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Thursday, December 14, 2017

Clients' Fears of Being Abandoned By Their Psychotherapist

In prior articles, I've discussed fear of abandonment in relationships as well as psychotherapy clients' fear of being a disappointment to their therapist (see my articles:  Fear of Being a Disappointment to Your TherapistFear of Abandonment: Leaving Your Relationship Because You're Afraid of Being Abandoned, The Connection Between Fear of Abandonment and Codependency IssuesFear of Abandonment Can Occur Even in a Healthy, Stable Relationship, and How Psychotherapy Can Help You to Overcome Fear of Abandonment).  In this article, I'm focusing specifically on clients who have a general fear of abandonment because of their early traumatic history and the clinical implications of that fear in relation to their fear of being abandoned by their psychotherapist.

Clients' Fear of Being Abandoned By Their Psychotherapist 

There are many ways that clients, who have a fear of being abandoned, could perceive the therapist  as abandoning them.   Clients who have this fear are often hypervigilant for any possible signs that the therapist is not fully present in the therapy hour.

Most psychotherapists, who are trained in psychoanalysis or psychodynamic psychotherapy, have the ability to be emotionally engaged in the therapy session to the client's therapeutic process, including subtle shifts in the client's self states (see my article: Your Shifting Self States Can Affect You For Better or Worse).

Experienced contemporary psychoanalytic and psychodynamically trained psychotherapists are trained to intuitively pick up on what is going on in the intersubjective space between the client and the therapist even during times of silence.

But this doesn't mean that every psychodynamic psychotherapist is perfectly attuned during every moment of the therapy session.  There might be times when the therapist's mind momentarily wonders.  This is often related to the client's process even when it doesn't, at first, appear to be related.

For instance, if a psychotherapist is working with a highly dissociated client who is fairly disconnected from what he is talking about to the therapist, the therapist might find that her mind wonders momentarily as if both client and therapist are caught in the client's "cloud" of dissociation.

For an experienced psychotherapist, who is knowledgeable about dissociation, this momentary joining with the client in the dissociative "cloud" is important clinical information about what's going on with the client as well as what's going on between the client and the therapist.

For example, if, for a moment, the therapist "hears" a song in her mind, she asks herself inwardly whether this song has come into her thoughts unconsciously and how it may or may not be related to the client (see my article: The Psychotherapist's Empathic Attunement to Unconscious Process in the Therapy Session).

Psychotherapists who are comfortable disclosing their thoughts to the client might explore with the client if the client thinks it is related.

So, for instance, the therapist might say, "You know, you were just talking about your relationship and the song, "I Can't Make You Love Me" by Bonnie Raitt just popped into my head.  I'm wondering if I'm picking up something unconsciously about what's going on with you and your spouse."

More often than not, in this type of situation, even if the client wasn't talking about his feeling that his  wife no longer loves him, he might suddenly realize that the therapist picked up on a dissociated part of him that, until now, he was unaware of.  It's often a disavowed part of himself (or a disavowed self state) that he was unaware of but which was in the intersubjective "air" between the therapist and the client on an unconscious level.

When this happens, this phenomenon allows this disavowed self state to come "online" for the client. It might have been a part of himself that was just below the surface, so to speak, and was being unconsciously communicated to the therapist.

Although the client might not be happy to realize that he's really worried about his wife not loving him any more, he and his therapist now have a deeper understanding of a part of himself that was dissociated, and this part can now be worked with in therapy.

So, this is an example of what seems like a lapse in the psychotherapist's attention, but it's actually the client's unconscious material becoming conscious and furthering the work.

But a client, who is not ready to deal with his fear of not being loved by his spouse--even if he expressed this fear in prior therapy sessions--and who generally fears being abandoned, including by his therapist, will deny that the song that popped into the therapist's head is relevant.

Not only will the client deny it, he will also perceive the therapist's momentary thought about the song as being intrusive and a form of abandonment, "Why are you thinking about songs when you should be paying attention to me?"

The client sees this as "evidence" that the therapist really isn't interested in him because the therapist's mind wandered for a second.

Months later, when the client becomes ready to own his fear about his wife, he might tell the therapist that it was prescient of her to pick up on this dissociated fear a few months back in the form of the song.

But before the client is ready to allow that disavowed part of himself (the part that has this fear about his wife) to fully emerge, he will only see this phenomenon as a disruption to the therapy session and proof that the therapist abandoned him--even if it was just for a second.

What the client is unaware of is that the abandonment which he fears will happen already happened with his primary caregivers and this is now the template through which he sees his relationships, including his relationship with his therapist (see my article: Developmental Trauma: Living in the Present As If It Were the Past and Overcoming Trauma: When the Past is in the Present).

Let's take a look at a fictional clinical vignette which illustrates these dynamics:

Sandy
Sandy started therapy because she wanted to be in a relationship, but whenever she got close to anyone in a romantic relationship, she would become too afraid to remain in the relationship and she would find a way to consciously sabotage it (see my article: An Emotional Dilemma: Wanting and Dreading Love).

In hindsight, Sandy would see how she sabotaged the relationship but, no matter how many times this happened, she was unable to see it while it was happening.

