Imagine taking a four-month break from your patients. It’s hard to fathom. But that’s exactly what is required by New York State for LQP graduates before they receive a limited permit to practice. Justine Duhr, MFA, writes about her surprising journey through this process, encountering guilt, shame, anxiety, loss… and a newfound relationship with her analytic identity.

 

Very early in my analytic training, I had a dream I can’t forget. I dreamt that my three times per week patient, new at the time, my first ever, was knocking at the door to my apartment, lightly at first, then harder and louder, growing more and more insistent. I hid in the quiet safety of my room, hoping she’d go away. Finally, after what seemed an eternity, the knocking stopped. Silence. Then, almost inaudibly, the gentle scrape of metal on metal: the door latch sliding, slowly, carefully, inch by inch, and eventually coming undone. In the moments before the door creaked open, I felt intensely afraid. What will happen, I wondered, when she gets in?

This dream has stuck with me over the years. I think of it often when I see this patient, who has become quite dear to me and who, because she committed to the work and to me, was instrumental in my training as an analyst. I quite literally could not have done it without her.

Which is something I’ve been thinking a lot about over the past four months on this New York State-mandated hiatus from my clinical work. (For those of you unfamiliar with the licensing process for Licensure Qualifying Program (LQP) candidates, according to New York State law, unlicensed candidates must stop seeing patients until they’ve received a limited permit that allows them to continue to practice under the auspices of their institute.) This time away from my patients has been strange and surreal, and difficult in a way I never saw coming. I knew it would be hard for them, each in a unique way closely connected to how they relate to themselves and to the world – the woman who lost her mother, an ambiguous loss she could never fully mourn; or the young man who wonders if I really want to see him, if I’d be there with him if given the choice. What I didn’t know is how hard it would be for me.

When I broke ­the news to my patients, told them we couldn’t see each other for a few months but I didn’t know yet exactly how long (which may have sounded to an anxious ear like I’d never come back), we spent weeks exploring their feelings. Some felt panicked and fearful; others angry and betrayed; still others relieved, grateful for the time apart. All to some extent felt abandoned. I did my best to allow space for their myriad responses and reactions, which wasn’t always easy. I invited their anger at me especially, holding an awareness that this was perhaps one of the more challenging feelings to access and share. I told them I was sorry, that I didn’t like it either, that I wished there were a less disruptive way to move forward, while simultaneously trying to own responsibility for my role in the situation. It is me, after all, who needs a license. It is my need, the realities of my professional life, that is impacting the treatment so dramatically. We processed our feelings as best we could and said goodbye, not knowing when we’d see each other again.

The feeling I was most aware of at the time was guilt, guilt for being in training and wanting a license and creating a hardship for my patients because of it. Guilt over my needs impinging on their own. A few short weeks into the hiatus, the feeling that emerged to my great surprise was longing. I missed my patients. I missed being with them, talking with them, connecting with them, and even those times we struggled to connect. I missed it all. I remembered the woman who in the final moments of our last session touched my hand and said, “It’ll be okay.” Turns out, she knew something I didn’t. We had spent session after session analyzing my patients’ feelings about our time apart, and we had conveniently overlooked my own. My guilt, I believe, was a cover for the deep sense of need I’ve come to feel for the work and for these individuals with whom I’ve grown close. In this “helping profession,” it’s far too easy to focus on how our patients need us and ignore all the ways we need them.

One patient seemed particularly reluctant to discuss our upcoming separation.

“I just don’t know what to say about it,” she explained more than once. “I won’t know how I’ll feel until I feel it. Can we stop talking about this now?”

At the time, in my own eagerness to explore and my own anxiety about the disruption, I understood this as a form of resistance (problematic concept that it is), an unwillingness to look at a potential source of pain and distress, but now I wonder. Now I identify. Was she, in her “resistance,” picking up on a part of me that was unwilling or unable to acknowledge the emotional challenges our separation would present for me? Perhaps I myself didn’t want to know just how hard on me this would be, just how much I’ve come to depend on this work and on these people who make it possible.

I wrote some time ago in The Candidate Journal about identity, about the precarious process of building an analytic identity from scratch and the particular challenges of that process for LQP candidates. I’ve come to view this hiatus, disruptive and disorienting as it’s been, as yet another brick in the analytic identity I’ve been building since the start of my training. (Though I still maintain, New York State, there has got to be a better way! But that’s a blog post for another time…) If this break has taught me anything, it’s to acknowledge and appreciate what my patients offer me. They give me, I now know, access to certain parts of myself otherwise unreachable, diverse experiences of particular versions of myself, and an identity as an analyst. I have a new appreciation for the deep significance of this work, not only what it allows us to do for others and for ourselves but all that our patients make possible. In the spirit of Winnicott, just as there is no such thing as a baby, there is no analyst without her analysand.  

 

There’s a part of the dream I left out, a part that came before my patient broke my door down, a part I dismissed as minor, irrelevant, until recently. Now I think it’s the most important part of all.

I’m in my bedroom. I’m in a deep, sound sleep. Something wakes me. I reach for my phone on the nightstand and hear my patient’s voice on the other end of the line.

Hello? she says. Hello, are you there?

I’m here, I say. But it’s the middle of the night. Why are you calling me?

Justine, my patient says softly, almost lovingly, you called me.

 

 

Justine Duhr, MFA, is a fifth-year LQP candidate, Assistant Director of the LQP, and Co-editor of the Analysis Now blog at the Manhattan Institute for Psychoanalysis. She owns and operates WriteByNight, a writers’ service dedicated to helping people achieve their creative potential and literary goals.

 

 

 

If you enjoyed this post, we recommend:

Psychoanalytic Training with a Side of Pasta by Lindsay Nejmeh, LMHC
On Psychoanalytic Training by Steve Kirschner, LCSW
Like Waltzing Around in Underpants by Tricia Brock, MFA