Dependency in Psychotherapy
Dependency and independence represent one of the fundamental issues which we as psychotherapists and physicians must struggle. There is a fundamental conflict between our dependence on our patients for our livelihoods, and our duty to encourage their independence and self-reliance, which I think is not acknowledged enough. This issue can be most easily appreciated in the context of long-term, insight oriented psychotherapy, but can also be noted in the context of other therapeutic modalities including psychopharmacology. I have seen situations where a patient is doing well, and has voiced a desire to withdraw from therapy, or perhaps has begun missing sessions, which are interpreted back to the patient as an unconscious treatment resistance which requires more therapy to overcome. While in some cases this may be an appropriate diagnosis, I also believe in many cases this represents treatment success, and is an indication that the patient is ready to attempt either a therapy or medication wean. I believe as therapists we need to be aware of our own needs (financial, psychological) which drive us to attempt to maintain a therapeutic relationship past the point of diminishing returns for the patient.