The Right Amount of Nothing

By Simon Y. Feuerman

Gary, a clinician friend of mine, has an extraordinarily successful practice. Some of his patients have been with him for 20 years or more. The funny thing is that while some patients have resolved major difficulties, have achieved life milestones and prospered, others after many years, still struggle with the same problems with which they entered treatment.

Several of the women patients who came for “help to get married” have remained single. Others have wanted to lose weight and many years into the treatment are still as heavy as the day they walked into his beautiful office. One man I know has been seeing him for 10 years and is as broke as the day he was on day one. What’s more is that a goodly number of these “less successful” patients are in group as well as individual treatment.

What keeps them coming — knowing that he and they fail — week after week, month after month, and year after year?

Nearly everyone is familiar with cases of prolonged resistance: The man who took 19 years to finally propose to his fiancée. The mom, who is so self-depriving, after 23 years of dreaming about a trip to Switzerland, she finally “allows” herself.

Wait a minute! Don’t patients want us to help them make life changes?

The answer would seem to be yes, but some evidence points to the contrary. In fact, if we are too ambitious for our patients, it could be harmful.

A famous analyst, the late Dr. Phyllis Meadow, said what patients want is a (psychological) warm bath. The patient comes to us, like a newborn infant. She is frightened, thirsty, hungry, and in terrible need. After all, the she has just been thrown out of the womb – the closest thing to Paradise we will ever experience in this lifetime. A literal Garden of Eden where every need was met, every hunger satisfied. The baby was one with mother, immersed in an amniotic sac with soothing sounds and completely cushioned from all shocks and blows. The fetus doesn’t even have to labor to breathe until the moment she is thrust into the world.

Therefore, Meadow advised, patients need to be met at their temperature. Not too warm, not too cold, a warm blanket, a small amount of nourishment.

A supervisee of mine, Cynthia told me of a patient who has been with her for 9 years. “I swear I don’t do a thing for her,” Cynthia said, but still, she keeps coming. “It’s a year for every month in the womb, I told her. She needs to be with you in relative silence without any disturbances. You are healing her, by being with her.”

But clearly, others need much more than compassionate silence. They need stimulation, interest, excitement. And if they don’t get it, they frequently walk away before they can really derive benefit from the treatment. So what in fact, does the therapist do to keep people connected and committed to treatment in a way that is healthy for both therapist and patient?

The answer may lie somewhere in the idea that we in the helping profession are not really helpers at all. Perhaps the term “helping profession” is a misnomer — the understanding profession may be a term that is more apt.

“But people do come to us for help,” my supervisees protest. “They don’t come to be understood.” That is absolutely correct.

And yet, it seems that those who are most successful in “helping” people in this field may be the practitioners who don’t help people at all. Gary put it this way: I am not interested in helping people. I am interested in helping them to say everything and understanding why they won’t.”

Truthfully, helping people to say everything on a consistent basis is a much harder task than anyone realizes. People have all kinds of objections to doing it and herein lies the art.

In order to help people to say everything, we often have to refrain from helping them.
Sometimes we have to give them what I call just the right amount of nothing. This is a killer for most practitioners. It is far easier to give. Often, we have to tolerate watching people suffer. We have to observe while they make terrible decisions.

Cynthia described a long-time patient of hers — a woman who wasn’t happy unless she was burning through a friendship or a marriage every few years. She would wreck one relationship after another. Nothing was right for her – no experience, no person.

She would go into a restaurant and demand a different table, another kind of chair. This was one was too close to the radiator, the other, to the door. She was never at the right seat. Her clothes and shoes did not fit. They were too light or too loose. Her life was never good, nor would it ever be good.

For a long time Cynthia tried to help her. She would be a soothing, understanding presence – a “good” mother. (Cynthia was once a hotel manager – a natural born soother. She could calm a savage beast. This kind of unflappable calm came to her naturally) Cynthia would alter her schedule in order to accommodate her. She would not charge her for missed appointments. The patient was appreciative and kept coming.

Nevertheless, Cynthia was unsuccessful in “stopping” her patient from her self-orchestrated train wrecks and derailments. Cynthia felt impotent and helpless and rageful toward her patient for making her feel that way.

“Why try to change her?” I asked. “Human beings are natural born killers. The only thing that stops us is mother’s love.” Then Cynthia revealed something fascinating: her patient’s mother could never make her comfortable. In fact, she was thrown out of the womb several weeks early because her mother’s blood was incompatible with hers. She could not be nursed.

Not only could her mother not calm her down, she could give her nothing. And yet with each job, with each marriage, with each relationship, she hoped against hope that here someone could help her. This time it will be different. Here she will finally get nursed.

It became clear to Cynthia through our talks that she needed to allow herself to be “ineffective.” Cynthia needed to give – verbal nourishment or whatever, only to the extent that it helped her patient to talk. Only take actions designed to help her say more.

As Cynthia began to give less, she could sense her patient’s level of frustration rising. This made her nervous. “The patient is gathering steam in order to explode into murderous rage. I am afraid. I feel compelled to give her something to make things better – to quell her, but I know that is not useful.”

This is a dangerous profession. You need to work slowly. “She’s been with you 10 years, but she has hardly begun to work,” I said. “Ask her if she is comfortable in the treatment room. Tell her there can be no progress in life without comfort.”

The next time I saw Cynthia she was completely at ease. “I followed your recommendation, Simon. My patient began talking about all the ways she was uncomfortable in the treatment room and how I had failed her. I was silent as the words kept coming. I kept listening. At the end of the session she stood up and said, “that felt very good.”

Simon Y. Feuerman, Psy.D, LCSW has a private practice in psychoanalysis and psychotherapy in New Jersey. He is the Director of The New Center for Advanced Psychotherapy Studies, a teleconference course and group supervision center for mental health professionals. http://www.ncapsonline.com