Continuation vs Termination

A patient in her 30's entered therapy with Major Depression and PTSD. Her background history includes emotional parental neglect and sexual abuse by a neighbor in childhood.

Her manner of presentation suggests very low self esteem, and she has struggled with a power imbalance in her marital relationship. She has intense unmet childhood needs for nurturing, yet has strong resistance to it because of past disappointments. It is extremely difficult for her to trust.

She is very intelligent and is able to intellectually grasp how her past is affecting her now. She always shows up for her sessions and works incredibly hard in them. Yet she seems unable to let go of her self-blaming tendencies and wilingness to be victimized in her relationships. She has difficulting regulating emotion and under extreme stress tends toward wanting to self-harm.

She has been in therapy 2 years now, and has made alot of effort and some forward movement. But she seems blocked by feelings of shame and difficulty trusting, so that she cannot fully work through her issues but remains "stuck," particularly when it comes to letting go of self-blame and putting blame or responsibility where it really belongs. In addition, her fear of change and the upset it will bring to her life and relationships (marriage) is also contributing to her unconscious resistance and keeping her from moving forward more quickly.

She seems to truly want to change and improve her life. But considering the time spent in therapy and the anxiety and stress she continues to feel over change, a question has arisen over whether or not the therapy sessions are adequately addressing her needs and helping her move ahead in her life (get "unstuck.")

A discussion of possible referral to a therapist with more experience (rather than a LCSW) brought up tearfulness and anxienty, as it triggers her old abandonment issues. She said she would rather quit therapy than start all over with another therapist. However, she also said that after this much hard work and progress, if she stops now, she will never feel good about herself again.

She says she wants to continue therapy and is willing to do whatever she needs to in order to heal.

Any suggestions are certainly welcome.

Replies:

A few ideas, by Jim Pretzer, 06/07/02 Re:Continuation vs Termination, by Sofia Rocha Coutinho, 06/22/02

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