“Why?” I asked him. “I've come to understand your other rules. But this one seems needlessly cruel. How do I know what might happen during the next year? What if I need you? What will I do?”
“Termination doesn't end the process,” he told me. “Old issues will still come up, along with new ones you hadn't anticipated. It isn't the end; it's just the beginning of a new chapter in your life—one where you handle things on your own.”
“What if I can't handle it on my own? What then?” I asked, beginning to panic, to regret the commitment I'd made to set a termination date in summer, just a few months away.
“Do you think you can?”
“I don't know. What if I can't?”
“I think you'll find yourself more capable of it than you might believe right now. But, if something became so burdensome you couldn't handle it on your own, I could refer you to another good psychiatrist.”
“I don't want another psychiatrist!” I insisted. “I don't want to have to explain my whole life story to someone else. You understand me; we have a history.”
“We do have a history, and that doesn't change. Our bond didn't end when I took vacations. Our bond won't end just because you've terminated.
“Don't you see?” he said. “You've changed, Rachel. In fundamental ways. You aren't the same person you used to be. You couldn't return to be that if you wanted to. Our history is a part of you now. No one and nothing can take that away from you.”
“It sounds like death or something,” I lamented. “Like this is forever. Except that, unlike a death, you'll still be here holding sessions, maybe with someone else who was where I was a few years ago. It's like mourning someone who's still alive. Why do I have to?”
“I didn't say forever,” he reminded me. “I said a one-year no-contact period. After that time passes, you are free to come back again if you need it on a limited basis or an open-ended basis.”
“Why a year? Why not four months? Six months? Forever? Why any limit at all? Don't you trust me? Are you afraid I'll cling to you for life?”
“The subconscious mind is always at work,” he explained. “When you terminate, a part of you will feel pride, independence, and joy that you've moved on. But another part of you will still be ambivalent. You could subconsciously create a crisis just to avoid the separation.”
“Like an emotional hypochondriac?”
“I don't know if that's exactly how I'd put it. But, after you leave here, there are going to be some hard times. They could be based on unresolved issues. But they could also be based on a subconscious desire to run from perceived abandonment. If you know that there is a defined length of time when you can't see me, you'll be more inclined to work through these temporary moments on your own and see them as challenges not failures.
“If, after a year, you still feel you have unfinished business to work on, you are welcome to come back. By having the limit, both of us can be assured that if you do opt to resume therapy, it will be for the right reasons, not just to avoid the pain of saying good-bye.”
I considered this for a moment. I had to admit it made sense. As much as I wished the rule didn't exist, I had grown over time to understand that his rules and limits were there for my best interest.
“You know,” I said sadly, my eyes filling with tears, “I'm probably going to cry like a baby when I have to say good-bye. You're one of the best things that's ever happened to me. I'm going to miss you.”
“Believe me,” he said, his own eyes glistening. “The feeling is mutual.”
As wistful as I was at the prospect of saying good-bye, I did believe him. He would miss me too. Both of us had committed ourselves to therapy, and we had developed closeness and mutual understanding. Termination, while inevitable and necessary, wasn't going to be easy—for me or for Dr. Padgett. But, like the parent who puts on a brave face to his anxious kindergartner as she goes off to her first day of school, he wasn't going to let his emotional ambivalence exacerbate my own.
Moving day went fairly smoothly. The friendly movers managed to move eight years of accumulated furniture and belongings out of our city house before noon. I felt a touch of remorse and fear as I looked around the now empty home. The walls were barren. Outlines still shadowed the bedroom carpets where the ghosts of bed frames and other furniture remained.
The previous week I had gathered nearly a thousand scattered yellow ledger pages, a series of emotional snapshots of my therapy process. I didn't want the movers touching these. I'd packed all of them away into a big, black filing box that sat in the corner bedroom as I vacuumed and swept, erasing our presence for a new family.
Once I finished the final cleanup, I snapped pictures of every corner of the house. I never wanted to forget this house and the years we'd spent there, the good times and the bad. The joy of bringing Jeffrey and Melissa home as newborns. The beautiful oak staircase we painstakingly restored.
After lingering in the house for a half hour or so, shooting pictures, letting the waves of melancholy wash over me, I had to leave. Mourning was a part of letting go and moving on to the future. I locked the door for the final time, took a few last photos of the house and yard, and drove through the neighborhood streets on my last day as a resident. Slowly I passed the houses of my friends, the neighbors with whom I'd worked side-by-side fighting the city battle. My role would be passed along to someone else.
I went by the homes of the choir members who had been there for me in my worst times, who had come to be the close and supportive family I had never known. I was tempted to stop at every one of them for a final hug and yet another round of tears. But my family was awaiting me in Nottingham. I'd had six months to say my good-byes. It was time to move on.
As I drove alone down the interstate, my car stuffed with cleaning supplies and the precious black box of writings, I realized that as sad as it was to leave, this time I wasn't running way from anything. This time I was going on to something better. The friendships I had in the city, like my relationship with Dr. Padgett, were a part of me now, and I vowed to keep in touch with them. The most important people in my life, Tim, Jeffrey, and Melissa, would be with me. By the time I reached the Nottingham exit, I was no longer looking behind but ahead to the life that awaited me there.
