I think some people do realize this, but the abandonment feelings are feelings from the past. They are like PTSD flashbacks. So while the rational part of your brain knows that you are not being abandoned, the emotional part of the brain overrides the rational part of the mind, especially for those who by their nature, feel things more intensely. There's been several times where I took a break or 'quit' therapy with this therapist and every time I spiraled into massive feelings of abandonment even though I was the one in control and initiating the separation. The separation itself triggers the emotional re-experiencing of an abandonment regardless. When therapists handle this poorly, i can imagine how much it would intensify these feelings.

Coping skills can certainly help, but long-term psychodynamic therapy seems to be, imo, the only thing that fixes the core of the problem, changing how a person relates to oneself and others (personality) in attachment relationships.

And there's the problem--there aren't enough therapists competent in this area. I can't see that it's abandonment issues that need addressed, but ego strength, intra-psych structure, internalized object relations, etc...all things that take years to transform by someone with appropriate training who has gone through years of their own therapy as to avoid the enmeshment and inabilitly to handle countertransference that I frequently see occurring by poorly trained therapists on here who end up calling it quits.

I do think it comes down to this ^ in more cases than not. This population makes up a considerable proportion of outpatient and inpatient mental health care utilization in comparison with the low prevlance in the mental health population, and the profession needs to do more to address this, help these clients. There are so many Ts who don't even take insurance, and often the most experienced ones with full client panels can cherry pick the 'most desirable' clients, leaving those with these issues in the hands of the less trained, the less experienced, the less dedicated, the less everything. This population really gets shortchanged through no fault of their own. No one asked to have abandonment issues or BPD/CPTSD, and I think clients do they best they can to deal with these issues.

I am lucky to have someone well-versed in treating clients with my issues, but I still cannot afford to get the treatment I need even though he reduced his fee considerably to accommodate me.

So while it might be true in some cases where no matter what the therapist says or does the client may feel abandonded, the professionals, who control the training, ethics, and professional standards, are the ones who I think need to do more, not the clients.