I went in to full-time private practice in 1973. It was a rarity for psychologists to do so in those years. I was on the faculty of the Boston University Medical Center and most of my colleagues thought I was making a mistake to give up such a promising career. But I had always been primarily interested in doing clinical work and I had quickly lost my motivation to be in administration, dealing with lots of silly politics and endless meetings.

Another key motivation was the fact that my sons were now almost eight and five and I wanted to have a life that allowed as much family time as possible. In those days, town sports didn’t begin until children were eight and I knew I wanted to be involved in coaching my sons’ activities as well as attending school events and just having lots of playtime. Private practice was the only way I could have that kind of control over my time.

I had built up a part-time practice during the five years I was at BU, so the transition wasn’t that difficult, although there was certainly anxiety about not having a regular paycheck. Since there were few child psychologists in practice and because my approach centered on working actively with the schools and the families, I was seen as very different from the child psychiatrists in practice who rarely left their offices. Referrals from guidance counselors poured in and I quickly convinced a colleague and good friend, Ethan Pollack, to join me. Almost immediately there was a waiting list and a few others joined us on a part-time basis.

Ethan and I created a group called Needham Psychotherapy Associates (NPA). It was just for sharing overhead and some collegial support. We agreed that we never wanted to be owners of a practice. We were in Needham together in part to escape from the headaches of administration. Our vision, which grew over the years, was a practice of experienced colleagues who shared equally in the ownership, provided a superior level of services and were more likely to remain with the practice, minimizing turnover. Of the original five, three were still present at the end of my run; one was a member for years before starting his own sole-owner group and one therapist left by mutual agreement.

Fast forward many years and I became one of the early leaders in bringing business concepts to independent practice. The group had grown significantly and became incorporated in 1998 as a Limited Liability Corporation (LLC). I had created a model in which each new member was an immediate partner, everyone kept what they billed, and we all shared the overhead. We had elected officers, attendance at weekly business meetings was required as was regular participation in small, peer consultation groups. Everyone was also required to be on major insurance panels. This was our commitment to serve the community and it made it easier to build a strong bridge to the local physicians who also operated on insurance panels. We grew to 21 therapists before I retired.

From the beginning I kept my promise. I took eight weeks vacation each year, being off each of the three school vacations plus half the summer. We couldn’t afford major trips. Except for visiting family, we would spend a few weeks at the Jersey shore each summer. Mostly I used the vacation time to just be home with the family and play a lot! I also coached many teams with both boys who were very athletic. Since I lived and practiced in the same town that sometimes created some ethical dilemmas in terms of dealing with some of my patients. By the way, I dealt with the extensive vacation time by projecting an annual income based on a 44 week year so I wouldn’t get upset about “lost income” when I wasn’t seeing patients.

I loved doing clinical work and especially enjoyed being part of a group practice. I didn’t have the sense of isolation that solo practice can create and I felt secure surrounded by the support and knowledge of my colleagues. When I reached the age of 60 I began to seriously think about retirement. Although I knew it wasn’t imminent, since I was a marketing person, I always worked off a business plan that was revised annually and was based on a 3-5 year vision. I have always been someone with many interests and activities besides my clinical work. I was increasingly aware of my desire to create more time to pursue other interests. In addition, I had put on too much weight and was not exercising enough, not a good thing to be doing regardless but especially with a strong family history of heart disease.

My personal life played a role in this assessment of my professional vision, as it should. I had divorced and remarried in the early 80’s and my wife, Ellen, had become a very successful executive. Since she was the primary breadwinner by this time, it allowed me more flexibility in choosing what to do about retirement. Also, I am nine years older, so we had agreed that I would probably retire before she did. Finally, one of my strong interests was investing and managing money, so I had a good handle on what we needed and how we would get there.

