A STORY OF BETRAYAL ~ I Lost My Balance and Fell

by Martha Stark, MD / Faculty, Harvard Medical School


Dr. Mary Nelson is a PhD psychologist whom I have known for a long time.  Many years ago, Mary came to me for a one-shot consultation – at which time she presented with many borderline features and a dreadful early-on history of multiple traumas.  But most striking was Mary's desperate desire to get better.


Twelve years later, Mary returned to me for another consultation, reporting that in the interim she had been in treatment with a superb clinician, Dr. Rose, with whom she had worked intensively for 10 years – and whom she still saw intermittently.  They had done extraordinarily good work – they were obviously an excellent match and deeply committed to their work together.  Over the course of the years, Mary had gained considerable insight; had learned to tolerate intense affect and internal conflict; and, over all, had developed a much more solid sense of herself and her own capacity.


But Mary reported that her world had been shattered when, eight and a half years into their 10-year treatment, Dr. Rose had announced that in six months she would be returning to school for several years of postgraduate education, a time-consuming proposition that would require of Dr. Rose that she cut back on their sessions from twice a week to once a week and, more generally, that she be less available to Mary between sessions.


Dr. Rose and Mary did the best they could to plan for the disruption to their work.  But once Dr. Rose's rigorous training program began and she found herself consumed with her many new clinical responsibilities, Mary began to come undone.  In her desperation, she frantically reached out to her therapist for help – just as she would have done in the past when in crisis.  Dr. Rose attempted as best she could to respond to Mary's pleas for help but eventually, as Mary's demands continued to escalate, Dr. Rose – simply unable to devote either the time or the energy – became more and more defensive, angry, and withholding.


Dr. Rose told Mary that she would need to face the reality that Dr. Rose could simply no longer be available to Mary in the ways that she had once been; she suggested that Mary's relentlessness spoke to Mary's refusal to confront the reality of this – and that Mary needed to let go of her unrealistic expectations. 


But Mary, unable to contain either her devastation or her outrage, had had 10 hospitalizations over the course of the next year (for alcohol and drug abuse and, sometimes, suicidality) – amazingly enough continuing, all the while, her private practice of psychotherapy (admittedly with frequent interruptions). 


It was in this context (and with the blessing of her therapist) that about six months ago Mary – broken, frantic, enraged, confused, and desperate – returned to me after twelve years for a consultation, which has become an extended evaluation.  Although Mary is in a rage at Dr. Rose and in excruciating pain, it has been obvious to both Mary and me how much she has grown as a result of the hard work she and Dr. Rose did together. 


In our work, it has become clear (over time) that Mary's outrage at this point has to do not so much with the fact of Dr. Rose's decreased availability as with her refusal to acknowledge that she is no longer emotionally (and lovingly) available in the ways that she had once been.  Whereas Dr. Rose's interpretive efforts are directed primarily to Mary's relentlessness, Mary's enraged protest is that what she most wants is for Dr. Rose to relent by admitting that she (Dr. Rose) is no longer as invested in Mary.


            In Mary's journal, she writes of her heartbreak as follows: 


I remember your telling me that it would be safe to deliver to you what I feared the most.


I remember your saying over and over again so many times, "I'm not going anywhere; I am here to see you through all of this."


You said I would never again have to cry alone. 


You made the space between us so safe that I could deliver to you what so badly needed to be said and experienced. 


You wrote me notes that I could carry with me if I forgot that you were there. 


You said I could call, especially when the pain got to be too much.


But then came all the changes.  I lost my balance and fell. 


All of a sudden I couldn't hold on to you anymore.  And the depression and the terror went so deep that I kept ending up in the hospital. 


People didn't understand why I couldn't just leave my therapy.  "Simple," they said.  "If it causes pain and it isn't working, then leave!" 


But I couldn't forget how it had once worked.  I couldn't forget about all the time, the energy, and the effort that had gone into our therapy. 


But now I can't find you anymore.  I don't know who you are or where you went. 


I have pulled inside and don't reach out to you anymore.  And you don't lean forward in your seat to listen to me anymore. 


I do cry alone – I cry because of all the pain.  You promised that you would always be there for me, but you aren't. 


I am so worn out and panicked that you, as I knew you, are never coming back. 


I tear apart inside trying to get back to the place where we once were.  I keep trying to find you but you are not there.  I cry out – but you no longer listen.


I am broken and my heart is shattered. 


Are you gone from me?  Trust me, this is not something casual – this is something so serious.  It is the core of the work that needs to be done – but you are nowhere to be found. 



I believe that, at lest in part, it is Dr. Rose's refusal to acknowledge her change of heart in relation to Mary that is responsible for shattering Mary's heart – not simply the fact of Dr. Rose’s change of heart.