I have witnessed the most obscene, ornate, loud, and grand displays from both clients and colleagues. Center-staging isn’t just about the magnitude of these performances or the elaborate lengths taken to create a spectacle. It’s the seductive pull—the mystique—of creating one giant emotional and behavioral maelstrom. Center-staging can trap clinicians and peers in the chaotic orbit of a client’s life, pulling them to the forefront as unwitting participants in the performance. Ironically, the clinician can find themselves front and center, cast in the role of savior, with the client’s inner turmoil as the stage.

I recall one client who, after living independently for decades, moved into an adult home. Almost immediately, her mental health spiraled, and she became fixated on her inability to manage even basic activities of daily living. Her apartment, once a source of pride, deteriorated as she lost hope. Our team scrambled to understand how someone could decompensate so quickly. In hindsight, we realized we had already been drawn into the gravitational pull of a client with borderline and histrionic traits, deep in crisis.

Finding ourselves center-stage in her life, we shifted focus to introspection and self-reflection. Countertransference built as we grappled with the desire to rescue her. She began requesting 24-hour care—help with toileting, meal preparation, transportation, and a live-in case manager. For someone previously independent, the shift was drastic. But for a borderline client with histrionic traits, the impulse to self-sabotage can run deep. It’s confusing for the client and bewildering for those supporting them.

When things began to deteriorate further, the client accused the team of neglect, blaming us for her “fall.” The weight of maladaptive reasoning and self-destructive choices became our responsibility in her eyes. Her demand for attention, sympathy, and guilt pulled at every thread of the treatment relationship.

I have also worked with chronically homeless clients with PTSD who repeatedly lose everything—caught in cycles of re-traumatization. Their emotional outbursts and destructive behaviors can escalate to dangerous levels, creating risk not just for themselves but for those around them. In these moments, the clinician must distinguish between necessary intervention and the need to simply hold space, offering stability without overreacting.

So, What Works?

How do you treat chaos and inconsolable behavior? The answer is simple—you don’t.

In cases like these, listening, redirecting, and gently disputing cognitive distortions as they arise is often the best intervention. There may be no immediate solution. These crises are complex, layered, and resistant to quick fixes. The goal is to resist the urge to “solve” the situation and instead focus on rolling with the resistance, avoiding countertransference, and staying grounded.

Clients can sense when a clinician feels out of control or afraid. In turn, this can escalate their anxiety. Modeling calmness and self-regulation often provides more therapeutic value than any verbal reassurance. Sometimes, the greatest intervention is simply being present—without judgment, without rushing to rescue.

For clinicians, the key lies in recognizing that while we cannot extinguish every fire, we can avoid being consumed by it. Holding space, staying centered, and trusting the process may not offer immediate gratification, but over time, it can be the foundation of genuine therapeutic progress.