Clients' Fears of Being Abandoned By Their Psychotherapist

This part of her that unconsciously destroyed her relationships was so dissociated that it operated as if it were not a part of her at all.  She would tell her therapist, "It's as if it's 'not me' acting in the relationship--as if I'm in a dream and I only wake up after I've damaged the relationship beyond repair."

Sandy talked to her therapist about her fear that if her friends or a potential boyfriend ever really got to know the "real me," they wouldn't like her and they wouldn't want to be around her (see my article: Overcoming the Fear That People Won't Like You If They Knew the "Real You").

Her therapist was aware that, most likely, if Sandy had this fear with others, she probably had this fear with the therapist as well because this is a common experience with clients who have this fear.

When her therapist attempted to explore whether Sandy had this same fear with her, Sandy denied it.  But her therapist sensed that this fear was out of Sandy's current awareness and Sandy wasn't ready to recognize it.

A few weeks later, when her therapist told Sandy that she would be going on vacation in a couple of months for three weeks, Sandy became highly anxious.  She struggled with her internal conflict of  wanting to suppress this fear and wanting to talk about it.

A week later, when Sandy came for her next session, she told her therapist that she was having nightmares about being a young child who was being accompanied by a woman in a subway station.  Sandy didn't recognize this woman, but in the dream this woman seemed to be a nanny or some sort of caregiver.  Suddenly, in the dream, the woman, who was accompanying her, disappeared and Sandy was lost and confused in the crowded subway station.  She didn't know where to go or what to do and she began to panic.

Each time that she had this dream, Sandy told her therapist, she woke up startled and couldn't go back to sleep.  Her heart was pounding and her thoughts were racing.  Even hours after she woke up, she still felt a sense of dread that was residue from her dream.

Sandy and her therapist explored the meaning of the dream, especially as these dreams began right after her therapist told Sandy that she would be going on vacation in a couple of months for three weeks.

Sandy's first reaction was that she felt ashamed.  On the one hand, she knew, logically, that her therapist deserved to go on vacation, as everyone does.  But, on the other hand, a part of her feared that her therapist wouldn't come back or that if she came back, she would decide that Sandy was "just too much" for her and end the therapy.  Then, Sandy would be left on her own, feeling abandoned and not knowing what to do.

Given Sandy's childhood history of her father disappearing one night (never to return) and her mother's major depression where she was barely able to function, it was understandable that Sandy would have a fear of abandonment because she had been traumatized by each of her parent's abandonment--the physical abandonment by her father and the emotional abandonment by her mother.

This fear of abandonment was what was getting in the way of Sandy having a lasting relationship.  She unconsciously sabotaged the relationship to end it because she wanted a sense of control of the end rather than waiting for her boyfriend at the time to abandon her.

Sandy's fear of being abandoned by her therapist was now out in the open for her and her therapist to work on.  Sandy knew that she didn't completely believe that her therapist would abandon her--it was only a part of her that felt this way, but it was a powerful part (see my article: Reclaiming a Lost Part of Yourself).

As Sandy and her therapist talked more about her fear, she felt the fear somewhat subside.  She was aware that her fear was based on her childhood trauma of real abandonment (not just fear of abandonment).  So, over time, Sandy and her therapist were able to process her early trauma, which was the origin of her fear (see my article: Psychotherapy to Overcome Your Unresolved Childhood Trauma) and, gradually, the fear of being abandoned as an adult began to subside.

Conclusion
People who have a childhood history of emotional or physical abandonment often have a fear that important people in their life, including their psychotherapist, will abandon them.

At first, the fear might not be explicit.  It might be just under the surface and come to light through dreams or other unconscious material.

Before clients realize that they have this fear, the fear can get played out in other ways, like missed appointments, or in some cases by the client aborting therapy altogether rather than, from their point of view, risk being abandoned by the therapist (see my article: When Clients Leave Therapy Prematurely).

Once the fear is out in the open, clients often recognize that there is a part of them that has this fear.  In other words, they're not completely convinced that the therapist will abandon them--it's more like a disavowed part (or self state) contains this fear.

Becoming aware that what they fear has already happened in their childhood and that this has created a relational lens through which their fear is projected onto current relationships is helpful.

Even more helpful is the processing of the original trauma so that the fear of being abandoned doesn't get triggered in current close relationships.

Getting Help in Therapy
Fear of being abandoned is one of the major reasons why clients come to therapy, especially if this fear is being enacted in important adult relationships.

Clients often don't recognize that they have this fear about their therapists until there is an upcoming separation, like the therapist's vacation.

When the fear comes to light in therapy, there is an opportunity to work on this issue because it's alive in the therapy.

Just knowing logically that the fear of abandonment is from a prior trauma, although helpful, isn't enough to overcome this fear.  The client and therapist need to do trauma-informed therapy to process the original trauma so that the fear no longer gets enacted in current relationships.

If you're struggling with fear of abandonment in your close relationships, you could benefit from working with a licensed trauma-informed mental health professional who can help you to overcome this fear (see my articles: The Benefits of Therapy and How to Choose a Psychotherapist).

Once you no longer fear being abandoned, you can live your life with a greater sense of ease and well-being.  You can also live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I have helped many clients overcome a history of trauma, including a fear of being abandoned.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.












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