Constructing the Psychotherapy Narrative


At the beginning of our first session I ask MacKenzie, a 32-year-old single woman, what prompted her to seek treatment. Although she mentions occasional depression and anxiety, she seems most focused on her inability to maintain relationships. She has never felt truly intimate with any man she has dated. It might go on for several months, but inevitably she finds reasons to break it off. He’s not smart enough. He’s not ambitious. He’s too needy. She doesn’t like his friends and family. By this point in her life, she recognizes that these ostensible reasons are mere pretexts. She knows that she’s afraid of intimacy but doesn’t understand why.

Over the next few sessions, she fills me in on her personal history. Mom was an alcoholic and MacKenzie often came home from school to find her drunk or passed out on the couch. Dad was a workaholic and neglected the family, then divorced her mother and largely disappeared from their lives when MacKenzie was in her early teens. My client was left more or less in charge of her younger sister and stood in for parent as Mom disappeared deeper and deeper into her addiction. As an adult, MacKenzie has always been hard-working, utterly reliable and valued by her employers. She consistently advanced in her career at a major corporation and now occupies a mid-management level position.

I eventually suggest to MacKenzie that her experience of early childhood — dependent upon adults who consistently let her down — taught her that it was unsafe and unwise to rely upon other people to meet her needs. In order to survive, she became self-reliant to an extreme degree. Whatever she needed, she would provide for herself. I further suggest that this early trauma and her response of defensive self-sufficiency helps explain her present-day relationship problems. Whenever she feels herself growing attached to the man she’s dating, she’s afraid she’ll become emotionally dependent upon him; the past has taught her that such an experience can only end in disaster. In order to save herself from such agony, MacKenzie stifles any feelings of attachment and breaks the relationship off.

During the next few weeks, I notice that MacKenzie seems to be pulling away. She cancels one of her sessions, offering what feels like a feeble excuse, then shows up the following week and at first has little to say. When she finally warms up, she starts describing a problem she’s having at work with one of her subordinates. She seems entirely focused on this woman’s workplace difficulties, offering psychological explanations for her behavior and working out in my presence what she intends to do about it. I eventually suggest to MacKenzie that she had previously felt herself growing attached to me and our work together; afraid that she’ll become emotionally dependent upon me, she is now becoming more self-sufficient, more like a therapist herself, and pulling away from me. She seems surprised by what I say and acknowledges that she has been thinking about discontinuing her therapy. I point out the analogy to her relationship patterns.

My description of MacKenzie and the course of her early treatment is entirely fictional but closely resembles my work with a number of clients over the years. It illustrates a process I think of as constructing the psychotherapy narrative. Along cause-and-effect lines, we look to the painful past in order to account for present-day character traits and defenses. Past neglect and abandonment explain a present-day inability to sustain intimacy. The client and I are writing a story together, so to speak, in which she is the main character and we’re forging links between her past and present day experiences.

We don’t actually know whether the narrative we’ve written is entirely accurate, not in a factual way. We can’t say with certainty that Experience A caused Character Trait B. Rather, reconstructions in psychotherapy are a kind of fiction that we try on for size to see whether it “feels” right. Clients like MacKenzie must decide whether this historical account of her emotional life makes sense and helps her to better understand herself. If it does, she might in time learn to access the fear of abandonment, the terror of dependency that comes up when she starts to get close to the man she’s dating. In an effort to re-write her story along more emotionally satisfying lines, she might try to be brave, bear with her fears and not run from intimacy.

Whenever I write about someone like Lance Armstrong, Charlie Sheen or Anthony Weiner, some readers inevitably ask me how I can presume to diagnose someone who isn’t a client. I’m not diagnosing anyone to begin with. I don’t believe that affixing a label to anyone does much of anything other than to stigmatize. What I am actually doing is constructing a narrative in a way not entirely different from what I do with my clients. I look to the past to see whether it sheds light on the person’s present day character traits and emotional difficulties. Based on my experience with clients who’ve come from similar backgrounds, I attempt to construct a narrative. For the narcissist like Lance Armstrong, I often link early emotional trauma and the shame it causes to a characteristic set of personality traits that arise as a defense — arrogance, grandiosity, contempt, etc. It’s a theory, a psychological narrative I’ve constructed to shed light on a person I may never have met but who I “recognize” even from this distance.

