Help! What If My Therapist Goes on Maternity Leave Again?

I have a history of complex trauma and a disorganized attachment style, with massive abandonment issues. I have been seeing a very skilled clinical psychologist who specializes in this work for the past five years, and we have done good work together. However, she has had two maternity leaves of six months each in that time, and they have become progressively harder and more painful for me as the work has progressed. Her recent two weeks of annual leave have been so terrifying and painful for me that she had to organize a backup therapist because I decompensated so much. She has said that she may have to take maternity leave again in the future but cannot warm me in advance or let me know if she is planning that. I respect her reasons and think that she is right (she doesn't want to potentially bring her own miscarriage trauma into my therapy) but it means that I am now hypervigilant about her potentially leaving again, and every session I am looking at her body and analyzing her words for clues as to whether she might be pregnant. It is hugely getting in the way of our work because she does not feel safe, and the safety in the relationship (which was containing me and helping me to move forward) feels as though it's gone completely. I'm just waiting for her to leave and seeking reassurance at every session, barely hanging on between sessions, etc. I can't go through her leaving again; it's just too much. I don't think I could survive that pain. I don't know what to do, as she feels that she cannot offer me safety (and acknowledges that she is "less safe" than another therapist would be) and I want her to be happy, but I just cannot bear this and it is getting in the way, to the point where I am wondering if I should just leave and find someone else who can offer more stability for me to continue the trauma work. We have spent weeks talking around this, but it just feels stuck, and I think she is angry with me because she doesn't like not being able to provide what I need—she is a highly ethical and committed practitioner. But it is not safe for me to trust her or rely on her when she could go at any time, and so we cannot do the therapeutic work when we keep being stuck in the same discussion. Please help me. I don't know what to do. Should I leave her? It would take me years to get to this point in the work with someone else. —Left in Limbo
Dear Left in Limbo,

This is a gut-wrenching position you find yourself in. On the one hand, you’ve done some great work with this therapist and built a strong relationship with her; on the other hand, the work seems to have stalled because you are preoccupied with her potential departure. Should you stay or should you go?

It sounds like the therapeutic relationship is actually bringing out some of the relational issues you are working to address—fear of abandonment, distrust, and generally feeling unsafe. While it is deeply uncomfortable, and I in no way wish to minimize that, this can be a powerful way to work through these issues. The therapeutic relationship is different from any other relationship in large part because it is designed to serve the needs of one person—the person who sought therapy. You can raise the issues you are having in the relationship and deal with how they are affecting you, how they are connected to the past, how they are connected to other relationships in your life, and perhaps most importantly, how to heal from them. You do not need to be concerned with how your therapist is affected by this. If necessary, she can take care of herself through supervision and her own therapy. This relationship is 100% about you and your healing and growth.

It seems like you are having a very difficult time engaging in this process because of the deep-seated fear you have of her taking another extended leave. Presumably, if she were to go on another maternity leave, there would be a period of time for the two of you to work on preparing for this. Maybe you could even have a joint session with your therapist and the therapist who would cover for her during the leave, so that you three could talk about where you are in treatment, how you could best be supported during the leave, and what could be worked on. While it would not be easy, this sort of process could really contribute to your healing.

Finally, while your therapist has acknowledged that she may not be the safest therapist for you due to potential maternity leaves, it seems important to acknowledge that there are no guarantees in therapy. There is no therapist on the planet who can promise, beyond a shadow of a doubt, that he or she will be able to be there for you from the start of your work until you reach resolution. Illness, death, relocation, job change, and other issues can come up for anyone, including therapists, at any time. This is a frightening and painful truth about life, and this therapeutic relationship just might help you come to terms with that. I suspect that would be deeply liberating for you.

Best wishes,
Sarah