we did our mid-year patient clean out today, getting rid of our more treatment-resistant cases, which is simultaneously awesome and sad. even though we got into this practicum knowing that we're not going to actually cure many of our patients in the time we have, it's hard to not have the expectation that they'll end up happy, grateful. that attitude, though, is just one step removed from the naive "why can't they just try harder to be happy?" line of reasoning -- for many patients, even therapy isn't enough. in the end, something gets us, for most people, it's heart disease, cancer, the common things, but for some, it's depression, and somehow, that feels less ok. less ok, because there's that niggling illusion that the patient just didn't want it enough, or worse still, that the therapist wasn't persuasive enough, that someone in that alliance didn't try. when drugs don't work, it's a lot harder to place blame; with therapy, there's always someone to point a finger at, and no matter how much you tell yourself that there is no "fault", it was not a matter of "trying", the feeling, the very human feeling that somewhere things screwed up: that's something that lingers, and is hard to chase away.