better. But this, too, is part of the process, as unoriginal as my longing. Grappling with being one of many without diminishing my own value has been a challenge, but one worth taking on.
With the outsize emotions that are the main currency of therapy it’s no surprise that the potential messiness of the encounter over the course of treatment must be delimited by a rigid set of ethical and professional standards. Unless you’ve made a big mistake in choosing your shrink, there is no physical contact between patient and doctor. As obvious as this prohibition is, the other potential transgressions of the psychotherapeutic boundaries are just as dangerous but far more subtle and difficult to police. There may be phone calls after hours, but should those phone calls reach your doctor at home? This invites the patient to partake in a rich fantasy of participating in the doctor’s life, however liminal the connection. Then there is the doctor’s need to monitor the charged emotional exchanges in session. In part, this calls for checking the temptation to take on an overly paternal or maternal role in which the patient’s agency erodes, its weighty responsibility ceded to the doctor. The willingness to allow oneself to see and confront one’s responsibility for sustaining a life—either one not wanted at all or one stripped of its pleasures—is therapeutic magic. The temptation to skirt this terrible responsibility by giving it over to the doctor’s wisdom and authority is disastrous. Preventing this is the doctor’s job.
Therapeutic exchanges feel “intimate,” and they are. Although the word carries sexual overtones, it’s useful in describing the emotional alliance, trust, openness, warmth, and familiarity of the therapeutic relationship at its best. And even if, as is invariably the case, a sexual undercurrent courses however consciously or unconsciously through the exquisitely cozy 50 minutes, its valence complicates every exchange, inducing a kind of hot zone where each word gains potency and each look the potential for transgression.
I’m better at regulating these charged exchanges now—as is my doctor. But 20 years ago, I was sexually intoxicated by the idea that Dr. Kohl was taking me in, writing in his notes who he thought I was by using our words and presence together in the enclosed room to make something of me from crude raw material. I believed he alone could make my life worthwhile, if he just would. That startling potential, along with the assertive gaze of his startlingly intelligent, kind brown eyes, played through my mind in a relentless loop between appointments. I reveled in how he looked at me without flinching or averting eye contact no matter how awkward or charged the moment. The pleasure in it was, and remains today, being recognized with such extraordinary clarity.
Believing in one’s own importance, one’s own right to take up a share of the oxygen in the room, comes more easily to some than to others. To matter to another is potent medicine no matter what sort of transaction is involved. So why, come August, would I gracefully relinquish the prize of having the best version of myself reflected back at me twice a week?
Hard as I tried back then to cling to what Dr. Kohl saw, I failed. His kindness and the gentle compassion settled like a fine, warm glaze on my skin the way icing glosses a hot donut, but it never quite set, flaking away the minute he disappeared from my sight. I have a much firmer hold on myself now, one that needs polishing now and again, some days more than others, but one sturdy enough to withstand the August doldrums.
It’s not that I no longer miss the sparks of warmth and intimacy that result from what can seem like endless clots of dollars, words and gestures corralled by 50 minute sessions. I do. But even if it has taken me two decades to discover it, I’ve found that the best antidote for this loss is to find an escape of one’s own; the classic East Coast summer retreats from Maine to Narragansett do not exclude patients no matter how persuasively they coax therapists, psychologists, and psychiatrists to return. Short of pulling a Bill Murray on your shrink during their family vacation as his character did in Frank Oz’s 1991 film What About Bob? I’ve learned to deploy my own vacation to peel away the layers of routine in which those prized appointments take such prominence. Now I, too, leave. What better cure for all those baggy, unpunctuated weeks?
Midway through August, sporting a tan and flip flops worn so thin I can feel a pebble beneath my heel, I remind myself that my doctor will be there in the fall, waiting to call me in. There, the last shimmer of summer dispatched by Labor Day weekend, she will help me reassemble the loose, fraying strands that have accumulated into a messy fringe over the weeks of absence. And then I can really rest when that taut moment of reunion saunters in, charged and ready after conspicuous absence.
Originally published in Literary Hub.
