This was a response I'd written to a chapter for my Psychology of Personality class.

Defending Neurosis, The “Easy” Client 

I saw two counselors at John Jay before I was kicked out of the counseling program.

Every year, I’d unwillingly start with a new counselor (as my symptoms were never severe enough to warrant attention from a senior counselor, so I was passed around by externs), but recognized that I did not have “real” problems, so I would acquiesce to the demands of the program. I was not a client in crisis, therefore, I would no longer be accepted a client. There were others that needed more help than I did. “Picture an emergency room,” I was told. “There are people having heart attacks. And then there’s someone with the flu.” You can still die from the flu, I had thought, it just takes longer, and people tell you you’re not that sick.

This idea of the emergency room resurfaced as McWilliams praised the neurotic patient. They will establish a working alliance with their client. They will uncover unconscious defenses, feelings, beliefs, fantasies. They can handle “aggressive focusing” on a conflict area; in fact, they may benefit from such pinpointing, these high-functioning clients who aren’t as sick as the others. Any therapy will be helpful to most clients in the neurotic range – they’ll cooperate because they know how. They’re good advertisements for therapy. They are the Easy Client. And it is selfish to solely treat Easy Clients. Real people are sick. Easy Clients can get by without you. (And if you are an Easy Client, I found out, you can get by without your therapist.)

I recognize my own biases in the response to McWilliams’ writing; obviously, she was

merely drawing a contrast between the neurotic, psychotic, and borderline clients she had seen. Still, I was bothered by the othering; in these chapters, neurotic clients were the “normal” she would make comparisons against. McWilliams had said psychoanalysis takes years; while my original questions were about when someone was “finished” with therapy, now I wonder what happens when the therapist decides for you that you are finished. Are there other circumstances when you are allowed to terminate therapy besides a gross violation of boundaries (or do you continue to treat someone after a gross violation of boundaries, with new limitations)? If I had been a borderline client, rather than a neurotic client, would something have changed? Would I still be seeing a student from Columbia finishing their externship, or would I be seeing a senior counselor? How far up the flagpole would I be referred to higher levels of counseling (externship student to a senior counselor) before I could see someone who would suit my needs? Does a borderline client count as a client in crisis? Does a psychotic person? If I had lost my observing ego, the ability to notice I was projecting, would I still be considered neurotic, or does this mean I am losing touch with reality? Is there an arbitrariness to the labeling process, not specified in the DSM? If the DSM has a categorical approach, do these labels work the same way? What about being a client in crisis? How many symptoms do I need to be considered in crisis?

In Chapter 5, Patient A apologetically explained to her therapist “‘I know I have no

reason to believe you’re critical of me, but I can’t help thinking that you are.’”

The confession mirrored words I had spoken myself to my counselors. I am the woman who is invested in staying anchored in reality and feeling “less crazy by inducing in someone else” the feelings I’m convinced they have. A psychotic woman does not care about the “fit”, so there is no pressure to confirm those feelings.

McWilliams spoke about how confusing it can be for the therapist – where does the patient’s defense end, and the therapist’s psychology begin? If the therapist is confused, though, wouldn’t it make sense for the client to share in that confusion? Is the neurotic patient allowed to be confused, if they have this ability to utilize their observing ego? Don’t you think that at points I was confused in therapy? Was it too much to ask of my therapist to help me work through this confusion?