Thus, when I turned 60, I reduced my practice to three days and saw roughly 20 patients/week. I began working out regularly and a couple of years later I finally changed my eating habits and lost 40 pounds. I returned to playing sports and all of this renewed energy added to my growing desire to retire from my practice and pursue other interests.
Developing a vision and a plan

By 63 I had made the decision to retire in two years. The global vision was to make a complete break, with psychology as well as with my long-term, substantial involvement with the Jewish Community Centers of Greater Boston. I wanted as clean a plate as possible so I would have the maximum available time to follow my interests. I pictured spending the first couple of years developing a few new interests, expanding a few old ones, and taking care of a number of overdue projects. New interests included learning to play golf and the piano. Expanding interests were photography (including scanning and editing 78 trays of slides), investing, traveling, reading (I rarely read anything besides journals and psychology books), and among many projects, I wanted to try and write/self-publish a book on parenting, the one professional goal never achieved. I expected all this to keep me very busy for about two years and then I expected to reach a place where I again had time but not a plan on how to use it. This was the real draw for me. What would I then choose to do to give meaning and value to my future years? I assumed something would emerge but I wanted to be careful to try and avoid figuring it out ahead of time as opposed to really allowing for something to emerge, perhaps something that would be completely different from anything I would have expected, including be aware enough to know that in the end I might choose to return to being an active psychologist again but in some other way.

With that vision in mind, I began to operationalize it. I choose June 30th, 2006 as my final day of work, in part to retire into the summer weather and because it is a more natural break time for my patients. Then I decided to inform my colleagues in September, 2004. The substantial notice for my colleagues was based on three factors. As cofounder of NPA and the face of the organization for so many years, it was going to trigger a strong reaction and require ample time to plan for my leaving including bringing in a new child therapist to pick up my clinical time. I knew I would stop taking new referrals at least a year before retiring and even before that, trying to screen carefully to avoid any potential long-term cases. (I felt it would be unethical to knowingly take a case that could last beyond my retirement date, though one cannot always predict this.)
Of course that also meant asking my colleagues to keep this confidential for a year until I told my patients. I must say I am very proud of how successfully they honored that request. As for when to tell my patients, I did some research but found little in the literature to help in making a decision. I chose the fall since that is the period of time that is a renewal, especially here in New England, and it is the time period when I don’t take a major vacation until the end of December, allowing adequate time to process the initial reaction to the news. Most of my patients by that time would be the long-term ones, ranging from 15-30 years of involvement. I expected it would be traumatic for them and for me. Nine months (okay, symbolic as a gestation period) seemed reasonable. Six months, which one article had suggested, just seemed too short. Interestingly, near the end I polled my patients about the choice of time frame and it was almost unanimous that nine months was the right choice. The few that disagreed actually suggested longer!

As part of the preparation I created a form letter to hand out to each patient (see below). Though I would review all this, the shock of the news made it likely they would forget the details. There were important items to be covered; especially emphasizing my health was fine, what will happen with their records, and what contact would be acceptable post-retirement. I also thought it was important that each letter, though generic, be signed personally. The final version reflects input from colleagues. In addition, we had long had a Death and Disability policy as a requirement for all associates. I needed to create a modified one that accounted for the fact that I would no longer be part of NPA. Fortunately it was rather easy for me to obtain the agreement of the same two colleagues to provide the necessary coverage. As you repeatedly notice, being part of such an exceptional group practice made this most challenging task of retiring so much easier. I cannot imagine doing this on my own.

The nine month experience

Returning from my summer vacation in early September, I waited until my second appointment with each patient to announce my decision to retire, effective June 30th. For a variety of reasons, not the least being that some patients were only seen every 3-4 weeks, the process took about two months. I explained to each patient that I was trying to insure that all my patients got the news from me and asked everyone to keep the news confidential until I the process was completed. Once again, people rose to the task and no one found out until I told them.

Telling the patients was very draining for me. My peer consultation group was an enormous help in processing my emotions as well as helping me explore the reactions of various patients. Interestingly, there was a lot of consistency in those reactions. Nearly everyone was shocked to learn I was about to turn 65, thinking I was much younger. That was nice to hear over and over!

There was definitely relief to be clear I was not doing this for medical reasons or because I did not like my work. Some, in fact many, cried at the initial news, which meant I was crying as well. The abandonment anger was almost totally absent except in some subtle ways, e.g., comments about how hard it would be to start over with someone new. No one cancelled/missed appointments. Everyone was supportive of my decision, especially since I was presenting it in this life affirming context that there is so much I want to do and that I should do it while I am relatively young and healthy.

But the surprising thing was how quickly therapy resumed its “normal” course. I probed this a bit but also felt I should not push for discussion if there didn’t seem to be a desire to talk about it at this point in time. Nearer to the end, patients said that nine months seemed far away and made it easy for them to avoid the real impact until later. Yet, as previously stated, they insisted that knowing early and then being able to avoid the issue for a while was a good thing from their perspective. It allowed time for them to digest this news privately before we eventually had to process it more intensely.