The question for the reader, as it is for my clients, is whether the narrative “feels” right and helps make the person more comprehensible. So often when the media and even professional psychologists write about the celebrity narcissist, they write about them as entirely “other,” suffering from a specific mental disorder that conforms to diagnostic criteria defined by the DSM5. In constructing a narrative about these celebrities, I instead try to make sense of their behavior and personalities, to make them seem less “other” and incomprehensible, more like people who become more understandable once we step into the life narrative that shaped them.

By Joseph Burgo

Joe is the author and the owner of, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.


  1. This reminds me of something I read recently (I think it was a therapist who said it… was it maybe you Dr Burgo…? I recently read Love’s Executioner, maybe it was in that?) well, anyway it was something about how the more a therapist gets to know the client the harder it gets to diagnose them. The general idea being that the more you hear of their life, their narrative, and the more the client is seen by the therapist, the more their behaviours and beliefs are understandable. If that makes sense.

    This story, to an extent, is familiar to me. For me though, my attachment issues and abandonment fears came out in a different way. I became anxiously and obsessively attached to my therapist, within the first hour of meeting him. Wanted to email him constantly, thought about him every second of the day, felt like I was losing my mind. How could I love this man more than I’ve loved anyone before in my life? I was jealous of his family, it physically hurt to hear him talk of his daughter, it would ache to have him show any kindness or compassion towards me. I’d tell myself he was just ‘doing his job’… he didn’t really care he was just tricking me so I’d ‘get better’ and he would have ‘fixed’ me so I could then leave him alone. I wanted him in my life and I wanted him to love me like I loved him. I couldn’t imagine just randomly finishing therapy, I couldn’t imagine him ever not being in my life. Equally I was repulsed and terrified of this dependence. It made it so hard to confide in him because I feared what he would think of me, I became so easily embarrassed and would spend a whole hour attempting to confess one tiny thing to him from my childhood or teenage years. I felt certain he was going to get sick of me and pass me onto someone else. I needed constant reassurance and would try my hardest to find out his likes and dislikes in an attempt to impress him… ‘you could love me because I like the same music as you…’ that kind of thing. This was at its most unbearable about two months into our once a week sessions, it grew and lessened in intensity over the months and now I am at a point that I never thought I would be. Ten months of therapy and I feel secure. Did I just say that? I feel secure in myself… I don’t need him to love me. I don’t long for him to reach out and hold me anymore. I have the inner strength to question and contradict him now without the fear that it will make him hate me. I don’t count down the days to our next session. I don’t obsessively check my phone for emails from him that never come. I can think of the possibility of ending my sessions without feeling an anxiety attack approach. I NEVER thought I’d feel like this.

    How does this link up to my childhood? A distant, emotionally frozen, passive-aggressive father who would have random explosions of rage and physical aggression that would burst in my direction with little warning. This is a man who would pretend he was listening to me but retain nothing and give no meaningful response, he’d saunter out the room when I was talking… I was never listened to. When I was a teenager, after years of serious self-harm, I wrote him a letter confessing all and asking desperately for his help. He never responded to my letter. Fast forward 15 years and I find myself agonising over not getting replies to emails from my therapist, imagining all these terrible things he must think of me because of whatever I wrote… it really is pretty clear what the link is. Through working with my therapist I became brave enough to bring my father to a therapy session in which among other things I brought up the letter. He told me he had read it many times and didn’t know what to do so he did nothing. He told me he knew he couldn’t help anyone else without first helping himself, he admitted to putting himself first my whole life. I cried for the first time in ten years during that session. An agonising yet deeply heeling experience. Validation and a cleansing of some of my life long shame and guilt. Onto my other parent – an alcoholic, narcissistic, possibly bi-polar woman who completely lacks the ability to empathise or make meaningful connections with anyone. As a child I was told I needed too many hugs, that I was overly-sensitive and that no one would ever love me. I wasn’t wanted and if I hadn’t come along my mother wouldn’t have stayed in her miserable relationship with my father. My father emotionally left us years before he actually left my mother. My mother needed me to parent her years before I actually became an adult. They both used me emotionally and then dumped me when they found new partners.

