The Person of the Patient

Patients come to us for many reasons, often associated with symptoms such as anger problems, loneliness, insomnia, lack of interest in sex, depressed or anxious mood, repetition of unpleasant situations, or general unhappiness. Some come hopeful, some without hope. Some are motivated to decrease psychological suffering; some seek increased self awareness. Some are coerced by others to show up; some are desperate for any relief we might offer. Some may ask for advice, yet might benefit more from figuring out what has prevented them from taking advice they have already heard. It is the therapist’s job to ‘feel’ our way into their moccasins. By doing so, and by listening openly, if nothing else we decrease their isolation by sharing in their experience. To this we might add engendering hope.

When patients seem to us to ‘fail’ to make an effort, to change, to accept responsibility, or to let us ‘fix' them, we may feel angry, helpless, incompetent. There will be things about patients that will challenge our capacity to engage them whole-heartedly. They may smell, be combative and oppositional, or they may be supercilious and insulting. They may scare us or make us feel incompetent or helpless with their self injurious behavior or their threats, or with their too slow progress. They may whine or chronically come late or not show up at all. They may be too clingy, call us too frequently between sessions, or behave as if what we say and do has no effect at all on them. They may delay or withhold payment. We do neither patients nor ourselves any favor by pretending that patients don’t get under our skin.

It is also the job of the therapist to collaborate with patients to understand the perfect sense that their constraining, obnoxious, or even harmful behaviors make in light of their histories. These behaviors were the best possible solution at the time, usually in childhood, of their inception. A child is without experience, perspective, cognitive maturity, or, sometimes, without any aid or advocate. And because these behaviors may hold a fragile self together, patients and their behaviors are to be respected, and to be changed only with great caution.