The next time the issue surfaced again with a little more intensity was after my December vacation. It was now 2006 and many commented that being in the year of my retirement now brought it closer and, for some, led to the beginning of working on the issues of loss and abandonment raised by my leaving. Still, it was not a dominate process until I returned from my February vacation. (I told you I take a lot of vacations!) Suddenly it was March and retirement was only four months away. The pace intensified, in and outside of therapy sessions. The latter referred to my discussing with each patient their decision, and my recommendation, for the need to continue in therapy. I ended up with about 20 referrals to make and, for the rest, a name to use if they decided to return to therapy in the future. This became a very time consuming task and I cannot imagine doing this without the advantage of being in a large practice. Trying to figure out the best matches and briefly discussing the potential referral with each colleague took a lot of thought and effort. Once again, my peers stepped up because even though many had totally full caseloads, everyone asked agreed to take my patients.

Meanwhile I began to grapple with some issues raised by reaching this late stage of the process. In assessing the status of each patient, with some I felt a sense of not having achieved our goals and began pushing for faster progress. I wasn’t alone in this. Some patients also set unrealistic expectations of what we should get done in the remaining months. As a part of this struggle, I also began to feel guilt for the first time and particularly with a few patients, felt the urge to apologize for leaving them before we finished what we had set out to accomplish. This was mostly with the “newer” patients, 2-3 years of work, making good progress, and having thought at one point we would finish by the time I retired.

All of this became regular topics in my peer consultation sessions which became increasingly important as the end approached. My colleagues were very helpful, and very direct, in keeping me focused on the process of saying goodbye and not trying to ”cure” everyone before I left. Part of this required setting reasonable goals for the final months of therapy, most of which involved using this loss as a chance to gain insights about and to learn to better cope with each person’s history of losses.

A couple of patients who had been coming in only sporadically asked to resume regular weekly sessions for the remaining time in order to try to get more closure on some issues we had worked on over the years. Interestingly, this deadline, which created a short-term therapy model in the midst of a long-term relationship, resulted in significant gains on the part of both patients.

As part of this process, I found myself questioning if I could have done more for some of my long-term patients. Had I allowed our relationship to just become a crutch? Had I grown lazy over the years and taken the easy, less challenging road with some of them? It was interesting how some of my colleagues expressed concern about being compared to me in taking over my patients. (I had built a reputation of excellence, especially with very challenging, complex cases.) I responded with my own expressed anxiety that what if they have more success with these patients than I did? Clearly a lot of issues about self-worth and competence lie not very far beneath the surface regardless of how long we do this work and whatever level of competence we think we have achieved.

A few patients that I had been seeing intermittently and who were clearly doing much better responded to my question of ending before I left in June by saying not only did they want to continue right to the final week but they wanted to come in more frequently (alternate weeks). They still felt they got something valuable from each of our sessions and wanted to pick my brain as much as possible before we ended. One was a mother seeking parenting advice and the other was a couple working on improving their marriage.

I had originally expected that by the last few months I would have very few patients to see. While a few did transfer before the end, most stayed with me to the final week and I do mean final week. People who were not weekly appointments and who would have normally had their last appointment the week before I retired insisted on moving that appointment to my final week. As one woman put it, “I cannot say goodbye and know you are still here for another week.” So, unexpectedly, I had a full half-time practice right to the end.

The final month

There were exactly four full work weeks in June. On Monday, the 5th, it began with my very first patient. Regardless of what had been processed before, every patient was hit hard by the reality of “the final month.” The sessions become emotionally intense and draining, beyond anything I had experienced. Session after session was tearful, theirs and mine. Patients were talking about our history together, insisting no one else would be able to help them because I had been there through all those difficult times, that I knew them better than they knew themselves. “You’re not really going to leave, are you?”
At the same time they worked on saying goodbye and talking about the journey we had been on. Even if there was more that needed to be done, this was a time when they wanted to focus on what we had accomplished, how much I had meant to them, and how much they appreciated me as a therapist and a person. Many asked for feedback in return. Not just the usual feedback; something deeper, more personal. How I viewed them; how I felt about them. It was a fair request and necessary for a healthy closure.

