Q: I’m working with a Black client with developmental trauma. Whenever she tries to do her therapy homework, she has nightmares and wakes up in a fetal position. She’s apologized for this and is thinking of ending therapy because she feels like a disappointment. What can I do?

A: It’s not easy when clients who we feel have more work to do in therapy tell us they want to stop. It can be even trickier when their leaving seems tied to their relationship with us.

However, as upsetting as it may be, your client’s brave confession could ultimately be a gift. She’s offered you an opening to explore how your work together has activated a traumatic threat response. Perhaps if you can openly address this, you’ll be able to uncover some pivotal truths and map a better path forward.

It sounds to me as if your client’s been experiencing a powerful threat response of submit and collapse, followed by the less-discussed response of appease. She’s tried to appease you by overriding the overwhelming distress of doing the homework, at a great cost to herself. Now that the appeasement isn’t having its hoped-for effect, the shame that’s arisen may be driving her away from you.

It’s also likely your client feels threatened and overwhelmed by the treatment process and, I’m…