Clients who can't be helped

We know – or could be very confident about – which of our clients will make no progress in therapy. I broached this subject several years ago, in a discussion of one client population I named “pathetic.”* Including and beyond that group, let’s see if there are any generalizations that could prove useful.

In “Pathetic,” the principal idea was that there are people who have not grown well into their adult self-medicative persona, which is where most of us live. Nothing moved or “convinced” them, so to speak, to ascend beyond childhood immaturity as their basic approach to life. While almost all of us have a hegemonic “inner child” (our stagnated psycho-development) that misdirects us to self-sabotage and leads to depression and the other psychiatric disorders, we have implicitly opted to live a somewhat independent life. We have written off the neediness of our “child.”

To amplify: The so-called pathetic and unhealable individual has remained constricted in childish feelings, needs, symbiotic-like attachments to parents and later to their replacements. This state will often reflect in his or her facial expressions which may be whiny or mopey or helpless, or in her lilting, wounded and youngish voice. What makes these individuals impervious to help is that to heal significantly from our childhood, we have to be bigger than our child. We have to desire to live on the somewhat elevated plateau of the adult life, knowing this means not just some distance from toxic parents, but a qualitative rift between us and them; and a desire or resignation to be self-supporting. The sad irony here is that these desires, which must be visceral, to move on do not produce any actual evolution to maturity. They simply form a compart­mentali­zation of child and adult where, when the moment of truth comes, when we are struck in the heart with our early, formative and critical pain, we collapse on the adult side of the divide. We have essentially given up hope for those parents to nurture us.

This will be the primary impediment to healing in our clients: They remain children. We cannot ask or expect children to undermine their critical attachments or to grow up, whether they are five or fifty years old.

There are other populations who have so grafted their self-medications into their character that they will never seriously question them and will never reach the pay dirt of feeling process. These behaviors include long-term substance abuse, the euthymic (fake happy) band of defenses (smiles, laughs, the false helium of a bright attitude), the intellectual who lives in cloudy thought because the ground is sharks or snowstorms, a parent’s conviction that he is by nature righter than his child, the ADHD-based “deliberate inability” to sit still on a feeling, and more. These clients would otherwise grieve deeply, exorcise fundamental pain on the principle that people change when they feel different.

Therapists would like to believe that almost everybody can be helped. When we put our wishful thinking aside, we’ll see more clearly that certain clients never really hear us, “feel” us. Others will always remain physically and psychologically in their parents’ home, or will believe in the incantation “forgive,” or will simply not want to look at them­selves, preferring “coping skills.” These clients will not change, though they may claim to have profited from therapy.

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* https://pessimisticshrink.blogspot.com/2015/04/pathetic.html.