Since the beginning of our work together, I’ve noticed that David escapes from being a client by becoming the person who instead “dispenses wisdom,” as he has described it. I’ve tried to talk to him about how he uses this posture to keep me at a distance, becoming a sort of therapist himself.

I’ve been watching cautiously to see where this would lead us. His difficulty bearing need and dependency seemed clear, but I’ve also wondered whether feelings of envy for me as his therapist might also be in the background.

Last Friday, the envy came to the fore – although I didn’t quite see it coming. During session, I was focusing on the way he goes from feeling unbearably small to becoming too big, all at once. He took issue with every remark I made; he became increasingly angry and contemptuous in his manner toward me until finally, by the session’s end, I had become a worthless, incompetent therapist he despised.

Only at the end did I realize I should have been focusing on this process all along. I did what I could in the final minutes to describe what had happened between us. Later that day, I received an email from him, extremely hostile and contemptuous in manner, telling me he wanted to take a month off to try something different.

In a brief email, I outlined what I thought had happened in the session and what I’d missed by not focusing on the interaction between us. I told him I thought that when he felt mired in shame and despondent about the dead-end of his life, it felt unbearable to be in contact with someone his own age whom he viewed as successful. It made him want to destroy me and the work we were doing, which is what had happened in our last session. (In the old days, I would have called this envy, but now it feels to me that the envy is secondary; because it’s unbearable, shame gives rise to an envy that is lethal and destructive.)

I wished him well, told him I would be available to him whenever he chose to resume treatment but that I couldn’t hold his hours open.

The following day, I received a long, contrite email in which David seemed to acknowledge that he had done the very same thing throughout his life, in all of his important relationships, and that now I could see what I was up against. He told me he didn’t want to quit therapy, so we continued this week.

The sessions have been difficult, to say the least. David began Tuesday with a remark about how “brilliant” the emails were that he’d written to me, so amazingly polished they ought to be published. He went on and on about their brilliance. I reminded him of what had happened the week before, suggesting that the unbearable feelings of shame he felt in relation to me made him want to become the “brilliant writer” himself so he wouldn’t have to feel so small and impotent.

Over the course of that session, he became increasingly filled with contempt, ridiculing me, calling me an ego-maniac, telling me he never read my blog and cared nothing about my stupid book. I’ve been here before with this difficult type of client and it’s incredibly painful and challenging for both parties. I feel for David and sympathize with the level of shame he must feel, and sensing the depth of his pain enables me to bear his contempt.

Today’s session was no better; he made it clear throughout that I was a very bad therapist, that I had no idea what I was doing, that I had nothing he needed, etc. He was full of scorn and contempt. Mid-session, he quit once again.

We will see what happens. My guess is that there’s a healthier part of David’s mind that will recognize his destructiveness and return, but today might very well have been the end of it. This is the make-or-break moment.

 


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    Last reviewed: 7 Jul 2012

APA Reference
Burgo PhD, J. (2012). The Make-or-Break Moment. Psych Central. Retrieved on December 22, 2014, from http://blogs.psychcentral.com/case-notes/2012/07/the-make-or-break-moment/

 

 

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