I Went Back to Therapy After Twenty-Five Years

You looked him up. You did not call.

That was three weeks ago, and the number is still in your phone, and every few days you consider it and then decide that it would be absurd, because you are sixty-one years old and you dealt with all of this in your thirties.

What returning is usually taken to mean, and what it actually means

A woman came back to me after an absence of twenty-five years. She had done good work the first time and she had gone off and lived, which is what is supposed to happen. Then a painful situation arrived that her usual methods did not cover, and she came back.

She was, I think, slightly embarrassed about it, and there was no reason for her to be.

The embarrassment rests on a model of treatment that nobody who does this work believes. The model says that therapy is a repair. Something was broken, it was fixed, and a properly fixed thing does not require the shop again.

That is a decent description of a knee operation. It is a poor description of what happens between two people over a year of conversation.

What you got the first time was a set of capacities, developed at a particular age and adequate to the problems of that age. They were real and you have been using them for twenty-five years without noticing, which is the best evidence that they worked.

But you were thirty-five. Nobody at that age is equipped for what is coming. You had not yet buried a parent, or watched a marriage change shape, or discovered what your body intends to do in its seventh decade, or met the specific loneliness that arrives once the children are competent and gone.

The work you did at thirty-five was an education, not an inoculation. You are back because you are now sitting an examination that was never on the syllabus.

The advantage you are not counting

You are treating your history as a liability. It is the largest asset in the room.

Someone arriving for the first time at sixty has to be taught the entire business. What this is, how to speak in it, that the discomfort of the third week is normal and not a sign to stop, how to tell a real observation from a flattering one.

You know all of that. You know what it feels like when something lands. You can tell within a fortnight whether a particular person is any good, which most people cannot. You will not waste four months being polite.

In my experience returning patients move at something like three times the speed, and that is because the apparatus is already built.

The trap of the old vocabulary

One genuine risk, and it is worth naming since it is the one thing that can make a return less useful than a fresh start.

You have a formulation of yourself from 1999. It is articulate, it explains a great deal, and it is probably three quarters right. And it is twenty-five years old.

The temptation is to file the new pain inside the old file. This is my thing with my mother again. Sometimes it is. Frequently it is not, and the old story is being used to domesticate something genuinely new, because a familiar explanation is more comfortable than an unfamiliar one even when it is wrong.

So when someone comes back to me I am more suspicious of the tidy account than of the messy one. If the story fits perfectly, I want to know why the fit is so good, and I usually wait rather than say so early, because a returning patient’s formulation is also the thing that has been holding them up.

On being seen by somebody who is also older

The woman I mentioned said that what she valued was engaging with a real person rather than a resume.

I would add something to that, from my side. I am eighty-eight. When a patient of sixty tells me what it is to watch capacities go, or to be treated as finished by people in their forties, I am not extending professional empathy across a gap. I know precisely what she is describing.

That is not always an advantage and I try to watch it carefully, because there is a real danger of hearing my own experience in somebody else’s account. Whose feeling is this, mine or hers, is a question I have to put to myself more often with patients my own age than with anybody else. But when it is checked, it shortens a great deal.

What the first session looks like

I will ask what you worked on back then and what actually stuck, in your own words rather than the therapist’s.

I will ask what has happened since. Twenty-five years of it, in outline, which takes most of the hour and is worth the hour.

And I will ask what made you call in this particular month, because something did.

An Invitation

If the number has been in your phone for three weeks, that is the part of you that already knows, waiting for permission it does not need.

Coming back is what people do when they are still working on the thing.