The patient is an integral component of the therapeutic process. In addition to his/her response to the therapist’s interventions, the patient contributes to the initial orientation of the conversation between the two and particular points of curiosity that arise thereafter. In a sense, he/she is attempting to help the therapist help him/her, at least on some level. Whether consciously or not, whether he/she has mixed feelings about the therapist or not, the patient attempts to forge a relationship with the therapist so that the latter can become helpful to him/her specifically. Of course, from time to time, patients do not feel they can manage further exploration of a certain subject, they may feel intolerably ashamed or guilty if they verbalize something they have only thought in private, or they may be actively distrustful or even hostile towards the therapist in manner that stifles their joint efforts and joint curiosity. Over all, there are several facets of the patient’s conversation associated with treatments that become collaborative and productive. We can recognize these facets expanding and elaborating during treatments that feel generally productive, or just at the moment a patient discovers something about him/herself that had been kept out of awareness for a long time before.
For the patient, this can be an urgent and emotionally painful process. At times, the patient will relate his/her feelings or anything that is on his/her mind in a manner that fosters greater immersion in the emotional experience of what he/she is discussing, sometimes without much regard for coherence or consistency. To some degree, patients that come for treatment arrive knowing that they will relive difficult feelings in the description of experiences in which such emotions arose. Eventually, the patient and therapist could stumble onto more novel aspects of the patient’s mental life this way, and the importance of the patient feeling heard in this difficult endeavor cannot be overstated. For some patients, the only way they truly know that they have been heard involves having a genuine emotional impact on the therapist.
In contrast to immersive patient interventions, the patient also engages in a process of reflection, relatively removed from the visceral, emotional experience itself. This allows the patient to link such feelings and experiences with other experiences or otherwise articulate some meaning to the experience. Without a certain psychological distancing, the patient’s feelings will overwhelm his/her ability to discover or create meaning. More reflective moments in conversation allow the patient to play with various ideas he/she has had about a given feeling, with trial meanings explored, consolidated, and/or adjusted in vivo and along with the therapist. Just as children use play to manage or work through a variety of difficult feelings and ways of relating, there are a few characteristic ways patients demonstrate how they make use of a similar opportunity with their therapists.
The content of what patients discuss in treatment can vary depending on the situation. Sometimes, without necessarily realizing it, patients describe feelings that seem to be at odds with one another. Patients also often refer to their past, and to lesser or greater degree link the past to a process of ongoing emotional development. They manage anger and related feelings in a manner that can feel out of control or adaptive or triumphant. The patient may also discuss yearning, tenderness, intimacy, lust, and other feelings that arise in close relationships, which might be at odds with other feelings or feel out-of-control. At times, a patient may focus on his/her sense of him/herself, and related matters of self-esteem.
As the process unfolds, the patient often becomes increasingly capable of exploring these issues collaboratively with the therapist. The patient engages the therapist him/herself, such that the patient’s experiences can be examined together, necessarily affected by the presence of a relatively neutral, warm, and interested therapist and his/her own emotional reactions to listening and relating to the patient. Click here to read about interactive aspects of the conversation between therapist and patient.