Gaps, Breaks, & Trips:
Understanding the Time between Therapy Sessions

by Carol Campbell, MFT

Emily was a forty-two-year-old, mid-level manager in a high-tech firm. She had over six months of psychoanalysis under her belt, and was pleased with how our work together had seemed to improve her relationship with her husband and children. Exhausted from a particularly tough quarter at the office, she was eagerly anticipating a ten-day trip out of town with her family. Our three-times-a-week therapy sessions would need to be put on hold until her return. Emily mentioned a time or two how she might miss our regular times together, but mostly she was looking forward to some fun and a change of scene. She was unprepared for what happened in our final sessions before her trip.

It seemed as if nothing I said was the least bit useful to Emily. Noticeably irritable, Emily snipped and snapped at me. I began to feel incompetent, pushed away, and vaguely selfish for not being as miserable as Emily seemed to be. These internal registrations of negative self-thoughts were my clue to finding a way to help Emily. Emily's unconscious mind was having a very different experience of anticipating the vacation than her conscious mind was having. She was putting her own bad feelings of worthlessness into me, where I could feel them for her and use that experience to help her come to know herself better and reclaim the feelings she was trying to get away from.

As is true for all of us, in her unconscious there was a parallel Emily. Emily's parallel self operated with the limited emotional capacities of a neglected child, which Emily had in fact been. Through our analytic work together, this parallel Emily, who had learned to survive emotionally by not caring about much of anything, had in psychoanalysis discovered what it is like to long for someone she could actually trust to care for and about her.

Now it seemed as if the rug were about to be pulled out from under her again, as it had been so many times when she was little. Even though the adult, competent Emily was the one who was choosing to leave town, to the parallel Emily it simply felt as if I were leaving her alone and vulnerable; and in her childlike omnipotence, Emily believed the reason I was letting her go on the trip at all was that I did not think she was good enough to stay with. What kind of a mother would not feed her baby for 10 days? She must be a terrible patient/baby! Emily was absolutely enraged with me for treating her so cruelly, and filled with shame for not being the person she thought I somehow needed her to be in order not to banish her to her vacation.

The last thing Emily needed from me was to deny responsibility for her agony, or to reassure her that everything was going to be just fine while we were apart, or even that I would be there when she returned. Rather, what she needed from me was complete validation of her deeply held and very painful feelings. First I needed to help her brush aside her urge to restrict her own awareness to just her logical, rational, adult self, who of course knew the trip would be just fine and that I would be waiting cheerfully when she returned. The hardest work of analysis is mostly with that parallel self – young, vulnerable, scared, previously betrayed or neglected, and convinced of culpability for this and other bad situations. I also needed to think about how my words and behavior may have unconsciously or otherwise gotten pulled into re-creating the ways of hurting Emily that were most familiar to her.

I spoke to Emily in simple words directed to her parallel self. I said that what she was feeling made complete sense to me. She was right to feel that I was abandoning her by letting her go away. By not seeing her at the usual times, I was depriving her of all the good things that she needed to be able to count on me to provide for her. I said it was bad enough that I make her wait for her session hour each time I see her, and that I let these gaps of the "off days" slip in between us and keep us apart when she needed me, just as all little ones need someone to take care of them. I said that I make her suffer through the weekends every week. Then there were the vacations and holidays that I take, which to the parallel Emily would also come to feel like endless empty spaces. As if all that were not enough, now I was leaving her as she and her family went on vacation. How could she not feel outraged and angry and scared? And why should she blame herself, when clearly I was the culprit?

This same experience needed to happen over and over again in our work together for Emily to get to the point that she no longer denied and hated her bad feelings about our breaks in the treatment. As we dug deeper, it became evident to Emily that when she really let herself feel her feelings, she felt bad about all our gaps, breaks, and trips, not just the family vacation. They all had a way of ripping open old and painful wounds. But, over time, she became far more skilled at feeling the feelings, identifying them, talking about them – and then they slowly lost their debilitating punch. They became valuable to her as something she had made and could be enriched and enlivened by.

The key to healing these wounds was for me to validate the point of view in her that had always been dismissed before as insignificant, wrong, shameful, and not true. In that way, Emily could re-experience the same feelings she had had as a small child when her mother had not handled separations with Emily's tender needs in mind; but this time, Emily was not alone in her pain. I was with her and could tell her she was not crazy to be feeling what she was feeling. She could grow new neurons, new habits of mind, and enjoy a more complete grasp of her own inner truth. These changes allowed her to get back on track developmentally and to deal more effectively with reality.

Ironically, it is the process of allowing oneself to slip into a deep but temporary dependency with the analyst, as Emily did, that allows for the gradual development of much better autonomy and emotional strength and health. The ability to let oneself become appropriately dependent on another person is an essential skill for a healthy love relationship outside of therapy.

For many patients, breaks in the therapy of any length for any reason prove to be golden opportunities to access and heal past traumas that have inhibited the patient's ability to thrive. The wise therapist will be on the alert for signs that any missed session, or even the time between sessions, might evoke reactions that could be an important key to deepening the treatment.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.