    Fast forward to a year ago – I had developed unhealthy attachment needs, perfectionist tendencies, obsessive compulsive intrusive thoughts and behaviours… among other things! Then the therapy starts… then I read about transference neurosis about three months into therapy when I desperately googled, ‘I think I’m in love with my therapist/I want my therapist to be my dad’ and I was just so struck by how hard I’d fallen into this standard ‘symptom’ of therapy. I was furious that no one had warned me of this. I said to my therapist, ‘I always wanted to be unique and interesting, I imagined I could be a challenging case for you, that you’d have to take stories of my sessions to your supervisor asking for help because you didn’t know how to fathom me… then I read about this transference stuff and I realise how textbook I am… how boring working with me must be for you!’ He reassured me that he has had to ‘problem solve’ in our sessions quite a bit and he said, ‘sometimes I’m exhausted after an hour of working with you… that shows how hard I’m working – and I love it… rest assured I love my job!’ I don’t know why but I was flattered by this.

    Anyway, in my usual War and Peace style I have tried to articulate here my therapy narrative. It fascinates me! I am far enough out the other side of what I presume was a crisis point in my life to look back and see what an amazing journey it has been. I’m still on it but I am more aware now.

    Ever grateful to you for your insightful posts and I apologise for this not being more concise.

    1. Don’t worry at all about being concise! This is very interesting, and a great personal example of what I’m discussing. Obviously this narrative feels deeply meaningful and explanatory to you — so much of your experience makes sense when you put these experiences into relation with one another. I’d add that it’s not “proof.” It’s not fact in the scientific sense but it has the unmistakable feel of truth. Thanks for taking the time to describe your experience.

      1. Thanks for your response. It’s interesting to observe that there is no scientific proof but that it ‘feels’ right. When I started therapy every part of my experience was cognitive, logic, words, proof, fact, evidence… this year has been about me moving into my emotional being, trusting my instincts, listening to my feelings… all those intangible, obscure, deeply personal things that rely solely on faith and acceptance. It’s been so freeing to experience the world in this new way.

  2. I did that with my last therapist-I made a narrative about him, in order to make him less ‘other’ and incomprehensible.
    I think I did a pretty good job, I read a lot of psychology, was very observant and connected a lot of dots.
    I have a feeling, though, that if I typed it up and sent it to him, he wouldn’t appreciate it.

      1. He has a long way to go in the area of self-awareness; he’s fragile, defensive and guarded.
        When I would point out something about him that I noticed he wouldn’t answer.
        For example, I said, “I think you take me personally” (meaning his feelings would seem to be hurt by my negative transference reactions), and he said nothing in reply.
        That was typical.
        It’s a status-switch, too, being analyzed by your (former) client that I don’t think he would like.
        Raising my status (as the client) in relation to him was one of my issues.
        Sometimes I think of writing a book myself…

        1. Sarah I have had a similar experience with my former therapist.Joseph what are your thoughts?
          I chose to bring the work to a close because I was finding these kind of responses from him unhelpful to the flow of the work. The work was at times profound. He and I had a very deep connection with each other and as a result he also found himself in uncharted emotional territory.. I consciously brought to the sessions a sense that there needed to be a merging between us in order for healing through healthy and eventual separation. This was after many years of therapy with female therapists, I and my former female therapist believed that because of my attachment history with my father, ( alchoholic, narcissistic and sexually unboundried ) It might be beneficial to work with a male therapist. I found a body psychotherapist because I have immense confidence in the role of body work in psychotherapy. But we did very little body work together and there was an erotic attraction between us right from the beginning of the three years that we worked together. We spoke about this openly and I feel that he believed that he could ‘hold’ both of us. We acknowledged much current and historical theory around erotic transference and counter transference ( I am also a therapist) within the sessions. I made the decision to stay with the work, despite friends and colleagues advice to get out, because I believe that the mix held immense potential for healing. However I now feel unsure. There is a very powerful pull in me to go back to him and continue exploring this territory with him at the same time it feels unsafe. There is so much more to this story and i am still grieving the loss of the sessions.The relationship has been one of the most intimate relationships in my life. I would find comments very useful

            1. Hi Joseph. Thanks for your response. I can give more information here..or what would a consultation involve? particularly the cost?

