The best way to build yourself is to build

Image of then-2-year-old Alice with part of Pneuma sculpture, © Kelsy Landin

There’s a phenomenon most therapists have been confronted with, but few explicitly identify or discuss (partly because it’s hard to know what to say about it): the patient who is financially disincentivized from working. Often it’s because the patient receives some form of disability benefits contingent on demonstrating their continued incapacity to work; other times it is the patient’s parents or other family members who, with the best of intentions, fall into playing the role of the “disability office.” Regardless, the observed effect is the same: an arrested development that makes it impossible to achieve any but the most superficial and transient gains in therapy—until and unless the anti-work incentive gets explicitly addressed and challenged.

To be clear, my experience of working with such patients was not that they were “lazy” or that they lacked motivation for treatment. Many were combat veterans injur…