Why did the T refuse to work with you in that way? I understand if she was unable to handle the conflicts, but having theoretical discussions about your feelings and how those fit in a model that can be used for improvement? That should be the basic job of a T.

I think many people like to identify with their mental disorder, it can give them a sense of knowing where the issues come from and a sense of belonging, including to a community of people who deal with the same. Then there are those who adamantly fight against such identification, e.g. when people refuse to be referred to as, for example, schizophrenic... and prefer the term a person with schizophrenia. I can understand both perspectives. I personally don't mind at all identifying with a current, ongoing problem that can be changed because it gives me a reminder to take it seriously and to work on it. Two examples from my own life were an eating disorder and alcoholism. I dislike including these things in the identity of people who have successfully and stably recovered from them and do not have symptoms, because it kinda suggests stagnation and that there is no real way out. But others find that useful e.g. as a reminder that they can never drink or use drugs again. I think the most important is to respect everyone's preference when interacting with them and Ts should be especially mindful in this sense.

I think the sense of self is a complex phenomenon and the interpersonal part that we are discussing here, that develops in relation to other people, is only one element. When I personally think about it, it is not even the first one. What occurs to me first is usually whether a person knows what interests and motivates them in life, their likes and dislikes, preferences, personal fears. Many people don't and this is what is sometimes referred to as "living someone else's life", when people follow and choose according to external expectations rather than their own. This is definitely also something where early life experiences are key and a person can easily get suppressed if their environment rejects and suppresses their choices. So surely the social factor comes in.

I also personally don't think one needs to fit in much in order to have a good sense of self. In fact, fitting in too much can generate what I mentioned above, a suppression of own needs, wants and individuality. What's very important though IMO is the opportunity and sense of contributing to something larger than the self, to society, in some way. For me, it is always best to contribute using the unique abilities of the self, so this also starts with knowing who we are and what we can do well. A lot of cases where people feel as a personal failure are when they are trying something too hard that does not naturally fits them.

Another important social component is culture, and this is something not many therapists consider much, in my experience. Some have a special interest and they kinda specialize in it, and can be quite knowledgeable about cultural factors in development and optimal functioning, but most just don't think very deeply beyond their own cultural biases and perhaps the most common forms of social discrimination. Where culture can get quite damaging IMO is when someone is born into one that does not fit well with and does not support their emerging sense of self... and they do not have the opportunity (or courage) to move out of it and find a more suitable environment. This is something I experienced myself and was lucky enough that I could get out of my country of origin easily, including not missing anything about it or suffering from cutting ties. Very interesting that I never, even for a day, felt "homesick" or even keen on going back for visits. In my view, it's a clear sign that I didn't feel belonging to that environment and most likely could not have self-actualized there. For many people, moving around is just a temporary wanderlust especially in youth, but for me it was essential part of my self development and finding my true niche. Some things I've learned is that I need an environment where I can be free to do whatever I want and there are matching opportunities, and that ideally it is a culturally quite diverse environment. Homogeneity and too limited possibilities can depress me, kill my motivation and, indeed, make me feel like a misfit or alien. I know with certainty because I tried and suffered the latter by choice as an adult for a while - that was where mental health issues emerged pretty fast. It was very destructive on me, even with a pretty strong sense of self, perhaps exactly because of that - I felt the contrast very intensely on many levels and felt trapped and unable to be myself. I absolutely believe these days it is possible to break out of a given culture and environment we happen to be born into, but it does require a sense of self-interest to begin. When I moved away from my country of origin, and chose a pretty daring professional shift as well, many people around me discouraged it and even told me it wouldn't work out. They were wrong. Fortunately, I always had enough supportive others in my life and, again, my father was probably the most important. As a parent, of course he would have liked me to be where he was but he never, for a minute, used that to limit me. He also taught by example because he was fiercely independent himself and would never take manipulations and limitations from others when they got in the way of his exploring whatever he wanted, including my mom, who was subtly manipulative and often passive aggressive. She got very depressed in the last 10 years of her life and I really believe the fact that both me and my dad rejected her in many ways, for decades, triggered or exacerbated that. It was sad that she didn't have other means in her personality to manifest her wishes, but I never regretted rejecting the negativity (and clinginess) for a second. I am not sure I would have had the self-awareness and courage to reject/avoid if my whole family was made of people like her though, without a better model that was much closer to my own nature.

One extremely annoying thing my first T tried with me was to impose himself as a sort of father figure - I was seeing him while my dad's health was declined and when he eventually died. I passionately rejected that as well, not because I think no one can be as good as my biological father, but because he obviously did not fit that role relative to me. The T and I had almost nothing in common and he constantly misunderstood/misinterpreted me because he could only see things through the lens of his own experiences and pet theories. But his world just didn't seem to overlap with mine, why he was a bad T for me to start with. He must have been flexible and self-aware enough (calling himself a T) to recognize and accept that though and admit that we were not a good match. Instead, he kept trying to manipulate and hold onto me. How could I not have gotten intensely mad at him for it? There may have been some maternal transference going on in how I viewed his attempts, but I don't think there was anything in it for me to "explore". I already knew it very clearly why my mom and I didn't match personality-wise and that it is better for me not to associate myself closely with such people - we just have such a strong dissonance in personal values and needs that the relationship would not go anywhere. My mom was okay for me as an infant, to provide for the need of an infant who does not have a sense of self yet and mostly needs shelter, food and basic forms of connection and love, but once that separate, individual sense developed, the clash became obvious. Similar for me in a T: I would never need/want them to provide for child needs because I don't think I have any. I would want them to help me find solutions to adult problems and maybe to encourage me to see new perspectives that do not occur to me, but in an adult-to-adult, mature, also practical way. Inevitably, they need to be mature and open enough to interact with me in that way. My second T definitely had that, he more just lacked the willingness (or maybe ability) to challenge me. And without that, the therapy was not much more than a series of interesting conversations and pleasant company.

Anyhow, it's probably easy to see why I personally just can't see how a T can realistically be sufficient to help a client to develop a sense of self, or a more accurate sense. They just cannot provide all factors necessary for that. I do believe they can provide one or two, and sometimes that can make a real difference if what they are able to manifest happens to be what the client was/is missing and has other resources for the other elements. I believe they can be good self-object to a client if they happen to be highly compatible in their own personality. But to be sufficient for all those needs and factors? That's nonsense IMO.