          1. You wrote that you’re grieving the loss of the sessions but you also write that you decided to “stay with the work”; that’s confusing.

            I don’t know if this helps or relates to your experience but I’ll just say I think my therapist has weak boundaries. He ‘became me’ during sessions. He has a face like a baby’s, mirroring me and looking instantly sad if I related something painful or instantly joyous if I described a triumph.

            This caused an intense transference response on my part. I felt like I had the bond I never had from my parents but needed as a baby/child.

            The problem was my therapist didn’t know how to handle it. He loved it when it was positive (he’s a bit of a narcissist) but when it turned negative (out of fear that this attachment would hurt me) I saw what an insecure, clueless and counter-attacking person he was.

            I cannot even describe how badly I wanted the relationship to turn out well. I’m sure he had no idea because I was so negative and critical towards him. He abruptly, unprofessionally and manipulatively ended my therapy. I’m sure he felt stuck, angry and miserable. I relayed in detail how he ended it in a Yelp review.

            It was traumatic. It took me two years to work it out (the bad ending). I am not going to take any more chances with therapists. There is absolutely no way to know if they are trustworthy.

  3. Hi Joe, hope you and your tribe have a great Xmas/ new yr.
    We here in Australia, celebrate Xmas, while swimming in the ocean.
    Of course, as a therapist, the focus for you.. In
    Working with( or writing about), narcissistic personalities.. Is to understand their behaviour thru looking at their childhood traumas.
    As a person( ex wife/ co parent), to a narcissistic personality, it becomes more black and white, surely ?
    My ex just continues to Show no compassion/ empathy for our children.
    What to do? Except close him out… Or rather , watch our children close him out…
    Understanding his childhood pain, surely, can inform my watching. But, for them, the pain is best dealt with by just letting him go.

    1. With the extreme narcissist like your husband, I agree that the best course of action is usually to get as much distance as possible. Often, we can’t entirely escape from them, though. In those cases where we have no choice but to deal with them, it’s truly helpful to understand the pain/shame they’re running from so we can avoid triggering them, and avoid getting into those battles-to-the-death where they must always be “right.” I’ll have more to say about this in my book.

      Thanks for the Christmas wishes, and the same to you and yours!

    2. From the perspective of a daughter of a narcissistic parent etc etc (read the first comment for more detail) I would urge you to reach out to your children and help them understand the pain they feel when their father doesn’t live up to what they need. I would suggest rather than encouraging or allowing them to ‘let him go’ perhaps attempt (although very difficult for so many reasons) to help them understand how limited some people are in their ability to express emotions/show empathy/be who you need them to be. Let go of the pain but not the person.

      If at least one of my parents had reached out to me and told me I was loved and that I was ‘okay’ I think that would have changed everything… I’m not sure where I’m going here and I’m sure you already do all this as it sounds you are very aware of the possible damage that could result from having a relationship with someone like your ex.

