The therapist’s dilemma: connection, drugs, hospitalization


Susan is a patient of mine, 55 years old, single and never married. I have been treating her for five years and see her frequently 2-3 times a week. She is also the artistic director of a prestigious New York gallery and an accomplished artist.

She grew up in a very violent upper-middle-class Jewish family in Riverdale, where she was verbally, emotionally, and physically abused by both parents on an almost daily basis. It was not uncommon for her father (now deceased) to throw her down the stairs while her mother stood there, encouraging him to hit her harder. The family secret was well kept. No one knew what was really going on behind closed doors. Susan has a younger brother, who witnessed these devastating events over the years. He hid in his bedroom and blew up his stereo in an attempt to escape the family drama. Interestingly, even as an adult, he never came to his sister’s defense and, in fact, invalidated all of her abuse allegations, just like his mother.

Despite her desperate situation, Susan was an excellent student and was able to obtain a scholarship. She suffered from severe suicidal depression and anxiety and comforted herself by regularly consuming gallons of chocolate ice cream. His social life was practically non-existent. His only childhood girlfriend was Penny, a model child, whom his parents adored. They continually reminded Susan that they wanted her to be like her friend – pretty, popular, and smart. How Susan was able to endure an entire childhood of abuse without any support from family or friends still amazes me to this day.

Susan first saw a therapist in her early teens because of “severe stomach pains”. However, the abuse was never revealed in therapy. It wasn’t until her early 20s that she was finally able to open up to a therapist and begin to manage her trauma. Over the years, Susan has had various diagnoses including: clinical depression, anxiety, bipolar disorder, eating disorder, personality disorder – the list goes on. He was prescribed a multitude of antidepressants and anti-anxiety medications over the years, none of which helped.

When I started seeing Susan, it was clear that everyone in her life – including boyfriends, coworkers, and girlfriends – had all abused her in some way. Her entire social and professional network was made up of toxic people who treated her much like her abusive family. Susan lived her life as if she were still the little girl abused by her parents. It wasn’t his fault. She was unconsciously repeating her story. Violence and abusive relationships were familiar. That was all she knew.

One of my therapeutic goals was to help Susan realize that the reason she continued to feel so helpless, helpless, depressed, anxious and, at times, suicidal (as she did as a child) was due to the poisonous people (like her parents) whom she continued to collect and keep in her life. I felt that if I could help her change this pattern, she would have a chance to live a satisfying, even joyful life. Zero toxicity was the goal. There were times when Susan wanted to end her therapy with me. Having a loving, empathetic, and caring therapist didn’t feel right to me. It’s not unusual. When people are used to abuse, support and unconditional love is confusing and wrong.

Susan was probably at the lowest point of her life last winter. She had just broken up with an abusive boyfriend and spoke frequently of suicide. In consultation with her psychiatrist, her family doctor as well as another therapist with whom she had worked for more than 25 years, it seemed that a hospitalization was imminent. Reluctantly, I too felt that working with her on an outpatient basis at that time was not going to be enough. Susan had recently started taking another antidepressant which did not help – as had many she had taken in the past. She took time off from her job and we talked about the need for her disability. Her family doctor wrote a long letter to disability stating that he believed Susan would never be able to work again.


Susan and I researched and discovered a South Florida community that had received rave reviews from residents and the media. It looked like a 50+ adult resort. There were clubs, churches, synagogues and sports of all kinds. People could dance day and night and connect. It looked like paradise. I kind of convinced Susan to visit this Adult Disneyland. She reluctantly agreed. A few days after she left, she called me and asked if I thought she should buy a house in the community. The idea seemed absurd. Where was it?

It’s been six months since Susan left her Upper East Side apartment for Florida. She bought a house and made friends. For the first time in her life, she met people who truly cared about her well-being. She goes to the gym every day, attends a variety of classes, has taken up gardening, and is slowly beginning to feel a sense of calm. She no longer has toxic people in her life. Her depression is slowly rising. She takes no medication and obviously does not need to be hospitalized. Although she is still on disability, I believe that if she continues to live her life in a way that is in her best interest as she has done, she will be able to work again in the near future.

So what is the moral of this story? Yes, some people need medication and hospitalization. And yet, what I have discovered over the past 35 years is that when people feel they are part of a tight-knit community, where human connection and purpose are valued, nurtured and encouraged, that type of environment can have incredible healing powers in ways that are unimaginable.

(Details have been edited to protect “Susan’s” identity.)


Visit, it’s an excellent national resource for anyone who has been sexually assaulted or abused.

Beatty Cohan, MSW, LCSW, AASECT is a nationally recognized psychotherapist, sex therapist, author of For Better for Worse Forever: Discover the Path to Lasting Love, national speaker, national radio and television expert guest, and host of the weekly “Ask Beatty Show” on the Progressive Radio Network. She has a private practice in New York and East Hampton.

Beatty would love to hear from you. You can send your questions and comments to him at [email protected]. For more information, visit


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