The concepts of neediness and emotional dependency have negative connotations in our culture; when it comes to psychotherapy, many people (especially those who’ve never had any kind of treatment) take a very dim view of clients who come to depend “too much” upon their therapist. You may hear the very cynical opinion expressed that psychotherapists deliberately instill a kind of emotional dependency in their clients in order to exploit them. It seems that a great many people think that emotional dependency in psychotherapy is bad.
In truth, for psychotherapy to be effective, a degree of emotional dependency is inevitable. Clients with extreme amounts of pain and confusion, who have a history of unstable or chaotic relationships, may become highly dependent for long periods of time. If your life isn’t working, if you come from a deeply troubled background and never developed the kind of emotional capacity and self-awareness you need to get through life, you have to turn to and depend upon someone else to help you develop it. Effective work can’t happen and you can’t get what you need if you don’t.
This is not to say that most clients who come for therapy are eager or especially willing to become emotionally dependent. In fact, resistance to dependency is often one of the first issues that comes up in therapy: despite the large amount of pain they may be feeling, and a kind of desperate hopelessness that finally compels them to seek professional help, many clients don’t want to become dependent upon their therapist. They may hate feeling needy, often because childhood taught them that to be in such a vulnerable, needy state means you’ll get hurt.
For people who come from impoverished backgrounds, need equals frustration and disappointment. Need stirs up anxieties about being abandoned. Need makes you feel small and helpless, at the mercy of those who have what you need. Such people, as clients, may have little or no faith in the possibility that someone might actually be concerned about them, and want to give what is needed. The fact that they must pay for what they need makes the subject more complicated; they may believe that payment means there is no genuine concern involved on the part of the therapist.
These issues often become the focus of treatment early on, the first manifestation of the transference. While many people think of the transference in classically Freudian terms, as a kind of distortion of reality — You’re reacting to me as if I were your father — the transference actually serves as a microcosm of q person’s emotional issues, a first-hand experience of the psychological issues that confront our clients. So if someone hates neediness and emotional dependency, if that person can’t develop stable relationships of any depth or duration, she’ll have the same trouble in her relationship with me. He’ll find ways to keep me at a distance; he may continually have one foot in and one foot out of treatment. My first job is often to help these clients see the continuity in their different relationships — within and outside of psychotherapy — where the common theme is a great difficulty in tolerating their own needs.
In my recent work with one client, these issues dominated the treatment. From the beginning, she expressed a fear of becoming dependent upon me. In different ways, both of her parents had abandoned her, literally and emotionally; with reason, she had scant faith in the goodness or dependability of other people. She struggled with often uncontrollable urges to binge eat, turning to food instead of people as a source of comfort whenever painful emotions began to surface. She had a difficult time committing to our work together, stopping and and starting therapy several times. She often cancelled sessions on short notice, then worried that I would give away her hour to someone else.
Instead of sticking to interpretation — that is, doing my job and simply helping her to see and bear with her fears about emotional dependency — I made the mistake of offering to hold her time open, regardless of whether she used it. I thought this might reassure her, and make her feel that I was safe … different from the other unreliable people in her life. Instead, she used this new policy to regulate her feelings of dependency. She repeatedly cancelled our sessions; recently, when I offered to reschedule, she explained that she didn’t want a make-up because she preferred not to feel too dependent. Cancelling the session made her feel as if she didn’t need me. At that point, I realized that I’d unwittingly offered her the means to avoid the kind of dependency she needed to experience in order to get better — that is, to relinquish her eating disorder and find better ways to cope with feeling in the context of a human relationship.
When I told her of my mistake and changed my policy, telling her that I would no longer hold a regular hour open for her but would still see her whenever she felt the need to schedule a session, she became angry and quit. I can easily understand why. While it was my mistake in the first place (offering to change my usual policy), rescinding that offer no doubt felt like abandonment all over again. You’d think that after 30 years of practice, I’d be able to avoid such mistakes, but there it is.
This has been a lesson in humility: It’s a kind of hubris, to believe you can somehow compensate for a lifetime of abandonment and indifference by adjusting your cancellation policy. Next time I encounter such an issue, I’ll do what I should have done and give the client what he or she actually needs: someone consistent and reliable, who knows how to set reasonable limits and stick to them.