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The few people I spoke with about this all had the same question: Why didn’t you just stop going?
It’s a fair question. By the time I finally ended things with Sam in September 2021, I’d spent three months in a mental hell—a breakdown that was itself caused by the therapy. (I learned a word along the way: iatrogenic. That means that an illness caused by a treatment.) I knew I was being harmed. I said so, out loud, to Sam, multiple times. I couldn’t sleep before sessions. I described the experience as “toxic.” But I kept going back.
I’ve thought about this a lot in the years since, both in therapy and in reading the research about this kind of therapy abuse. And what I’ve come to understand is that the question—why didn’t you leave?—makes an assumption that isn’t true. It assumes the patient is operating with the full agency of someone who can weigh costs and benefits and walk out the door. That isn’t what’s happening. What’s happening is closer to what happens in abusive relationships, and the clinical literature on boundary violations says so explicitly.
Here’s what I’ve learned that I wish I’d known at the time.
The therapist is the person you’ve been trained to go to with problems. When something goes wrong in therapy, you’re supposed to bring it to therapy. Talk it through. Work on it together. Sam explicitly encouraged this. She told me that leaving would cause more harm than staying, would “re-traumatize” me. She framed continued treatment as the responsible choice and termination as avoidance. She was using my therapeutic education against me—the belief that you don’t run from hard feelings, you work through them. Except the hard feelings were being caused by her, and working through them meant more sessions in which she simultaneously caused and claimed to treat the injury. Iatrogenic.
The power differential operates below the level of conscious choice. A therapist’s authority doesn’t come just from the degree on the wall. It comes from years of being the person to whom you exposed your deepest vulnerabilities—and who you believed was keeping you safe. When that person says “stay,” there is an enormous psychological weight behind the word. Hook and Devereux, who study exactly this, call it “the exploitation of dependency”—the patient’s trust and reliance on the therapist is itself the mechanism through which the therapist retains control.
Intermittent reinforcement is the most addictive pattern there is. This is the slot machine principle. A reward that comes unpredictably is more compelling than one that comes reliably. Sam’s oscillation—warmth then coldness, intimacy then distance, “I love you” then “You move me”—created exactly this pattern. Every session I went back hoping this would be the one where she was honest, where she finally owned what she’d done, where the warmth would return and stay, where something might change for the better in our relationship. And occasionally it did return, just enough to keep me coming back. It’s the same mechanism that keeps people in abusive domestic relationships. Gabbard, one of the leading researchers on this, writes that erotic enactments in therapy “repeat earlier trauma, transforming therapy into a site of renewed injury.” The relationship itself becomes traumatizing, and the trauma becomes the reason you can’t leave.
Leaving means admitting it was real. As long as I stayed, there was a version of reality in which this could still be fixed—in which Sam would take real accountability, the relationship could be salvaged, I wouldn’t have to face the full weight of what had happened. Leaving meant closing that door permanently. It meant accepting that three years of what I’d believed was meaningful therapy had been wasted, corrupted. That’s an enormous thing to accept. It’s easier, in the short term, to keep showing up and hoping.
And there was nobody to tell me how abnormal this was. I didn’t have a framework. I didn’t know the term “boundary violation” in any clinical sense. I didn’t know that what Sam was doing followed a well-documented pattern—the slippery slope, the double-bind, the defensive rationalization. I didn’t know there were researchers who had studied this exact dynamic. I didn’t know any of that until it was over, until I found a lawyer, until I read the literature. By then I was cooked.
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Boundary Violations in Psychotherapy - A Personal Case Study 