When the Therapeutic Alliance Makes Clients Dependent

When Should We Stop Seeing Difficult Therapy Clients?

David Treadway

After 22 years, I can still see Amy sitting there, cross-legged, with her arms folded across her chest and her dirty blond hair falling down over her face. She was perched on the hood of my car. It was 9:00 p.m., and I was just leaving my office. Amy glared at me as I approached. Our therapy session had ended five hours earlier.

"Oh shit," I thought to myself, "here we go again." And I was dumb enough to think that we had had a good session earlier. Amy was one of my first private practice patients, and I was too embarrassed by the case to admit to myself what a mess it had become. It hadn't started out that way.

Amy's mother and her same-sex partner had asked me to see 16-year-old Amy in individual therapy because they thought she was depressed and possibly had an eating disorder. They also described her as increasingly combative and hostile.

After several false starts, she whispered haltingly about being little and her dad in the middle of the night; the smell of his breath, the weight of his body. Despite my never having done trauma work with an incest survivor, I felt I could help. Then Amy confided in me that she sometimes cut her wrists and often thought of killing herself. "I never thought I would ever be able to tell anyone," she said. I felt like her knight in shining armor. I should have known then that I was headed for trouble.

Amy began calling me at home. When I tried to help her understand that it wasn't okay to call me there, she was devastated. She began making hang-up phone calls, started cutting her wrists again and threatened suicide.

Finally, Amy tried to make good on her threat and slashed her wrists, took an overdose of Valium and drank a bottle of wine. She was rushed to the hospital. The staff there concluded that Amy was a Borderline, that she was overly dependent on me and that it would be better for her to stop seeing me. I felt both relieved and terribly guilty. I knew Amy would be deeply hurt by my withdrawing from the case, but I didn't stand up to the clinicians. I was too afraid that they already felt I had bungled the case and was way too enmeshed with Amy.

1996--The phone rang during dinner one summer evening. "Just don't hang up. I'm okay now. Please let me talk to you. Just for a minute. Please."

After 17 years, I still recognized that voice. Through the years, I had assumed that Amy had either continued to struggle in and out of hospitals or had finally killed herself. Instead, she sounded great. She had actually moved to Montana and become a dental hygienist. She also reported that she was happily married and had a 2-year-old baby girl.

She confided that she had been to many therapists since seeing me and that no one had ever been able to help her as well as I had. She asked if I would please be willing to consider doing a few phone sessions with her about parenting, because she was having a little difficulty with her daughter.

Incredibly, I agreed. I thought I knew what I was doing. Surely I could help Amy appropriately within safe boundaries in a carefully managed short-term contract. I thought that, if I set it up carefully, I might be a bridge for her into a healthy therapeutic alliance in her own community. Part of me worried that once again I was falling into my knight in shining armor role, but I felt like I was being careful and avoiding the obvious pitfalls.

Unfortunately, within the first month of seemingly benign phone sessions, Amy's secrets began tumbling out again. She had been stealing painkillers from the dentist's office and drinking wine. She confessed that she sometimes raged at Heather, which would made her feel terrible, which led to cutting and suicidal fantasies.

She was caught in the vortex once more and, like a complete fool, so was I. Like many trauma survivors, Amy was desperately seeking gentle, loving compassion. But our therapeutic relationship seems to have provided a dollop of caring that invariably stimulated an insatiable hunger in Amy that she couldn't manage.

Was I still playing the knight in shining armor after all these years? Probably. But I had already turned my back on Amy, and I simply decided that I was going to hang in there and hope for the best. The role we three defined for me felt like a balance between my being overly involved and simply disconnecting from her. I hope it was the right choice.

Although she still thinks about suicide, Amy also has a part-time job and a good relationship with her daughter. Her therapist has been as steady as a heartbeat and feels that Amy's making slow, but substantive, progress. Our monthly talks are just support calls. She gives me honest and painful updates on her struggles, and I don't offer much advice. I commiserate and bear witness.

It's been embarrassing to write about Amy's and my story, because it seems clear that I made a lot of mistakes throughout, and maybe I am continuing to make a mistake. Am I still acting out some ancient rescue fantasies? Probably. But it's unclear whether the impact of my efforts is ultimately positive for her or not. I don't know, nor do I think I ever will. I do know that, in the end, I have to live with my choices, and I'd rather have risked caring too much than too little. I pray for me, too.

This blog is excerpted from “How Involved Is Too Involved?" Read the full article here. >>

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Topic: Parenting | Trauma

Tags: ethical issues | acting out | boundaries | cutting | eating disorder | ED | guilt | HEAL | individual therapy | sex | suicidal | suicide | survivors | TED | therapist | therapists | therapy | Psychotherapy Networker | clients | borderline | David Treadway

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1 Comment

Tuesday, January 9, 2018 8:02:20 AM | posted by John Hanson
Thank you for this thoughtful article. I'd like to understand better. I have two questions. 1. Is "the role we three defined for me," reference you, Amy, and her therapist? 2. Does Amy pay for the supportive phone calls?