      Maybe you’ll find that with your validation, patience and modelled compassion you will find your children can develop a deep sense of compassion and understanding for their fathers shortcomings and develop an emotional distance – they will know that nothing they have done and nothing they are has made him the way he is. That he loves them he just doesn’t know how to show it. In the long run I fear it will hurt them more if they close him out. Believe me I’ve thought about it many times and did for a few months with both my parents but it didn’t make me happy. The only thing that has put me onto the path of healing is compassion (and feeling unconditional positive regard from my therapist – but as a parent you can show that to your children). When I started therapy I would say, ‘I spent my whole childhood doing all I could in a desperate attempt to be enough for them, to make them love me, why couldn’t they show me they loved me?’ My therapist over the months helped me see that they simply couldn’t. That I was enough. Yes they let me down and neglected me (and emotionally abused me) but it was because of their failings and shortcomings not because of anything I did. It wasn’t enough for me to know they’d had tough childhoods – i was brought up knowing this but it made no difference to me. It made me angry that they knew this and still didn’t fix things. But realising that they don’t know how to fix things helped me – I don’t know if this is highly un ‘PC’ but here is the analogy that my therapist used which completely fits for me – ‘You wouldn’t blame a person who has no arms for never hugging you… you wouldn’t get angry at a person who doesn’t speak English for not understanding you… for your parents it wasn’t a choice they made, that’s all they have to give, it just wasn’t enough for you.’ I really get it when explained like that, it helped a lot. I wish someone had shown me this understanding when I was younger – it would have saved me many years of self blame. Maybe also try some mindfulness meditation with your kids – that’s also helped me and I now do it every day with the ten year old kids in my class that I teach.

      Good luck to you on this journey, sounds like you’re already doing a great job.

      1. SJ, I feel similarly. Your post was very helpful. Our Narc parents went through hell as children, it’s likely. I don’t think “they loved me but couldn’t show it” is right. Quite often my parents showed that they were aware of their cruelty, which was most of the time by design (emotionally.) They did take care of my physical needs exceptionally well. I forgave them with a lot of effort and dedicated research on the subject. My mother is 90 by we have almost no contact. I’ve learned a lot about my own self and my strength in this journey. I survived. I SURVIVED and I’m not being corroded by anger. What a reward, what a gift. I’m better off now than before the final crisis…. Maybe pain has a purpose after all.

  4. Your narrative sounds right and makes a person’s reactions in a situation seem comprehensible. It is easier for the reader to visualize.

    My concern is when you say: “I eventually suggest to MacKenzie that she had previously felt herself growing attached to me and our work together; afraid that she’ll become emotionally dependent upon me, she is now becoming more self-sufficient, more like a therapist herself, and pulling away from me. She seems surprised by what I say and acknowledges that she has been thinking about discontinuing her therapy. I point out the analogy to her relationship patterns.”
    It would be helpful to know the time frame of “eventually,” Is the timing and method of revealing such a heavy truth person-specific? I would imagine that, for some, if you said those things to the person, they would immediately flee therapy. Hints on how to reveal these truths to the patient would be helpful.

    The other question I have is, do you believe knee-jerk reactions based on previous abuse are always narcissistic?

    1. Since this is a fictional client, it’s hard to answer your question about “when,” but in my experience, clients don’t flee therapy when you point out something like this. It makes sense to them when you explain that a therapy relationship, though different in important respects, is still a relationship, and many of the same issues that crop up in “outside” relationships are like to occur in the context of psychotherapy.

      I’m not entirely sure what you mean by your last question but I would probably say ‘no.’

  5. Hi, I am glad you made reference to the workplace with the clients background. I searched your articles for more on how we create a dynamic similar to our early family structure. Working in the Corporate environment was a catch 22 for me. I eventually burned out trying to receive what I needed from childhood from the higher ups and could not accept or believe how much I excelled and asked for more responsibility and harder assignments. I needed to be perfect but, couldn’t accept their praise that I was exceeeding expectations. Perhaps Never receiving praise as a child convinced me it was not possible but, I needed it so badly I couldn’t stop pushing myself. An addiction gone wrong? My sister is in a profession that is a skill and involves creativity. She’s very good with her clients and as a result she draws in more business. However she is highly sensitive to making any mistakes to the point of obssession. When the peace of her coworkers is threatened or her own feelings of doing good she falls apart loyally sticking to her appreciative employers but, lives in agony all the time getting very angry that there are disturbances. I don’t know how she gets such awful trouble making work mates. I do know she feels responsible for their behavior and protects anyone being attacked by injustice or harm. I am exactly the same as what I have described in the workplace drama.

