Grace was a heroin addict who had been clean for about six months; I was a 34-year-old therapist in training. When we started psychotherapy, in 2006, Grace had a lot going against her. She was an unemployed single mother who had been in a string of relationships with violent men and was addicted to drugs. Yet despite these challenges, she was struggling bravely to put her life back together and retain custody of her young son. (I’ve changed my patients’ names and some details about them to protect their privacy.)

Our therapy focused on supporting Grace’s attendance at Narcotics Anonymous meetings and reducing the anxiety she said had driven her to drugs. The first few months seemed to go well. Every week, she told me about her successes: She attended the NA meetings, got a job, and found a boyfriend who respected her.