Clients Who Lose Control for the Sake of Care

Image via Raimond Klavins

A client walked into my office for an appointment. They seemed fine at first, but it quickly became apparent that something was wrong as they sat down on the couch across from me and began to twiddle their thumbs and shuffle their legs uncomfortably. This went on long enough and eventually I asked if they were nervous.

“No” they replied. “Well, maybe a little…I did do cocaine.”

“…When?” I asked, somewhat surprised, mostly because it was only a few minutes past 10 o’clock in the morning.

“Right before I came here.”

I looked at the client, carefully considering what they had said to me, letting it settle in my mind. What did it mean for this person to sit before me, young, impulsive, painfully naïve, and share this information? To opt for truth when they easily could have lied. There was a look of disappointment and expectation on their face as they waited for me to say something.

“Do you want me to be upset with you?” I wasn’t sure if this was the right question, but I knew that any sort of declarative statement would be of no use. Not until I could understand this person more fully, and with my question I started in on that task.

Nothing is done for the sake of nothing, and human agency is goal directed even when the goal is unclear, as is the case in many instances. It is easy to judge someone who shows up to an appointment high on cocaine as being out of control. Maybe they are, but there are also certain benefits to “being out of control” which must be considered. Losing control, by which I mean acting in ways that are risky and potentially harmful to oneself or others is a proven way to elicit care from others.

Imagine a person whose experience teaches them that their wants and needs are not important, or even worse, receives the message that they are not entitled to have any wants or needs because of their status. This message crystallizes around their existence, and it is often the case that the only time an exception is made is when they are ill or in trouble. On these rare occasions, rather than being dismissed, the person is showered with attention, and this attention, no matter how positive or negative, caring or chastising, is still an improvement on being from being the recipient of emotional indifference.

At some point such a person makes a discovery, which is that when they are out of control, people are more likely to take care of them. The person sitting before me, who had been passed over many times in life, was such a person. Branded as a troublemaker already, they explicitly rejected this label, but implicitly accepted it and used it to get attention and care from others. They could have cancelled the appointment or just not shown up at all, but they didn’t, and their confession of drug use doubled as a confession of desire, that there was something they wanted from me. Chiefly, positive attention in the form of caring concern, but I suspect that if I had become angry at their confession this would have been an acceptable substitute. Anything but nothing.

The problems inherent in this strategy are obvious. As previously stated, it is risky, and there is the chance that a person goes too far in their bid for attention and commits a mistake they cannot easily recover from. This strategy of losing control to make people take care of you is also a form of manipulation, and once caught, the person is even less likely to receive the care they initially wanted. At that point either the jig is up, or the person becomes more desperate in their manipulation, resorting to more dangerous versions of losing control to get their needs met.

These regressions may involve harming oneself or others, risky drug use, indiscriminate sexual activity, and episodes of uncontrolled rage. The ways to lose control are numerous.

What other options are available? The person most likely to entertain this strategy struggles with recognizing and acknowledging their wants and needs so they must learn how to begin doing this. They must experience what it is like to be encouraged to share their experience with another and have it validated instead of dismissed. And they must learn that the stakes do not have to be so high for them to feel entitled to receiving care from others.

When they no longer must lose control, they are free to try other things. They can talk about how they feel and what they want and make requests of others. They can learn how to meet their own needs, through exercise, a warm bath, enjoying a favorite meal, and many other things. Or they can give up some of their wants and needs, which may be the greatest sign of an individual’s growth and maturity. When a person consistently gets at least some of their needs met, they are not desperate for limited opportunities to do so.

The client didn’t want me to be upset with them, as it turns out. Truthfully, they didn’t know what they wanted, or why they did what they did. Only that they were struggling and wanted help from somebody. An outcome they would have to learn could be achieved without clumsy concoctions that I would not choose for them, but am thankful that they chose to share with me.