When Helping Too Much Stops Helping
The Drama Triangle, from our earliest relationships to the therapy room
Sometimes, the desire to help can become part of the problem. And this does not happen only in psychotherapy.
In families, friendships and romantic relationships, we can sometimes find ourselves repeatedly occupying familiar positions: the person who needs to be rescued, the person who must rescue everyone else, or the person who is blamed for what has gone wrong. These patterns can become so familiar that we barely notice them.
I am an Adjunct Professor of Psychiatry at Vita-Salute San Raffaele University, and a psychologist and psychotherapist specialised in relational psychodynamic psychotherapy. Psychotherapy is interesting because these same dynamics can eventually appear there too, offering an opportunity not simply to repeat them, but to understand them.
The Drama Triangle: Roles, Not Identities
One way of thinking about these relational patterns is the Drama Triangle, originally described by Stephen Karpman. It describes three positions: Victim, Rescuer and Persecutor.
These are not personality types. They are positions people can move between within relationships.
Someone feeling powerless may seek a Rescuer. The Rescuer may feel responsible for solving the other person’s problems. When this fails, frustration or blame can emerge, and positions can suddenly switch: the person who was initially the Rescuer may feel like a Victim, as the inability to help generates frustration and anger, while also be experienced as the Persecutor by the person that they are trying to help.
These dynamics do not just unfold between two people. They can also become organised in triadic relationships, where one person experiences another's behaviour as the Victim and another steps in as the Rescuer. At that point, the roles may become even more complex: the Rescuer may turn against the perceived Persecutor and, in doing so, become a Persecutor in the eyes of someone else. The original Victim may later feel controlled or disappointed by the Rescuer, while the original Persecutor may begin to experience themselves as the one being attacked. Roles can therefore shift quickly, sometimes several times within the same interaction.
The important question is therefore not “Who is the Victim?” but “What pattern is developing between these people?”
Where Do These Patterns Come From?
Our expectations about relationships do not appear from a vacuum. From our earliest relationships, we gradually learn what it means to need someone, to ask for help, to express distress, to disagree, to become angry or to depend on another person.
Working within the cognitive psychotherapy framework these relational patterns originate from early attachment experiences and from what attachment theory calls Internal Working Models: internal expectations about ourselves, other people and relationships, that develop through experience.
For example, a child may grow up in a family in which vulnerability repeatedly leads someone else to take over, or where conflict is organised around blame and rescue. Over time, certain relational positions may become familiar ways of maintaining closeness or obtaining protection.
This does not mean that every difficult family creates a Drama Triangle, nor that these patterns are fixed forever. Rather, earlier relationships can provide templates that may later be reactivated in adult relationships, particularly when we feel vulnerable or under interpersonal stress.
We may therefore find ourselves recreating familiar patterns with partners, friends or colleagues, without consciously choosing to do so.
When The Pattern Enters Psychotherapy
The therapy room is not magically protected from the rest of human relationships.
A patient may arrive feeling powerless and implicitly ask the therapist to become a Rescuer. Or they may bring an external “Persecutor” into therapy: a partner, parent or another person experienced as responsible for their suffering. The therapist may then feel invited to become a defender or ally against that person.
This can be particularly relevant in some presentations involving borderline personality disorder, where interpersonal experiences may become intensely polarised. It is important that therapists recognise their own possible positions within the triangle so that they do not unconsciously collude with an invitation to become the Rescuer.
But not rescuing does not mean doing nothing. Nor does it mean ignoring genuine abuse, danger or injustice. The distinction is between supporting someone and taking over for them.
If therapy repeatedly communicates “You cannot manage this without me,” it may inadvertently reinforce the patient's experience of helplessness instead of helping them discover their own capacity to think and act.
The Therapy Relationship as a Relational Practice Space
This is also what makes psychotherapy potentially valuable.
Patients do not simply tell therapists about their relational patterns. Sometimes patient and therapist begin, without initially realising it, recreating them together. So, it’s particularly important to observe what happens in the “here and now” of the therapeutic relationship, rather than focusing exclusively on the content of what the patient reports.
A patient who repeatedly seeks someone to protect them in outside relationships, for example, may eventually experience the same need with the therapist, i.e., my therapist can be my Rescuer against the outside-therapy Persecutors. Someone who expects helpers to eventually disappoint or abandon them may begin to interpret the therapist through the same expectation.
Therapy can therefore become a kind of relational practice space: a familiar pattern appears again, but this time there is an opportunity to slow it down and observe it together.
Making the Pattern Visible
Importantly, the Drama Triangle should not necessarily remain something that only the therapist thinks about. As therapy develops, it can become a shared framework through which patient and therapist explore what is happening between them. This may increase the patient's awareness and sense of active participation in therapy.
A therapist might notice, for example: “When you felt attacked by your partner, it seemed very important that I took a position against them too. I wonder what you needed from me at that moment.”
Or: “When I didn't respond in the way you expected, it seemed as though I suddenly became another person who wasn't helping you. Does that feeling seem familiar?”
The purpose is not to accuse someone of “playing the Victim”. It is to transform something that happens automatically into something that can be noticed, understood and eventually changed.
Victim, Rescuer and Persecutor are not diagnostic categories or personality types. They describe relational positions that people may temporarily move into and out of. These dynamics can occur especially during periods of intense emotional or interpersonal stress, when our need for proximity, reassurance and protection can become stronger. Under these conditions, older expectations about relationships may become more powerful. The Drama Triangle is therefore perhaps most useful not as a description of who someone is, but as a way of asking what is happening between people at this particular moment.
From Rescue to Cooperation
The alternative to rescuing is not caring less. It is creating relationships in which care and agency can coexist.
For therapists, this may mean asking themselves: When I help, am I also recognising this person's capacities? When I am asked to defend them, can I understand that need without automatically becoming part of the conflict?
For patients, recognising these patterns can help connect what happens today with relational expectations developed in the past, while discovering that familiar patterns do not have to determine what happens next.
And this may be one of the most valuable possibilities offered by psychotherapy: a familiar relational pattern can appear again, but this time it does not necessarily have to end in the familiar way.
Note from the Author: I would like to gratefully acknowledge the work of Antonella Ivaldi, whose paper and book on “Il Triangolo Drammatico” provide an important conceptual foundation for the reflections developed in this article. I also would like to remember with gratitude and affection Professor Nino Dazzi, who first introduced her to this literature and whose teaching had a lasting influence on her clinical and academic thinking. He remains a deeply valued figure within the Italian psychotherapy community.
The text and images in this article have been reviewed with the assistance of ChatGPT (OpenAI) to improve clarity, linguistic accuracy, and overall communication quality.
