As a practicing psychoanalyst and a psychiatric nurse practitioner, I work with a full range of patients who benefit from psychosocial interventions (psychotherapy) and psychopharmacologic interventions (medication management). This is the story of Jacob, an anthropologist, who had a long history of depression, anxiety, and substance abuse. At the time he entered treatment with me, he made it clear that he was a "professional patient" in that he had been in one sort of therapy or another for the last 20 years. He tried cognitive-behavioral therapy with a therapist in Pennsylvania, which lasted a few years; he moved onto New York, where he entered classical psychoanalytic treatment with required sessions of 4 times a week. After a few years, he moved to the West Coast, where he engaged a Gestalt therapist for a brief period of time. He then worked his way back East, stopping along the way to work with Indian healers, drumming circles, wilderness programs, meditation, and biofeedback, to name a few. Jacob had experienced more psychotherapeutic modalities, both traditional and alternative, than the universe of patients in my practice.

We began our work together identifying chronic issues and problems that he had been prone to repeat over and over again. We identified impairing symptoms that prevented him from being as productive in his professional and personal life as he would have liked. We worked together, week after week, for almost 10 years exploring these issues augmented with different medications to address his varying level of impairment. The time came when I broached the subject of termination since he had been stable and well functioning for a significant period of time, had obtained a position at which he was very happy and had reconnected socially. At first he was very hesitant, but eventually, we agreed on a termination date.

When our final session came, Jacob wanted to spend some time reminiscing on our past accomplishments. We discussed how we worked through the pain of his first divorce and then his second divorce. He recounted the many positions that he had held over the years in which he was never able to find any sense of satisfaction. He mentioned his several relapses into drugs and alcohol during which I was the only person in his life who was there to help him through those difficulties and continued to believe in him. As we walked down memory lane, he often became tearful and, on a few occasions, sobbed openly, blowing his nose and wiping his eyes as he expressed his awareness of how he had progressed. On several occasions, I felt the tears welling in my own eyes. He continued talking about what he accomplished how he planned to continue his journey of growth and self-discovery in the years ahead. Then, as if interrupted by a loud bang, he looked up at me thoughtfully, wiped his eyes, and exclaimed, "And you're really not that good!!"

After I recouped from this surprising statement, I began to think about the importance of Jacob's feedback. Occasionally, we need to heed messages like this from our patients that remind us never to stop learning, never to stop expanding our knowledge and skill base, and never to relax in our quest to find more effective ways to connect with patients and ourselves. Whenever I find myself basking in my professional sense of self-importance, I think of Jacob and how much his simple and direct feedback during our termination session has helped me become a better practitioner.

Note: The name, places, and other elements of this story are fictionalized.