With all the transitions in my life, I was glad that I still had Dr. Padgett. It was a one-hour drive each way to his office, which gave me time to collect my thoughts and reflect on the way home.
In late June, a few weeks after the move, I set a termination date for therapy. September 12, 1995. I circled the date in red in my appointment book. Twelve more sessions, marked discreetly in my planner by the code “Dr. P.,” the final one with an extra line: “Termination.”
Setting the date had been easier than I'd expected. I'd made so many changes in my life, and right now this seemed like just one more.
Now that I knew the end was near, I was determined not to waste the precious time we had left together. The good-bye, I realized, was not going to be limited to the final session but would last for three months.
During our sessions I told him just how much he had meant to me, just how much of a difference he had made in my life—in all of our lives. Because of him, Tim and the kids would enjoy a healthy wife and mother who planned to live to a ripe old age and spoil her grandchildren. A man they had only met once spared them a potential tragedy. Someday, when they were ready, I would tell them about this man who had helped give their mother a second chance.
It was also a time of reminiscence. The changes had been so subtle and incremental they were impossible to see on a day-to-day basis. But over the course of four years, I had been completely transformed. I had fit every one of the terms in the psychological profile. “Manipulative.” “Self-destructive.” “Seductive.” “Attention-seeking.” “Histrionic.” The fact that I could look upon those labels in the realm of the past gave me hope that I really had changed, that they would not be a part of my future.
“How did you put
up with me?” I asked him. “I said some pretty vile things. I deliberately threatened you, manipulated you, and pushed you to the hilt.”
“Because,” he smiled, “I always knew that underneath the layers of caked-on dirt you had a diamond core. I knew it from the very first day.”
“Did you ever dream that I'd make it to where I am now?”
“If I didn't, Rachel, I would never have taken you on as a patient. No one can read what the future holds. But I always knew the strong possibility was there.”
“You never gave up on me, did you? You know, you should be really proud of what you've accomplished here.”
“I just helped you,” he reminded me. “You did the work. You're the one who never gave up on yourself. The real accomplishment, the real pride, should be yours.”
It wasn't just false modesty. I knew he was right. Both of us were proud.
“One more question?” I asked, as that session was drawing near to an end. “Once upon a time you diagnosed me as a borderline. A lot of the stuff I've read says it can't ever really be cured. Am I a borderline now? Will I always be a borderline?”
“What do you think? Do you believe you're borderline?”
“You're the doctor,” I said, wishing just this once he wouldn't answer my question with one of his own. “I'm not the expert in the field. You are.”
“Right now,” he said, “I'd say you have as thorough and intuitive understanding of what it means to be borderline as a lot of the psychiatrists who write about it and treat it. You are equipped to answer your own question.”
“But that's something I can't find in the books,” I persisted. “Everybody talks about what it is and its effects. But I can't find any that say it can be cured. Or, if it could be cured, what would constitute a cure. Cancer is more clear-cut: The tumor's malignant, or it's not. The chemotherapy works, or it doesn't.
“But with borderline personality disorder, who can tell? A few of the researchers seem to think that once a borderline, always a borderline. That you can't cure it—you can only control it. That a lot of people are destined to live their lives in and out of institutions, that there isn't much hope.
“I'd hate to think I've made all this progress but that there's some little vestige of BPD inside me, like a cancer cell, just lurking in the background, waiting to grow like a cancer and take me over again.”
“I've told you before,” he said, “that the BPD diagnosis is an incomplete definition—a rough guideline that's useful in some ways but very broad, encompassing all kinds of different people who manifest the illness in many different ways.
“In a lot of cases the writers you talk about are right. Some borderlines are destined to spend the rest of their lives in and out of psychiatric wards and prisons. But I've never looked at you as a borderline or used some cookie-cutter approach for treating borderlines. You're an individual.”
“You still haven't answered my question,” I sighed.
“I think the changes within you are significant and real. The agony you felt made you act as you once did. But at your core I've always seen you for the exceptional person you really are. Together we revealed that person and let her sparkle like a diamond.
“You're a strong person. One of the strongest I've ever met. And your future holds a lot of promise. The potential you've always had now has a chance to be realized.”
After he finished I reflected. Some answers could not be found in a textbook or handed to me by a specialist. I had to discover them within. As it should be.
All I knew is that I now viewed both life and myself in a way I never would have dreamed possible. And the man now sitting a few feet away from me had stayed with me every step of the way to guide me and had seen my potential long before I'd been able to see it myself. Even in my darkest moments, Dr. Padgett had never given up hope. He believed in me until the day I could finally believe in myself.
Dr. Padgett was human and imperfect but one of the most remarkable, compassionate, and generous people I could expect to meet in a lifetime.
Saying my final good-bye to this man would be agonizing.
