Your guess about potential countertransference is a good one and fits with control-mastery's idea that patients often test to see if the therapist will confirm or disconform their worst fears, and in Caroline's case she might very well have presented herself as shameful or bratty , but the fact that she did not elicit these counter-transferential feelings in me was an omen, I believe, of the strengths this patient would reveal in the coming months. I felt very touched by her story and was pulled to respond to the history of neglect with a strong protective stance toward her including active interventions on several fronts, and reaching out to her in every way I could. She did not look to me like a borderline, as another participant suggested. Control-Master Theory has not found the diagnostic category borderline particularly useful. Patients who are difficult to treat and therefore often get diagnosed as borderline tend in our view to be patients who use passive-into-active testing as a primary mode of interaction with the therapist, creating powerful and uncomfortable counter-transferential feelings.
Again, your intuition that substance abuse is not as easily conquered as the early hours imply is excellent. I hope you will be able to see how the pattern of relapse parallels important themes as the case unfolds.