I just hate myself.
She practically spat those words at me during our intake, when we were sitting across from each other, going back-and-forth, engaging in the typical therapist question-and-answer banter. She didn’t have a defined therapy goal or objective, and even though she was referred to me for her debilitating substance use, she didn’t have much to say beyond that very sentence.
I just hate myself.
Low self-esteem was an understatement. She could not produce a single attribute she liked about herself. She could not endorse a single moment she had pride in.
I just hate myself.
There are some clients that tug at your heart strings, that you think about in the middle of the night when you can’t fall asleep, when your thoughts flow through you with a rampant energy. You think about what they’re doing- if they’re safe- if you’re even helping them at all.
We had so many sessions together. On the surface, she did what she needed to do. Abstained from drugs and alcohol. Took her depression medication and visited her psychiatrist. Practiced her positive coping skills. Decreased her isolation. Denied any suicidal ideation or plans. She even took up yoga. On paper, she was technically progressing. Off paper, however, she would continue to state, as if to taunt the both of us, I still hate myself.
My desire for her to do well was insane. I believed in her more than she believed in herself. My all-knowing graduate school professors’ voices loudly echoes as these thoughts emerged. You can’t want it more than your client wants it. You can’t do the work for her.
This is easy to logically understand. We cannot change other people and we cannot make them do or feel anything. But humans do not run on pure logic alone, and I had to work at maintaining professional boundaries and my own emotions in check. I didn’t want her to hate herself. Why did she have to hate herself so badly?
Therapists have codependent desires, too. Strip us from our fancy chairs and degrees, and we’re incredibly imperfect people.
Still, I believe there is nothing more sacred in this universe than the intimate understanding that someone can wholly embrace you for who you are and isn’t afraid to say it.
I made it a point to tell her as often as I could that I was proud of her. That she was brave, amazing, awesome, incredible, or whatever word felt fitting in that situation. She couldn’t give herself positive affirmations, so I gave them to her. She couldn’t give herself the gift of gratitude, so I did it for her. Was this codependent? Possibly. Did it help? I believe it did.
I never acted with inauthentic hollowness- that would have been a disservice- but I made it a point to demonstrate why she mattered.
Most of the time, she scoffed and laughed at my compliments. You have to say that. You say that to all your clients. But after awhile, she started thanking me. And sometimes, she cried, because the words felt so jarring and uncomfortable to her, because she was embedded in an internal world of contempt and self-loathing, because she didn’t believe she deserved them.
She had no identity outside of hating existence and hurting herself with destructive thoughts and behaviors. We had to discover who she was together. This is why therapy is beautiful. I have the privilege of witnessing layers unfold and insight connect; I get to watch people play with the meanings of their worlds and redefine why they are living. I work to remind people that their existences are far greater than any sum of their presenting problems.
My client was a whole person, beautiful and complex and tragic wrapped into one evolving personality. She came to therapy armed with labels and diagnoses, and while those logistically mattered, they never did and never will tell the complete story.
We miss the essence of raw humanity when we rely on generalizations.
My acceptance for her felt foreign. It feels foreign for a lot of my clients. She was more comfortable with rejection and abandonment.
My individual therapy looks different in each session, but this a concept I do not waver on. My clients cannot and do not disappoint me, and I will do everything in my absolute power to provide them a space opposite of rejection and abandonment.
They are allowed to disappoint themselves, their parents or loved ones, and the rest of the world. And they will. Time and time again. Nobody enters therapy because everything is going well and they just need to brag about it.
But a client cannot disappoint me no matter how hard they try. And this client tried- she would miss sessions, blurt out outlandish and insensitive statements, scream and yell, relapse into old ways, do the opposite of what she said she was going to do.
She unveiled her vulnerability in all of its variations.
She wanted to push me away. She could not believe that she was worthy of my sustained attention. The world, she believed, had already given up on her. And this wasn’t all wrong. Most people were sick of her sickness.
When clients live entrenched with abandonment and trauma, they frequently sabotage and repel their interpersonal relationships by shielding themselves with perceived brokenness.
She starved for the consistency and stability I could provide, but absorbing it terrified her. In a life summarized by utter chaos, she couldn’t handle the calm.
Most of our therapy surrounded by my one goal of showing her that she was worthy of unconditional acceptance. I reminded her that she couldn’t disappoint me. Over and over and over again. I continued emphasizing I would be there for her and support her no matter what decision she made.
When we know someone is there, when we can feel it in the depths of our souls and bones, the desire to escape ourselves dissipates. We feel understood, but beyond understood, we feel connected and we feel loved.
Elie Wisel once stated, The opposite of love is not hate, it’s indifference. I have my own variation:
The opposite of being loved is not being hated, it’s being misunderstood.
She made sizable progress, as clients do once they want to, and once she reached a point of mental stabilization, she concluded therapy. We had transitioned from, I just hate myself to I’m not that bad. It wasn’t a miracle, but I could take it.
When she called me months later after a debilitating relapse, she spoke only with fear, with mental paralysis at the thought of collapsing back into an eternally dark abyss. I hate myself, I hate myself, I hate myself. She repeated this mantra, laden with sorrow and anguish and shame. The same negative feedback had returned, leaving her in an excruciating state of defenselessness and powerlessness.
It’s not that she didn’t make progress. It’s simply that those insidious thoughts of worthlessness and incompetence strike the hardest when we are fragile.
Desperate to help her, I asked her if she could come to my office the next day. Unfortunately, on an impulse whim, she had moved across the country.
With that, I listened to her cry. And I told her that her life mattered, that she mattered, and that regardless of where she was or how she was feeling, I would never give up on her. I reminded her that she was worthy of unconditional acceptance and healing, but that until she believed it- truly, truly believed it- she would likely continue harming and sabotaging herself and living in her anguished purgatory. She would continue living as a slave to her own misery.
I told her to call me the next day.
She said she would.
She didn’t, and I never heard from her again. I don’t know if she’s safe. I don’t know if she’s alive. But I do know that whatever happened, happens, or will happen to her, I still accept every part of it.
*All reasonable efforts have been made by this writer to protect utmost client confidentiality. Because of this, names and identifying details in this piece have been changed, omitted, and/or embellished.