My conversation with PTC on BabblingCats raises more thoughts about what can trigger abandonment feelings in an woman during eating disorder recovery treatment. Making a referral can bring up abandonment issues yet a referral is more like a bridge to take you across an impasse.
Sometimes I, as a psychotherapist, feel I'm at an impasse with a patient. I have doubts about whether I can help you. If and when that happens I will discuss this with you, study and contemplate more about your issues. I will seek supervision from a trusted colleague on your issues. I will attend seminars or workshops that seem related to your issues. If I still feel at an impasse I will refer you to someone I believe can help you better than I.
If this happens it's not about your being too sick or too much of a problem or being bad in any way. It's about my caring about you and your recovery and doing what I can to be sure you are in the best healing environment possible for you.
We both may feel sad at the parting, but it is not abandonment. It's a necessary separation so you can continue with your healing.
Also, a new patient may come into my practice, and I quickly discover that I don't have expertise in the situations they bring to therapy. As soon as possible, I do my best to help them find someone who does have that expertise.
The referal is necessary so they can receive the best treatment available. I refer as quickly as I can because often a bond can develop quickly.
Mine is a specialty private practice. I work with women who want recovery from eating disorders. Because of the wide range of issues we deal with in eating disorder recovery, I can and do work with women struggling with developmental issues who do not have eating disorders. There's an overlap between what these women need.
But a speciality practice means that certain kinds of people and certain kinds of issues are not under the umbrella of my concentration. When I refer people out it's because they have reached the limits of my abilities, training and expertise. It has nothing to do with any criticism or judgement of them.
Feelings of abandonment may come up. It's important to understand that the issues causing the separation have nothing to do with rejecting the person. The issues are much more about caring for the person.
And, I have patients who were referred to me by their therapists because my expertise was more of a match with their patients. If this is you, you may feel abandoned by your previous therapist. You may be wary of me because I'm a stranger. I'm a new person who is different from your previous therapist, and you worry that I will refer you out too, i.e. reject you.
In such a situation we build our relationship gradually. We talk, sometimes quite a bit, about your previous therapist and the work you did together. We talk about your feelings for her.
You learn that I am willing to talk about these things without criticizing you or her. We build on what you created with your past therapist so you can move more thoroughly into your own recovery. We talk about how your previous therapist was caring for you by referring you to me.
As our relationship deepens you won't feel abandoned. You'lll understand that one person who cares about you brought you into the practice of another person who is trustworthy and has come to care about you. That experience is healing in itself and can affect your perceptions in life.
It can help you tolerate necessary separations without plunging into the despair of abandonment. You learn about transitions and what it's like to have responsible, caring people in your life. And this understanding diminishes the power of your eating disorder. You are reassured that good does exist for you. You may even feel yourself healing.