This is an article I just finished writing, based on my own experiences and reading. I hope people here might comment on what they think about it:

Missing Your Therapist

Missing your therapist is a normal part of long-term therapy. Just as you might miss your friend when she is away on vacation, you can miss your therapist in a similar fashion. Missing someone, on this level, simply means that you value the relationship and draw something from it.

This is a garden-variety sort of "missing," but missing can also occur on much deeper and more painful levels. Failure to understand these phenonena, in my opinion, can contribute a lot to suffering and struggling during therapy.

There is always an aspect of dependency in a therapeutic relationship. On the most basic level, you depend on your therapist to help you in the same way as you would depend on your doctor or your mail carrier. However, many times in therapy, intentionally or unintentionally, an attachment relationship is formed between client and therapist, and this inevitably introduces a deeper kind of dependency. The therapist becomes someone that a client depends on, not just for advice, but for a basic sense of connection and security. How a client feels about and reacts to that dependency depends on the client's attachment history. Clients with a secure attachment history can feel comfortable depending on a therapist as one of possibly several positive attachment figures in her life. For clients without a secure attachment history, it can be impossible to establish comfortable and effective dependency without working through the prior history of insecure, disrupted, or absent attachment, and the emotions that go along with this history.

The process of reworking an inedequate attachment history is often referred to as "reparative work." The idea is that the therapist, in acting as a positive attachment figure, can "repair" some of the damage and deficits left by past negative experiences. This is a good idea in many ways, but there can also be very serious problems with it. If the experiences that need repair are fairly limited in number and scope, there is no reason that the therapist and client won't succeed in repairing them during the normal course of therapy. If, however, the deficits are extensive, severe, and early, it's extremely unrealistic to hold out the idea that 50-minute sessions can really make up for the client's losses. The size of the wound is infinitely larger than the size of the available bandage.

This discrepancy is what often brings up terribly painful feelings for the client of missing the therapist, and in some cases also anger at the therapist for not being more available. Nowhere is this more apparent than when the client is trying heal from negative or inadequate attachment experiences in infancy and early childhood. An infant expects her caregiver to respond to her physical and emotional needs 24 hours a day, seven days a week. If the caregiver does a good enough job, the child learns to accept the caregiver's occasional failings and moves on with her development. If that does not happen, the child will eventually find other ways of coping, but it often seems that a part of the individual never quite gives up hope of finding that ideal relationship at some point in the future. Therefore, when a therapist responds to a client in session in attuned and empathic ways, it can reawaken this hope and cause the client to reach out for the reparative experience. Yet, the reparative experience which is expected (being the center of the attachment figure's world at all times) completely contrasts with the reality that not only is the therapist not perfectly attuned and responsive during sessions, but even worse, the client has to leave the session at the end of the hour and cope alone in her life for the rest of the week. Every time her life feels stressful or overwhelming (which can be most of the time for some clients), her natural instinct is to reach for her attachment figure, and when she remembers her attachment figure is currently unavailable, this deepens her distress. When triggered by these circumstances, the client can be left with painful feelings of longing, rage, shame, isolation, helplessness, or panic. These feelings can be viewed as a kind of "emotional flashback" in that they seem disproportionate to the present circumstances, yet are incredibly convincing and bear no obvious sign of their origins in the past.

If things go well, the therapist and client will be able to confront the limitations of therapy and cope with them together. The therapist will help the client understand that the desired reparative experience is no longer possible given the client's current age and circumstances. This realization will most likely bring up excruciating feelings of rage and grief. The therapist will validate these feelings as completely justified given the unfairness of life and the reality of the loss. She will not take the client's anger personally. She will help the client bear the feelings of grief by empathizing with the client and demonstrating that she is committed to standing beside her in them. The therapist will frame the situation as a shared challenge and enlist the client's active cooperation in facing it. Together, they will find ways to help the client soothe and manage her feelings and reactions so that she can have a tolerable existence outside of therapy. They will generate plans for dealing with everyday triggers and stressors. They will create and enlist other positive resources and relationships in the client's life. They will find ways to bring into sessions for processing the feelings that typically come up at the end of sessions or in between. Finally, they will decide how to create as many reparative experiences as realistically possible, both in and outside of therapy, knowing that these can never be fully adequate. Moreover, they will work with the client's understandable resistance to truly taking in these positive experiences.

This ideal scenario is, however, easier said than done, and can be like walking a knife edge at times. If things do not go so well, many types of damaging situations can be created. Sometimes, the therapist consciously or unconsciously colludes with the client's fantasy that if only the therapist could do enough, she could avoid her grief about her early experiences. The therapist will do more and more, until she begins to feel burnt out and put-upon. Then she may blame her client for being demanding and for draining her, and begin more or less abruptly to cut back on what she gives the client. In extreme cases, the therapist may suddenly abandon the client, further traumatizing her. In other cases, the therapist may reject the client's dependency outright and exhort her to be more self-reliant. Sometimes, therapist and client will both get mired in loss and negative past experiences, without much movement in the direction of present growth. These are all easy pitfalls to succumb to, especially if the client's behavior intersects with the therapist's own vulnerabilities.

The most important thing for a therapist to understand is that for people with attachment wounds, they simply cannot heal without experiencing substantial amounts of pain. However, there is nothing healing in itself about feeling pain. Healing takes place when pain is experienced within a context where it can be made sense of, validated, and soothed, and in which different behaviors and outcomes can be created. If the client sees the benefit in facing her more painful feelings, and feels that her therapist will help her through them, then she can move through them willingly and therapeutically. If her therapist can't motivate her to the task of facing these feelings, and can't convincingly persuade the client that she is on her side and able to sit with her in her pain, the therapy will fail in that respect. This is why it is important for therapists to do enough of their own work to exude a quiet confidence about the benefit and possibility of moving through the most difficult and painful human experiences.