As with most cases, there are multiple ways of looking at the "whys" of Kathy's refusal to recover. I'm not sure we can ever really assess and know the "exact" answer or even if there is an exact answer. Humans are complex individuals and a simple answer does not usually do justice to the multidimensional aspects of human cognition, affect, and behavior. Does Kathy's refusal provide a re-enactment of her mother's refusal to recover? Does Kathy's behavior find its basis in "maladaptive" attachment and ensure that she will not leave the family? Does getting "well" carry with it the threat of loss and abandonment, particularly the loss of the the therapeutic relationship? I believe it is possible to answer each question in the affirmative. They are not mutually exclusive. They can all provide insight into Kathy. However it is Kathy's insight into herself that can provide the most accurate description. I wonder how much a part of the family Kathy feels at this point anyway. Is her contact and emotional involvement such that enmeshment is obvious? 'Are the ties to the family based on guilt? For anyone that has issues of loss and abandonment the "threat" or "preceived threat" of losing the therapeutic relationship by "getting well" is very real. Only when the client can accept that the relationship does not just "disappear" with recovery can growth continue. On the other hand I find myself wondering if the WHYS really matter. Perhaps as therapists, we spend too much time "in our heads" analyzing and dissecting every detail, when in fact WHY doesn't really matter.