    Because our early childhood experiences are so powerfully dynamic they seem to play out in the work place inevitably recreating trauma and pain.

    Is there any chance you would consider in the future writing about these dynamics in an article. I would appreciate understanding how to stop sabotaging myselff in the workplace and being free from the fear of going to work, the dread and the pain it creates with clients, workmates and authority. The measurement of my work is extremely painful. Why can’t I just be mediocre and retain energy for my personal life?

    Thank You for your articles I always appreciate reading them and your database of related material.



  6. Hello Dr. Burgo. Through the arc of therapy it has become clearer and clearer to me how my past narrative informs my present reactions. The emotions and suffering and pain involved during this process of discovery has been surprising to me. Maybe some people don’t go through quite as much agony as others. You eluded to the fact that your fictional client getting close to you became a trigger to release these patterns into the therapy. Forming a relationship with a therapist creates the laboratory where this narrative you speak of is formed and tested and tried and hopefully rewritten. Recognizing the narrative part seems easy to me. The risk of doing something different, trusting in the relationship formed in therapy and hanging in there (and actually rewriting that narrative in my heart and head) has been the incredibly challenging and amazing part.

    1. “Forming a relationship with a therapist creates the laboratory where this narrative you speak of is formed and tested and tried and hopefully rewritten.”

      Very nicely put! And yes, rewriting that narrative is incredibly challenging.

  7. A useful post J; I’ve forwarded it to a client who’ll likely benefit from reading it. After doing whatever individual treatment is necessary, I always rely on extended weekly group therapy in a CBT/Interpersonal style. Experientially re-living these basic themes usually gives clients an opportunity to change their perceptions and habitual avoidance of intimacy. It usually takes 18 to 24 months for folks to realize there really are trustworthy people who’re safe to become emotionally close. Dr Bob

  8. Hi again Joe, I wanted to wish all those who share on this site a warm , cosy and loving Chrismas….thank you Joe, for being so open, real and honest. And thank you to all these amazing people, who share their pain and struggle towards healing..

  9. “The question for the reader, as it is for my clients, is whether the narrative “feels” right and helps make the person more comprehensible. So often when the media and even professional psychologists write about the celebrity narcissist, they write about them as entirely “other,” suffering from a specific mental disorder that conforms to diagnostic criteria defined by the DSM5. In constructing a narrative about these celebrities, I instead try to make sense of their behavior and personalities, to make them seem less “other” and incomprehensible, more like people who become more understandable once we step into the life narrative that shaped them.”

    An absolutely fantastic final paragraph that would have made the post worthwhile on it’s own (although I love the acknowledgement that psychotherapy doesn’t “prove” anything in the scientific sense (at least strictly speaking, if you really want to go down that road we don’t know the sun will rise tomorrow and science is all about men in white coats rather than the refinement of everyday thinking and mastering basic empirical reasoning which I would submit is what science is really about but anyway.

    I absolutely love the idea that psychotherapy is best used to increase our understanding of others and by extension our sympathy and compassion for them. If you ever read Ender’s game there’s this idea that truly understanding others makes it impossible to hate them which I think is a beautiful idea. (correct me if I misinterpret your position)

    On a purely narcissistic level this validates my decision to read your blog regularly as I sensed straight away that you had a next level kind of insight and judgement so I’m really pleased that I was right. 🙂 how mature :p

    1. Ender’s Game is one of my son’s favorite books and now I have even more reason to read it. I definitely agree that when you truly understand someone, it’s impossible (or at least extremely difficult) to hate them. I believe people aren’t born intrinsically evil but are sometimes made that way by life experience. Everyone suffers.

      That being said, the more sociopathic a person is, the harder becomes for us to understand them because their humanity is so hidden from view, inaccessible to themselves or to us. It takes a lot of work to understand these people and sometimes you have to ask, why bother?