It was a time of incredibly mixed emotions for me. The words of praise certainly meant a lot to me and hearing it over and over was an incredible trip to be on. But the pain of their loss and the pain of my having to say goodbye left me totally drained by the end of each day. I felt a surge of guilt again, especially with a few of my younger patients (mid-30s) whom I had seen since childhood or adolescence. They spoke of me being the good father they never had and questioned how that could be replaced. In turn, I was dealing with my own counter-transference, because I felt a sense of abandoning “my children.”

Interestingly, I came to expect that the final week would be the worst but it wasn’t. We had done so much of the important work that the last sessions were less intense…until the actual goodbye. The hugs and tears were powerful expressions of the strong bonds that had been created over the years. The hugging was interesting. I’m not a huggy therapist, so this was new ground for all of us. But male, female, older, younger, nearly all wanted, asked for, a meaningful hug at the end. Even patients I might not have expected to request one did. The power of contact in intimate relationships. How could I have been so foolish to forget that?

There were gifts from some and I made four tapes. Three were for my surrogate-child patients and one for a Dissociative Identity Disorder patient. For the latter I also included something from my office as well as a photograph. This had been worked out with my co-therapist on the case who specializes in working with DID patients. The tapes were a mixture of the history of our work together, my view of each as a person, and my expectations, hopes, and some guidance about the future. I wanted them to be able to hear my voice if they needed to. This also had been sorted through with colleagues. One other patient had also asked for a picture and took some photos in the office.

Finally, it was over. Our work is so strange. It requires us to say goodbye to people after building important connections to them. It restricts post-therapy contact so the goodbyes are quite firm and rigid. It’s one thing when the patient has made the decision to leave the relationship. But it is quite different when the therapist is the one to leave. As one patient said, “I wanted to be the one to walk out that door and feel our work was done and I had become the person I set out to be. Now I have to try and finish the journey with someone else.” Perhaps even more to the point, another patient said “I can’t talk to you anymore. Yet I know you are still out there. It doesn’t seem fair.”

Being retired: a summary of the initial months

One of the first things I did was to take care of some business of practice matters. I changed to being a life member of APA and my state association (MA), reducing dues in each to $50. With APA, that meant receiving the American Psychologist and APA Monitor. I also maintained my subscriptions to Psychotherapy Finances (great, inexpensive source of information about what’s happening in the practice of mental health) and Psychotherapy Networker (another excellent resource about the world of psychotherapy but in the form of some great articles). I cancelled everything else and withdrew from all APA divisions except 42. I had already cancelled overhead and disability insurance policies from APAIT in April when renewal bills came out. After I saw my last patient, I cancelled my malpractice insurance. Since I have a claims made policy, I have an insurance ”tail” that covers me forever for no additional charge. If I do resume seeing patients some day, I can reinstate the policy.

Early in June, I published a one-third page “Thank You Needham” letter in the local weekly, announcing my retirement and thanking the community for not only supporting my work but for being a great place to bring up my family (We moved after our boys had gone off to college.) I received a lot of nice feedback from that and it also served as great PR piece for NPA. I had allowed a few panels to elapse by not renewing (ones that I was no longer using.) On June 30th, to make sure there would be no confusion, I sent letters to the primary panels that I was retired and requested being removed from the panels. The rest will just fade away. Finally, on the last day, my phone was switched to outgoing message only, so for people who called they would be told about my being retired and would be directed to call NPA’s central intake number if they needed services or my two colleagues if they need information from their records. I plan to keep this message until next June.

Meanwhile, as I described earlier, I have always been someone with many interests and activities. Therefore, I anticipated no problems making the transition to retirement. I already had an unwritten list of many short-term and long-term projects and new adventures to purse. In fact, I expected that after a couple of weeks of relaxation, I would create those “to do” lists and dive into them.

Actually I had already started by taking golf lessons in May and was going to the range and starting to play on a real course by the time I retired. Also, I had increased my involvement in an over-55 softball program to twice/weekly doubleheaders instead of once/week. As soon as I no longer had to go to the office, all this physical activity, combined with some beautiful summer weather, resulted in an unexpected experience. I was like a little boy on summer vacation. I hadn’t spent so much time outdoors since I was a kid! It was an absolute blast. Of course my body got a bit sore from all the exertion but I scheduled some deep-tissue massages and that helped a lot. I quickly learned my first and, perhaps, most important lesson about retirement: Maintain maximum flexibility. I decided to ignore my lists until the fall and just experience the pure joy of this wonderful summer. Oh, I did slip in a few little projects here and there, just quickie house-keeping stuff, literally. I also read some good books.

