Winter Holidays as Stressors on Your Therapy

by Carol Campbell, MFT

Much has been written about how everyone is more likely to feel stressed around the winter holidays, and how that might be a good time to think about getting some therapy. But what about if you're already in therapy and the winter holidays roll around? In my experience as a marriage and family therapist, the holidays can be tough on your relationship with your therapist. Perhaps an ounce of prevention can come in handy…

For people who celebrate Christmas or Hanukkah, for example, great focus is often made on gift giving. Many people develop a deep connection with their therapist, and wish that they could exchange gifts as they would with any other very important close confidante in their life. While different therapists handle things differently, the current ethical standard is that great caution needs to be exercised with that possibility. Most therapists I know would not accept a gift from a patient, let alone give a gift to the patient. The only material exchange between the two should be the fee paid to the therapist. Any exception to that raises conscious and unconscious concerns about exploitation, unreliable boundaries, power abuse, trying to feel more special than others, and denial of the cold, hard reality that you are not friends with your therapist.

Wanting to exchange gifts, however, is a fabulous notion that can lead to very rich discoveries about the intimacy of the therapeutic relationship. A therapy in which the patient can share deeply held wishes and fantasies of what they wish could happen over the holidays between the therapist and the patient is a therapy that can reach deeper depths of intimacy. For example, memories of holidays long ago that were fraught with disappointment in caregivers can be re-worked, becoming part of the patient's overall narrative of her life that can be better understood now. What matters is not an actual exchange of gifts; what matters is that the therapist deeply understands and respects the longing to be able to do that.

As vacation days approach, anxiety increases for the patient, who needs to deal with the absence of the therapist not only consciously but unconsciously as well. What does that mean? Consciously the patient may actually be looking forward to the break: no trips to the therapist's office, money not being spent, a chance to test out new skills on your own, a break from the hard work of therapy, etc. What's not to like about that? Plus, the patient may consciously know to expect to feel left out, or alone, so she imagines all she needs to do is distract herself with something else fun to do.

The real issue is often unconscious. The patient may be unaware of a little self who feels ashamed for not being such a remarkably good patient that the therapist would not even consider taking a vacation in the first place. Or there might be a little self who believes she should feel guilty for having been difficult with the therapist, because that then caused the therapist to take a vacation. "Little selves" (we all have one) often feel omnipotent, and therefore responsible for everything that happens, especially if it is painful. The anguish of being left during vacation breaks can be greatly lessened if the therapist and patient can access the feelings in the sessions prior to the break, in which case the little self can freely express her outrage and experience the deep relief of being understood and validated. It is often challenging for a patient to realize that relief actually comes through being able to express such primitive rage at the therapist when the therapist is going to go right ahead and do what is painful anyway. Many little selves believe that unless you can change an outcome, there is no point in expressing upset. They expect humiliation (and often create it out of whatever the therapist says) for just wanting the powerful caregiver to erase something that hurts. What is actually true is that the experience of having the feelings validated as real and important is far more therapeutic and healing than erasing what hurts – in this case, having vacations.

In summary: The holidays are often really difficult when you are in therapy. To minimize the difficulties, unload as much rage at the therapist as you can before the vacation days come along and leave you all alone. A good therapist will expect that, understand it, help you connect it with past trauma, and validate how what the therapist is doing by taking a vacation is indeed painful to endure.

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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.