Ask Beatty: Connection, Medication, Hospitalization — a Therapist’s Dilemma

Psychotherapy session, woman talking to his psychologist in the studio - do you choose medication or hospitalization?
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Susan is a 55-year-old, single, never-married patient of mine. I have been treating her for the past five years and frequently see her 2–3 times a week. She is the art director of a prestigious New York City gallery and an accomplished artist, as well.

She grew up in a very abusive Jewish upper middle class family in Riverdale, where she was both verbally, emotionally and physically abused by both parents on an almost daily basis. It was not unusual for her father (now deceased), to throw her down the stairs while her mother would stand by, 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 would hide in his room and blast his stereo as a means of trying to escape the family drama. Interestingly, even as an adult, he has never come to his sister’s defense and, in fact, has invalidated all of her allegations of abuse, as has her mother.

Despite her desperate situation, Susan was an excellent student and was able to earn a scholarship to college. She did suffer from severe suicidal depression and anxiety and took comfort in consuming quarts of chocolate ice cream on a regular basis. Her social life was virtually non-existent. Her one childhood girlfriend was Penny, a child model, who her parents adored. They would remind Susan continually that they wished she was just 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 when she was in her early teens because of “severe stomachaches.” However, the abuse was never disclosed in therapy. It wasn’t until she was in early 20s that she was able to finally open up to a therapist and begin to deal with her trauma. Through the years, Susan has been given a variety of diagnoses that included: clinical depression, anxiety, bipolar disorder, eating disorder, personality disorder — the list goes on and on. She has been prescribed a multitude of antidepressant and anti-anxiety medication over the years — none of which helped.

When I began to see Susan, it was clear that everyone in her life — including boyfriends, colleagues and girlfriends — all abused her in one form or another. Her entire social and professional network consisted of toxic people who treated her not unlike her abusive family. Susan was living her life as if she was still the little girl who was being abused by her parents. This was not her fault. She unconsciously was repeating her history. Abuse and abusive relationships were familiar. It was all that she knew.

One of my therapeutic goals was to help Susan realize that the reason she continued to feel so helpless, powerless, depressed, anxious and, at times, suicidal (like she did when she was a child) was because of the poisonous people (like her parents) that 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 terminate her therapy with me. Having a loving, empathetic and caring therapist did not feel right. This isn’t unusual. When abuse is what people are used to, support and unconditional love feels confusing and wrong.

Susan was probably at the lowest point in her life last winter. She had just broken up with an abusive boyfriend and frequently talked about suicide. In consultation with her psychiatrist, family practitioner, as well as another therapist who she had been working with for over 25 years, it seemed as if hospitalization was imminent. Reluctantly, I too felt that working with her on an out-patient basis at that time was not going to be sufficient. Susan had recently begun taking yet another antidepressant which did not help her — as was the case with the numerous ones she had taken in the past. She took a leave of absence from her job and we talked about the necessity of her going on disability. Her family doctor wrote a lengthy letter to disability stating that he believed that Susan would never be able to work again.


Susan and I did some research and discovered a community in Southern Florida that had received rave reviews from residents and the media. It sounded like a resort for adults 50 and over. There were clubs, churches, synagogues and sports of every kind. People could dance every day and night and connect. It sounded like paradise. I somehow convinced Susan to to visit this Disneyland for adults. She reluctantly agreed. A few days after she left, she called me and asked me whether I thought that she should buy a house in the community. The idea sounded preposterous. Or was it?

It’s been six months since Susan moved from her Upper East Side apartment to Florida. She bought a house and has made friends. For the first time in her life she has met people who really care about her wellbeing. She goes to the gym every day, attends a variety of classes, has taken up gardening and is slowly starting to feel a sense of calm. She no longer has any toxic people in her life. Her depression is slowly lifting. She is not taking any medication and clearly does not need to be hospitalized. Although she is still on disability, I feel that if she continues to live her life in ways that are in her best interest as she has been doing, that she will be able to work again within the near future.

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

(Some of the details have been changed to protect “Susan’s” identity.)


Visit, it’s an excellent national resource available to anyone who has been victimized by sexual assault or abuse.

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 NYC and East Hampton.

Beatty would love to hear from you. You can send your questions and comments to her at [email protected]. For more info, go to

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