After we took our end-of-summer trip to Provence, softball came to an end and I began to feel a desire to begin doing something productive. I wrote a column for my website, I hired a tutor to begin teaching me how to use Adobe Photoshop and to scan slides onto my hard drive, and I began working on this article. I also realized that my original vision was unrealistic. Not having to go to work doesn’t mean you can get to everything on your list right away. I decided that this winter I would work on writing and self-publishing the parenting book. But that meant I should forget about trying to learn to play the piano until next winter (I intend to have another playful summer next year.) I also put off bridge lessons till some unknown point down the road. I still haven’t made my lists but expect to do that after I have finished this article and before I sink into the book.

Meanwhile, I was still billing patients for remaining balances. The first time I did that at the end of July a lot of emotion was attached to the process as I thought about each patient and wondered how they were doing. However, since then the process has become fairly perfunctory and the number of patients owing money has quickly shrunk. I have gotten a few calls from therapists to get more info about people I had referred to them. A couple of cases had to be shifted to different therapists for various reasons (e.g., insurance changes) but overall the arrangements I had made went fairly smoothly, with all but a couple of patients following through on the referrals so far and, in a follow-up I did in October, the reports were that the new relationships were taking root.

I did receive a couple of Jewish New Year cards from former patients and a couple of emails with news of changes in their lives such as purchase of a new home or arrival of a new grandchild. In each instance I responded to their question about how retirement was going with a very brief report about my golf and the enjoyment of the summer.

Final thoughts

Most of all, this brief experience with retirement has altered my perspective of time. For most of my life, especially my adult years, there has always been a negative relationship with time, meaning too much to do and too little time to get it done. While I have always been someone who stops to smell the proverbial roses and I really appreciate that I have had a better life than I ever dreamed of, I was still someone who put in a lot of hours pursuing many goals. Now, I have time and more than I actually need as long as I set reasonable expectations.

Perhaps I can say it best with the example of a typical evening question from my wife. “What are you doing tomorrow?” My typical response: “I don’t know yet.” Sure, there are some items on a desk pad but, with a few exceptions of routine errands or appointments, I don’t have to do anything. When I was explaining this to a friend, she asked what’s the difference between what you are doing and procrastination. The latter is putting off something that needs to be done now. Most everything on my list doesn’t have a deadline. I’m not putting off anything. I am actually choosing how I want to spend my time, day after day. So far, it is a wonderful way to live.

Kalman M. Heller, Ph.D. is a clinical psychologist, now retired, who specialized in providing services to children, families, and couples since 1968. He has written over 150 columns about parenting and marriage which are available on his website, www.drheller.com. He can be contacted at kheller714@aol.com .

Summary of Information Regarding Dr. Heller’s Retirement

The decision to retire is a personal one that I began planning a few years ago. It is based on my view of life as having much to offer and a desire, while still healthy and energetic, to experience many new directions of personal growth and interests. It is not easy to leave my colleagues, current patients, or future patients. I still enjoy my career as a psychologist. But, at 65, life grows shorter, and there are “miles to go before I sleep.” My sincerest thanks to everyone who has helped make my career meaningful.

The following information may be helpful:

1. I will be completely retired by 6/30/06.
2. I am no longer taking new referrals but I will still see former patients for brief consultations until my retirement is in effect.
3. For current patients, if services are needed beyond my retirement date, I will assist you in transferring to a new therapist.
   
4. Post-retirement, your records will be securely kept for six years after our last appointment. For minors, records will be kept one year after they reach 18 years of age but, in no case, less than six years. These are consistent with the current legal guidelines for HIPAA and the Commonwealth of Massachusetts. If, after my retirement, a situation arises that requires you to have a summary of your records, please contact either XXXX XXX or XXX XXX at (XXX)XXX- XXXX they will contact me.
5. In case of my disability or death, Dr. XXX and Dr. XXX will be responsible to take care of my records and respond to requests for summaries from past records.
6. After my retirement, if there is a need for additional services, please call Needham Psychotherapy Associates Central Intake at XXX-XXX-XXXX.
7. Some former patients have stayed in touch with an annual card or email (usually around the holidays). Please feel free to do the same if you wish. However, because I will be retired, I cannot provide any advice or consultation.