As July moved into August, the prospect of termination became more real. I was already beginning to mourn my imminent loss as the number of remaining sessions dwindled into single digits. Seven more visits before the final good-bye. While Tim understood how difficult this was for me, I found myself wishing I could be among my friends in the city who knew my history.
The people of Nottingham were friendly, but I didn't feel comfortable sharing my feelings at this time. To reveal the history of my mental illness could risk attaching a label to myself in a town that had not yet fully defined me. My friendships were just beginning to develop; the whole BPD and therapy scene might be too much to share.
Had I been mourning the loss of a friend, a family member, or a debilitating disease, I wouldn't have been as reluctant to share my pain in this community. But even my friends in the city who did know me well would find it hard to understand just how emotionally gripping the entire therapy experience had been and just how difficult it was to say good-bye. Even Tim, supportive as he was, couldn't fully grasp it.
With the bulk of settling in completed and most of my client base too far away to keep, I was home with Jeffrey and Melissa a lot. Emptiness and boredom descended upon me. I was tired and had too much time on my hands to be filled with second thoughts about the wisdom of the move. I began to retreat within myself. Had I been in the city, my old friends would have noticed this and asked what was wrong. Here, however, no one knew me well enough to notice or even care.
I'd considered picking up the phone and calling one of my old friends a few times but chose not to. I hadn't been keeping in touch as much as I thought I would and hated for the first words out of my mouth to be that I was down again. They'd supported me enough, I decided. I had to handle this on my own.
Was depression happening again? Had my chemical balance gone askew? Was this what Dr. Padgett had meant when he spoke of the subconscious motivation to keep therapy going on forever? Or were the experts right: once a borderline, always a borderline? Was I destined to be an emotional mess for the rest of my life?
I was slipping quickly.
Why don't you just call him? You can't keep running back to him, Rachel. What are you going to do when he's gone? He won't be there anymore. He'd want me to call if I were feeling this way. You've got to get used to handling things on your own, to flying solo. These feelings scare me. I need him! I just need to hear his voice. It's the subconscious thing, Rachel. The little girl's “last stand,” a way to manipulate your way out of terminating when you said you would. I can't help it. I need him. I can't be the first patient he's ever had to go through this. He'll know what to do.
The internal battle settled, I picked up the phone and dialed Dr. Padgett's service, now a long-distance call. A part of me felt ashamed of what I saw as failure. But a stronger part of me desperately needed a solution.
The phone rang a few minutes later. Hurriedly I picked it up.
“Hello?” I said anxiously.
“This is Dr. Padgett,” he said in the same calm tone he'd used to greet me with every emergency call. It was strange, though, to realize that his voice was coming from a different city. It had been months since I'd made a crisis call to him, and I was beginning to regret this one. But I went on nonetheless.
“It's coming back, Dr. Padgett,” I told him, my voice beginning to shake. “The depression. Horrible feelings. Can't eat, hard to sleep, hard to get out of bed. I've tried to deal with them, tried to put all of this into perspective. To handle it on my own. But it just keeps getting worse. I haven't done anything destructive, but I'm afraid I might if this keeps up. I'm so scared, Dr. Padgett. That's why I called. I'm sorry to bother you at night like this.”
“You did the right thing,” he assured me gently.
His words calmed me considerably. Obviously he wasn't taking my call as a sign of manipulation or failure.
&
nbsp; “I don't know what to think,” I continued. “I'm almost sure this has something to do with anxiety about termination. That's why I hesitated in calling you. I didn't want to keep clinging or anything. I figured I should get used to solving things on my own. I've tried. I really have. I've been writing like crazy, sitting here racking my brain to find a way out of this. But it isn't working. It's getting worse. Is this normal right before someone terminates therapy?”
As the words came out of my mouth, I realized just how neurotic I sounded.
“It's a normal reaction, and it's temporary,” he said patiently.
“But I'm still afraid,” I went on, in tears, unloading the burden now that I knew I had him with me. “What about all the progress I've made? Is it gone now?”
He paused for a moment.
“Have you ever seen a fire burn in a fireplace?” he asked, his voice soothing, almost a lullaby. “Can you remember that point when it really gets going, burning so hot that the logs are glowing red?”
“Uh-huh,” I said, sniffling back the tears so I could hear him.
“At that point the logs still have the same shape they did when they were first lit. Only now they glow in heat, almost daunting, so hot, so burning. But it doesn't last. The logs look like the same ones you put in the fireplace, but they aren't. They aren't solid the way they used to be. They are just a temporary illusion. Pretty soon the glowing embers fall to the fireplace floor. Just ash. The fire has changed them. They look solid for a time, but they aren't anymore. The fiery hot vision of the log turns quickly to harmless ashes.”
“Uh-huh,” I repeated, listening intently, unsure of the point of his analogy.
“The feelings you used to have, hopelessness, despair, real depression, were like the logs before they were lit in the fireplace. They were solid, entrenched. But they've changed forever. For a short time it looks as if they are exactly the same, just as the glowing log looks the same. In a way they seem even more intense than they were before, shimmering red-hot as they are.
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