The Art of Detaching from Results

Q: I have a few long-term clients who don’t seem to be getting better. I’ve tried everything I can think of to be helpful, without success. What am I missing?

A: You’re not alone. This is a problem most therapists face. And you may not be missing anything.

When we’re emerging therapists (actually, anytime), it makes sense to question our formulations and interventions when progress is slow, or the client doesn’t improve. We may need to learn more, read more, consult senior clinicians. If, however, we’ve done everything we can think of to move the treatment forward without success, that isn’t necessarily a professional failure.

It can take years to figure out that using both a client’s progress and lack of progress as a measure of our competence is unreliable. There are limits to what our—admittedly amazing—work together can achieve. Staying ongoingly and meaningfully connected to clients for the long term requires us to detach from the understandable need-to-see-results of our efforts. For us, the treatment can no longer be about success or failure, but about doing our best. Our therapeutic goal needs to shift from fixing or getting rid of what brought clients into our offices to helping them manage and live with it, which is often as dissatisfying for us as for them.

Often, it helps when I acknowledge my regret to clients—“If only I had a magic wand!” But I’ve discovered that what helps more is reminding myself that there are other ways to soothe my ego-driven desire to be effective all the time. One way is to invest in an endeavor independent from our work, one which challenges us intellectually, emotionally, and creatively just as deeply as doing therapy. It should be a solo project, requiring no one but ourselves, which keeps the locus of control inside us. This parallel activity can be anything. For me, it’s writing—an insight that came to me when I reviewed my final session with my long-term client Don. But first, a little backstory.

Don told me, just as our penultimate session ended, that he wanted to leave treatment. “It’s been 15 years,” he said with resentment. “You’re not helping me. I don’t feel better.” My gut response (which I did not share with him) was I’ve failed Don. But, with almost 30 years of practice behind me, I gave that knee-jerk reaction a nod of acknowledgment and moved on. That Don wanted to leave wasn’t about me. And it wasn’t about the success or failure of the treatment. Rather, for many years with Don, my job had been to stay present and connected to him no matter the outcome. What, now, was the right thing—the therapeutic thing—to do?

I didn’t argue. I asked if he’d be willing to come in one more time to review our years together so we could close thoughtfully. He agreed.

Meanwhile, in my personal life, I had been working for a year on my second book, a creative project I was deeply committed to. When I was writing, that was all I was thinking about. But when I wasn’t, I rode an emotional seesaw about it. I didn’t have the chops. Wow, the words were flowing. No, they weren’t. This chapter looks good. No, it doesn’t. And so on.

With these writing ups and downs ever-present as a mental backdrop, I mulled over how I should respond to Don without resolution. As I walked him into my office for our last session, I still didn’t know what to do.

He opened, angry and accusative, by repeating his reasons for wanting to leave. I didn’t argue or defend myself. “I understand,” I said.

This seemed to disarm him. He became defensive, as if I were trying to talk him into staying. “You’ve told me so many times that I have to trust myself! So, now I want to leave, and I have to trust myself!”

Again, I agreed with him. His affect shifted from resentment to sorrow. He regretted that he no longer found the treatment helpful, and that he wished he did, so he could stay. I affirmed that was my wish too. I said I respected his need to leave—and an idea presented itself. I offered him a compromise.

“Let’s frame our parting now as taking a break,” I said. “Let’s keep the door open. Return if you change your mind. I’ll always be glad to work with you.”

The session was five minutes shy of ending. He said, “This has gone so differently than I expected.”

“You expected to leave angry?”

“Yes. And that I could never come back.”

I smiled. “Like I said, the door is always open.”

We stood and he took my hand. “I’m sorry.”

“Me too. But it’s okay. Sometimes a break puts things in perspective.”

He left and I sat down in my chair, dazed and amazed. We’d parted without rancor and left our relationship open to a new beginning. I’d been completely present for Don. I hadn’t had any emotion at all beyond a heightened overall awareness and an alert interest in finding opportunities to respond therapeutically to him. What had enabled me to do such good work, without angst?

To paraphrase Virginia Wolf, we all need a room of our own. I realized my legitimate need for intellectual, emotional, and creative validation was being constructively met outside therapy work by my writing project. I saw I’d had no narcissistic attachment to the outcome of Don’s last session, and his treatment. I was okay with him staying. And equally okay with him going. What Don chose to do was out of my control.

I’d been perfectly balanced—for 45 minutes! And having experienced that sense of balance, stillness, and being fully present in session has proven transformative. Now, I’m able to return there at will by asking myself where my locus of control is—inside me or outside me with the client? If it’s on the client, is my sense of competence tied to their progress, or lack of progress? The answers to these two questions generally guide me to disengage my personal needs from whatever is happening with the client, and to redirect them elsewhere onto something outside the work.

But don’t take my word for it. Do something hard that you love and is independent of therapy. Devote yourself to struggling with it. Be prepared to be wowed by how positively that impacts your work in the therapy room.