Can Being Too Patient in Therapy Have Unintended Consequences?

Patience is generally considered an important part of psychotherapy. We recognise that clients need time to develop trust, become more comfortable with their feelings and approach things they might have spent years avoiding.

But I wonder whether sometimes, by being patient and waiting for a client to feel ready to explore something, we might actually be making it more difficult for them to approach.

One of the things worth considering is that when we agree to leave something alone in therapy, we may also be communicating something about how we view that difficulty, even if that's not our intention.

And over time, those messages can begin to influence how the client understands themselves, their difficulties and what feels possible within therapy.

When patience becomes part of the therapeutic relationship

For example, let's say a client comes to therapy struggling with grief. They describe feeling overwhelmed whenever they begin to think about the person they've lost and worry that if they allow themselves to experience those feelings, they'll become too much to manage.

During a session, we suggest exploring some of those feelings together, but the client tells us they're not ready.

We acknowledge that, respect their wishes and agree to leave it for another time.

Now, that might be entirely appropriate. There may be good clinical reasons for allowing more time, particularly if the client is experiencing significant anxiety or struggling to regulate their emotional responses.

But what happens if this interaction continues to repeat itself throughout therapy?

Each time the possibility of exploring the grief comes up, the client expresses reluctance, and the therapist agrees to leave it alone.

Over time, a pattern begins to develop between them.

The client may begin to understand the therapist's continued willingness to leave their grief alone as confirmation that their feelings really are too much to bear. Perhaps they begin to believe that the therapist doesn't think they're capable of working through them, or even that the therapist doesn't believe they're capable of helping the client contain those feelings.

Of course, none of these messages has necessarily been communicated explicitly.

But through repeated interactions, they can begin to shape how both people understand the difficulty.

Leaving something alone doesn't necessarily leave it unchanged

I think it's possible to imagine that when we decide not to explore something in therapy, we're simply putting it to one side until the client feels more ready.

Almost as though the difficulty remains exactly as it was, waiting for us to return to it.

But therapy doesn't really work like that.

The decisions we make about what to explore, what to leave alone and how we respond to a client's reluctance all contribute to the developing therapeutic relationship.

In our example, the client's original difficulty might have been a fear of becoming overwhelmed by grief.

But after several sessions of repeatedly agreeing not to explore those feelings, something else may have developed alongside that fear.

There may now be an additional belief that the therapist also considers those feelings too overwhelming to approach.

And perhaps an expectation that whenever the client expresses reluctance, the therapist will agree to leave the subject alone.

What began as an understandable difficulty with approaching painful feelings may now have become part of an established way of relating within therapy itself.

So when we eventually return to exploring the grief, we're not necessarily returning to the same situation we initially left alone.

We're approaching it within a therapeutic relationship that has developed its own assumptions and expectations around what the client can tolerate and what the therapist can help them manage.

When giving more time makes something harder to approach

This is where I think patience can have an unintended consequence.

We might initially decide to give a client more time because we hope that, as therapy progresses, they'll develop greater confidence in their ability to approach something difficult.

But if our repeated responses inadvertently reinforce the belief that their feelings are too overwhelming, we may actually be making it more difficult for them to approach those feelings later.

And this can create an additional difficulty for the therapist.

Having repeatedly agreed that something should be left alone, what happens when we eventually decide it would be helpful to explore it?

The client may understandably wonder what's changed.

If we've spent several sessions responding to their reluctance by agreeing to avoid the subject, introducing a different response may now feel unfamiliar or even inconsistent with the way the relationship has developed.

In that sense, patience hasn't simply delayed the work. It may have changed the conditions in which that work now needs to take place.

What is our patience actually doing?

Of course, none of this means that therapists should challenge every reluctance or encourage clients to approach feelings they're not yet able to manage.

There are times when allowing someone more space is precisely what's needed. A client may need support with anxiety regulation, greater trust in the therapeutic relationship or opportunities to develop the capacity to experience difficult feelings without becoming overwhelmed.

But I think there's an important distinction between giving someone time while actively helping them develop those capacities, and repeatedly agreeing to leave something alone in the hope that time itself will somehow make it easier.

In the first situation, patience is part of helping the client move towards something difficult.

In the second, there's a possibility that patience becomes part of how the difficulty is maintained.

And perhaps that's something worth paying attention to in our clinical work.

Not simply whether we're giving clients enough time, but what our willingness to wait might be communicating, and whether it's helping to create the conditions for change or inadvertently reinforcing the reasons that change feels difficult.