The Patient's Patience

Recently I wrote about the virtue of therapeutic patience. Specifically, the patience that refrains from being intrusively helpful, thus allowing a child or student to come into their own. In the context of psychotherapy, it means taking seriously Winnicott’s general principle “that it is the patient who has the answers.” The therapist then has the patience to sit on their hands, supporting the patient’s own exploration, insights, and interpretations.

This therapist’s patience can make some patients impatient. Which started me thinking about the value of patience for the patient. So here I offer some observations that serve as a reminder for those of us in therapy, and offer a useful tip for those seeking therapy. If you’re in neither camp, still much of what applies to a therapeutic alliance applies more broadly to our other relationships.

Being patient with oneself. I’ve done it often enough myself, and I hear it from patients all the time: the apology for repeating ourselves in therapy, for raising the same painfully familiar dynamics. I remind people I work with, and myself, that it’s natural and expected that we should repeat ourselves when doing deeper therapeutic work. After all, we’re exploring deep-seated patterns that carry emotional charge and momentum. Working with these is an iterative process, rarely a matter of one and done. (Much as we’d like it to be!)

Being patient with the therapist. There are definitely times when we shouldn’t be patient—if we have reason to feel we’re being neglected or misused by the therapist. But as patients we can be impatient in ways that don’t serve us. For example, we may be impatient with the therapist’s midwifery; instead of being drawn out, we want more of a parent or teacher or enabler, someone to give us advice and tell us what to do. There is a place for this, but in psychodynamic therapies it’s the exception, not the rule.

Likewise, we may be impatient with a therapist because we learned early in our lives to equate getting attention with drama, or being indulged, or being criticized, etc. A therapist’s contrasting behavior—non-reactivity and clear boundaries—can feel like a lack of warmth or caring, for example, when they end a session promptly though we’re in the middle of sharing something emotionally salient to us.

There are other things we have to be patient with in therapists, including the discovery of their failings and limitations. But even these can serve us; for if we can talk about it, we can move away from idealizing them and toward a more authentic “I-thou” way of relating. As for the disappointment we feel at seeing our therapist’s blind spots or foibles or vanity or whatever—that disappointment is gold. As I write about in Disappointment is Disappointing, it’s a mark of psychological maturity that we can feel disappointed—rather than, say, petulant or resentful.

Being patient with the process. As patients we can be impatient for results, the more so in a culture of scarce resources and quick fixes. Financial constraints can make us feel impatient with non-directive forms of therapy. We can be impatient at being invited to explore our childhood experience when our marriage is falling apart right now and seems to deserve all our attention. At such times, it’s useful as patients to keep in mind that what’s happening right now often won’t make sense or be able to be addressed without first recognizing the underlying dynamics. Otherwise we risk acting and reacting in our old habitual ways. We need patience for the process if we’re seeking the roots of our suffering, not just treating symptoms.

What makes all of this easier to bear, on both sides, is a good therapeutic alliance. This establishes a basic trust that there is a process. Even if as patients we're not clear what that process is, we trust that the therapist is minding the process, and therefore that this detour, or digression, or unfeeling insistence on ending the session though we’re not done crying, may be worthwhile…in the long run.