Where is the line between required effort and limitation? How much are we really capable of?
Clinicians possess a host of concepts for treatment, which also, maybe unsurprisingly, protect them. We say a patient is resisting when they reject a hard truth about their patterned way of responding to the world, which, if acknowledged, makes us appear right and right if not. We call it projective identification when we're "made" to feel confused, angry, and lost in our sessions. We describe the patient as self-sabotaging when they tend to find ways to ruin their relationships. And we label patients as treatment-resistant if our efforts persistently fail. Yet, all of these ideas hide an inconvenient and disabling truth: Sometimes, we just aren't that capable when we might have been.
As with other therapists, I chronically wrestle with how much responsibility I ought to take with a treatment's failure. And I'm damned if I do and damned if I don't. On the one hand, if we don't accept our limitations, we're self-important, believing that we should succeed where others have failed. On the other, we cast off all of the responsibility to our patients, blaming them, or at least their disorders, for the lack of any progress. Here's how the process usually goes: Therapy begins with some........