      1. Definitely worth a read! Your son has great taste! 🙂

        Yeh, I can see why people hate certain people for sure, like recently a singer in a British rock band was arrested for trying to have sex with babies and managing to convince some of his female fans to abuse their children for his own gratification. Now this is obviously an extreme example but even for someone “professionally compassionate” like yourself it’s going to be hard to try and REALLY empathize with this guy and you know, REALLY understand why he felt driven to do the (indubitably horrible) things he did. We could talk about childhood trauma and all that but on some level we recognize that many people have hard childhoods and not many of them become truly malignant and evil.

        Even if we saw the intellectual argument for empathising with someone like that (and I’m NOT saying we should) it might be too painful or distressing for us to think like that even for a moment.

        So really I should say, the more you know about others, the easier it is to empathize with them and the more naturally the position comes, but that doesn’t mean you’ll be able to (or should) ALWAYS empathise with others and some people are deserving of hate.

  10. 60 yr old desperate daughter of narcissist mother …have studied everything, short of going to psych. School … Read everything, consulted , tried any method to erase memories of 6 decades of loving subjugation, on my part. What WORKED? A friends referral to an Acupuncturist who treats me for grief. Immediate relief to rumination. AND something called EMDR, with progressive relaxation. Must share. Good Luck!

  11. Expectations. Lower your expectations of yourself and your performance and acceptance will rise. Lowering self-expectations takes time and effort, patience and practice, but it works miracles. It’s like a new world.

  12. Re your client, of whom you wrote….” I eventually suggest to MacKenzie that she had previously felt herself growing attached to me and our work together; afraid that she’ll become emotionally dependent upon me, she is now becoming more self-sufficient, more like a therapist herself, and pulling away from me.”

    No. I don’t believe that’s what she’s fearing. She’s fearing that she’ll become emotionally dependent on you, and that you will disappoint her and fail her. And frankly, you can’t really assure her that you won’t. Her belief is not necessary pathogenic. It may well be grounded in her true history. In fact, she has a point from the outset. Because it is a therapy relationship, it is doomed from the start because it will have a hard ending at termination, where neither the therapist not the patient knows what happens with each other after the relationship is over. Now, that’s a built-in disappointment.

    Basically, all the therapist can say to the patient is, “Well, that’s just a chance we both have to take.” But the therapist’s chance-taking is less risky than the patient’s. As long as the patient pays, the therapist’s risk is largely gone. And if the patient doesn’t pay for a few sessions, then the patient is gone, too.

    1. Yes, from a slightly different perspective, everything you say is true (and those are things I myself have said). The bit about her fears of disappointment being grounded in the reality of her childhood seems especially true. In a way, why SHOULD she trust me?

  13. Hi, I hear myself and my therapy history in SJ’s comments…to a point. However, 3 years into individual therapy, I am stuck in the extremely dependent, thinking about my therapist daily (ok, honestly, many times a day), wanting very deeply to have on-going interaction with him, checking email numerous times a day- though I know he is unlikely to reply to my emails unless it’s appointment related- in the past he told me it was ok to send emails. Write as much as I want to him. The thought was I have battled depression, been in and out of “remission” as we call it, and writing can be healing. Sometimes my emails are more like journaling. Often, though, I long to know he is out there, and hears me, and “gets” me. It reminds me of your blog post about Bearing Witness in Therapy. I appreciated reading that posting very much.
    My distress is feeling stuck in this intense longing for connection, affirmation, attention, acceptance stage….
    We have talked repeatedly in therapy about my past issues of loss, and perception of abandonment. Though in my head I understand, (I do minimize my losses, and think, “wow, this reaction is quite excessive for the minor losses I have had in life”) I feel extremely sad and lonely and hopeless when I Know that he is not really available to me for connection.
    Somewhat confused rambling, I am trying to say I feel similar to the clients you have written about, and to SJ’s early therapy experience. But I am not progressing.
    So, I guess I’ll keep trolling the blogs looking for answers…
    sign me,
    feeling too dependent still…

    1. I think you’ll find the actual “answers” in your relationship with your therapist. I hope you tell him about these feelings and that he discusses dependency and unbearable neediness, etc. in the context of the transference.

