Saying Good-Bye
I am closing my practice down for the next 24 months. In so doing, I am saying good-bye to all of my patients and colleagues. And though 24 months is not a very long time, it is just long enough to question if I am returning at all, and when I do, how I and my circumstances may be changed. It is just long enough to have uncertainty on all fronts.
In anticipation to the many goodbyes I knew were coming, it dawned on me how little experience I have with endings, particularly with therapeutic relationships. I have had little to no training here but I knew it was important. I believed I needed to give each good-bye with each patient its due. I felt anxious with the responsibility of the "perfect" goodbye, as if there was such a thing.
I noticed immediately the many ways people, including myself, try to avoid saying Good-bye. For example, many patients will insist we will see each other again, and I would play along. There were several good-byes that were muttered under the breath as the patient breezed past me towards the door, giving me no opportunity to say anything at all. Some goodbyes were all business and followed a script. A short, "thank you for your services", a handshake and it was done. In other cases, patients would not show up for their final appointment.
So what makes a good-bye perfect? It depends entirely on the parties involved. I think that is why I instinctually follow my patient's lead. My priority is that the patients have the good-bye they want or can handle, even if it might be more emotionally distant than I would like. So the good-byes that were perfect in my opinion were perfect because they were perfect FOR ME. These patients happened to be in an emotional space that matched my own. Of the hundred good-byes, two stood out to me.
With the first patient, though I had seen her only briefly, she came to the final appointment in person, during a snowstorm, using public transit. She could have made it virtual or not shown up at all, but she made a real effort to come see me. She wanted to tell me how impactful our last appointment had been and to tell me she was doing better. This was a perfect good-bye because it is rare for someone in my field to receive this kind of gratitude and closure. It allowed us to connect about what was going well for her. By saying good-bye how she did, by making sure I knew she was going to be ok, she gave me a wonderful gift. She was allowing me to stop worrying about her. She gave me permission to move on.
What made the second good-bye perfect was how it forced me to say good-bye from my heart, when I was trying to hide behind technique. The second good-bye was with a patient I had been seeing 2-4 times a month for the past 5 years. This meant the relationship was more intense and profound than what I am used to. I reasoned that ending the relationship was no different than processing any other topic in therapy. In other words, in the face of a potentially emotional event, I went into autopilot: the patient talks, I listen and reflect. There was still work to do. This, however, was not my patient's idea of how she wanted to end our relationship. She found it sterile and invalidating. I became so disconnected from her, that in our penultimate meeting, she became tense and angry with me. Because I thought I was doing the "right" thing, I was confused and alarmed. Only with the pressure that comes from an urgent need to salvage something before it is too late, did I realize what she was actually saying to me: she wanted me to be authentic and honest about how I felt. She was telling me that saying good-bye properly meant going off-script. When I realized this, I knew instantly that she was right. I had my own emotions I was ignoring. She was my first long-term therapy patient, and I was going to miss her. What I needed to say was how much she meant to me and how important she was to me. So that is what I told her, plain and simple. I had two other therapy firsts that day: I cried and we embraced.
What makes a perfect good-bye for me it turns out? fewer words, more hugs.
Until I had to face these endings, beyond the sadness and fatigue, I did not know that there would be joy and freedom with heart-felt good-byes. I come away feeling very grateful for the patients, colleagues, and to my surprise, even for the institution where I work. Past resentments and burn-out were replaced with awe and inspiration at what we have accomplished together over the years, against the odds.