Working with planned and unplanned breaks in clinical work

From traditional five-times weekly psychoanalysis through to the more common weekly sessions, fortnightly or ad hoc appointments, the time between therapeutic contact creates structure, rhythm and space.

Pauses are an inevitable feature of therapeutic work, but it is important to reflect on how they are experienced by the client, many of whom may feel rejected or abandoned due to their relational history. A change of rhythm to the therapy can give us access to the client’s internal worlds and attachment patterns.

Planned breaks such as the therapist’s holidays, sabbaticals, and parental leave provide opportunities for clients to fantasise about, and project onto the therapist; many will fall back on schizoid defences and some may protest at the separation. We will include a session on the boarding school client who may be particularly sensitive to breaks as a repetition of the comings and goings of breaks in term time as a child or show no response at all.

Unplanned breaks on the part of therapist may cause a rupture in the therapeutic alliance and raise questions around therapist self-disclosure regarding how to explain an unexpected absence and repair a therapeutic alliance. Unplanned breaks by the client may leave a therapist confused about how to follow-up if non-attendance persists, which is important to unpack and process in supervision.

With many practitioners now working partly or exclusively online, we will also consider how routine breaks and unexpected ruptures are experienced by clients and by practitioners when therapy is conducted ‘remotely’. We will explore the micro-breaks, disruptions and breakdowns that are often a feature of online therapy, which can provide important material for reflection.

The importance of taking breaks for the therapist’s self-care, as part of our duty of care to our clients, will also be considered.