This reflective paper explores the emotional and professional challenges of working with service users experiencing dual diagnosis, those living with both mental illness and substance misuse. Drawing on person-centred principles and clinical experience within a community mental health setting, the author discusses the tension between empathy and accountability in the therapeutic process. The paper argues that fostering empathic accountability, a balance of compassion and responsibility, supports service users in taking ownership of their recovery while maintaining dignity and agency. The reflection concludes by proposing empathic accountability as a key ethical and relational stance for practitioners working with individuals seeking to move out of addiction.