Confessions from the therapist
Note from Marla (May 2025): I wanted to share something from the front lines of real therapy — the kind that doesn’t always unfold neatly, but still matters. This moment stayed with me, and I suspect it stayed with the family too — even if I’ll never fully know how.
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I had a session recently that didn’t go the way I wanted it to. I lost my cool. I went head to head with a father in a high-conflict family system, and by the end, I told him I could no longer work with him. I ended the session early, told the group I was done, and followed up with the clinic to formally withdraw from the case. It was the kind of moment that would’ve haunted me in earlier years, but this time, it became something else entirely.
In the moment, it felt like a rupture—raw, uncomfortable, and deeply personal. But when I step back, I see that what unfolded was a kind of therapy that doesn’t always get celebrated. Not the quiet, perfectly regulated version we’re taught to model. Not the style that keeps everything in check so the client never sees our humanness. What happened in that room was psychodynamic therapy, the kind that doesn’t sit safely in theory but erupts through enactment.
This day, I didn’t perform neutrality. I didn’t cushion the truth. I went head to head with a man who had been dodging accountability for months. His daughter had once again tried to bring something real into the room, and once again, he dodged, deflected, and derailed. I stayed with him. I stayed on him. I didn’t raise my voice, but I didn’t back down either. I matched him, not to fight, but to show what was happening. And when he pivoted into something darker, a subtle, calculated threat that questioned my scope and professional legitimacy, I ended it. Fast. I told them I was done. I said, “I really like you both, but I can’t work with him. He is too dangerous for me professionally.” Then I ended the call. Abruptly. Not because I lost control, but because I refused to keep playing a role in something that was already beyond the bounds of what’s ethical, honest, or safe.
This is psychodynamic therapy. Not the version people read about. The real thing. Sometimes it’s quiet, an unconscious pattern that slowly comes into focus over months of work. But sometimes, the whole thing detonates in real time. The transference, the defense, the reenactment—it all bursts into the room before anyone can pretend otherwise. That’s what happened here. And even though it shook me, even though I ended it mid-session, I believe they got to see it. In that one volatile hour, the family dynamic that’s kept them stuck for years played out with nowhere to hide.
What’s hardest, and what I’m still learning to accept, is that I may never know what comes of it. This isn’t the kind of work that always gives you a glimpse into the ripple effect. I left the playing field mid-game. I don’t know what the daughter took from it, what the mother absorbed, or whether the father, somewhere down the line, replays the moment in his mind. There’s no follow-up, no resolution. Just a rupture, a truth exposed, and the therapist stepping away to protect herself. That’s the reality of this work sometimes. We don’t always stay long enough to witness the transformation, but we leave something behind that makes it harder for people to keep pretending.
This work doesn’t always look good. It doesn’t always feel clean. But when it breaks open, and we name it—even when it’s messy—something shifts. Something gets seen. And sometimes, that’s the most honest thing we can offer.