  14. Dr. Burgo,
    I am enjoying your blog so much. You are writing about topics that need to be brought out into the light and your voice is authentic, intelligent, and kind. I would like to share a bit about my experience of therapy.
    I was fortunate to find a ‘good enough’ therapist especially since like so many others, I did not have a ‘good enough’ mother or father. This therapist helped me profoundly, despite his limitations and failures. For me this is so good to know: that we don’t have to be anywhere near perfect to make a difference. Although he had some narcississtic tendencies and areas that he did not seem to want to explore, he also had good intentions and skill. In a therapeutic relationship with him after a half dozen years, I let go of the self-hatred that my mom had given me and that had gripped me all of my life (50 +years). And I replaced it with compassion: compassion for having developed avoidant defenses in order to survive and feel safe. And for the fear, loneliness, grief, shame, and despair that being hated by one’s own mother engenders. There is no better feeling in the world than to no longer torment oneself with self-hatred. I also was able to feel compassion for my mom, since she also had all of those feelings but wasn’t able to get the help that she needed. And I felt compassion for my therapist who despite imperfections cared enough to make a difference.
    Thank you for the opportunity to post on your blog and I look forward to reading more of your work.

    1. Hi Linda! Thanks for telling us about your experience. Given all the bad therapy out there, and all the criticism of professionals in my field, it’s nice to hear about such a positive outcome.

    2. Linda,
      I just discovered your comment and immediately felt better about my therapy. I so often feel that what I am doing is pointless, that I will never get past my self-hatred, which, as with yours, was the product of my mother’s hatred and rejection. Your words give me hope that I will someday be able to feel self-compassion, and maybe it will take six years, or more, to get there. Thanks for the hope.

  15. what was wrong with your therapist, his “failures”, etc? It would help us to identify that kind of professional. You mention it sooooo many times.

    1. He was pretty darn good, especially in his ability to deal with my difficult emotions. But he was wedded to a particular theoretical point of view that prevented him from fully understanding me.

  16. Deb, it is totally unethical for a professional to continue therapy with a person that s/he knows has feelings for him/her that go beyond the strictly professional arena. So, to begin with, if this man doesn’t dismiss you, you should move on and look for someone else, preferably a woman. The stage you are going through is not uncommon. We all tend to love those who care for us, or appear to care for us, particularly if we have abandonment issues behind. So, don’t torture yourself for something common, though unhealthy. You are trying to be healthy and not getting entangled in potentially legally dangerous situations. Many of the answers you are looking for now will come with the master of therapy: time. After many decades of all sort of therapies and a comfortable financial situation that affords me many specialists, I learn something new every day. Crises come and go. Keep searching, but accept what it is at this time. Kind Regards, Sol

    1. I disagree. The erotic or infantile transference is a central part of psychoanalytic work and a tool for exploration. It’s only therapists who take those feelings at face value, who don’t understand the transference and get sucked in that wind up behaving in an unprofessional way.

  17. It is very difficult to know what to do to break these kinds of patterns.
    Somehow, I always become involved with “unavailable” people. That means I’m unavailable, too!
    I will end a relationship when I can’t give anymore, or if it just feels like a dead thing. Ended therapy after a year & a half; the therapist never gave any hint if anything was actually happening, and I begged her for feedback.
    I need help, but everyone assumes you already know how to have a relationship—I don’t!
    What do you think?

    1. Sounds like you ended up with an “unavailable” therapist. I’d try again with someone who will be more emotionally present and challenge you on your own “unavailability.”

  18. Dr. Burgo,
    I hope you are well and that your absence from your blog is due to pressing publishing matters and not any other kind of trial. I just wanted to comment on your remark that MacKenzie “might try to be brave, bear with her fears and not run from intimacy.” Where does bravery come from? It and “courage” are words you use in WDIDT, and every time I read them I wonder how essential they are to change and where they come from. Do you assume that bravery and courage are attributes that everyone has, regardless of their circumstances? Are they essential to growth, and if so, what do those of us who don’t have much do about it?

    1. Yes, I think everyone is capable of bravery. Courage means pushing ahead when you’re scared sh**less or full of dread. I think you can work up to the big challenges slowly, building endurance as you go along.

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