[Note: this article begins with several Patient/Therapist dialog examples; the author discusses their implications in a section at the end of the article.]
Pt: (Looking down and back up) I don’t know what’s the matter with me…
Ther: (Thinks “I’m supposed to ask what’s the matter with him, but he’s pretty passive, so I’ll wait”)
Pt: (After a long pause) I guess I’m sorta… I don’t know…. depressed. I guess.
Ther: But you’re not sure?
Pt: Yeah, I’m…. I guess… I’m depressed all right.
Ther: Did you know that when you came in, or did you just figure that out?
Pt: I guess I knew it when I came in… sorta, anyway.
Ther: But you said you didn’t know. I’m puzzled.
Pt: Well, I guess I kinda knew, but… (long pause) My wife and I had this big argument last night, and…
Ther: (interrupting) Is this about your depression?
Pt: Yeah! See..
Ther: (interrupting) We can come back to that in a few minutes. I’m feeling unfinished about what we started with.
Pt: (looks puzzled) What….?
Ther: When you said you didn’t know what was the matter with you, but then later you said you did know. I said I was puzzled by that.
Pt: I don’t know what you mean (half-smile, looks down, then back up).
Ther: (Thinks “Now I have to make a choice, to stay with the earlier confusion or this second instance, because he certainly does know what I mean. The pattern is he professes to be confused when he really for some reason doesn’t want to connect directly. I’ll stay with the current instance because it’s the same issue but maybe a little clearer…”) (smiling) Why do you say you don’t know what I mean when in fact you do? Seems to be almost habitual.
Pt: It gives me time to think, I guess. Yeah, I guess that’s it.
Ther: (Thinks “He never says things straight out, but always with the ‘I guess’ or ‘soda’… I wonder if that’s part of the same mechanism”) Does it seem to you that you’re under time pressure to answer me? (before client can reply, therapist continues:) Take all the time you want (grins).
Pt: (looks uncomfortable) Yeah, I guess I…
Ther: (interrupts, says with emphasis:) No, take all the time you want.
Pt: What? Oh. I’m.. I guess I I don’t know why I do that.
Ther: I don’t agree with you. You do that so consistently, in such an organized way, that I’m convinced there is a specific purpose behind your behavior, even if it’s not easy to put into words.
Pt: I guess I’ve always done that.
Ther: (Thinks “At least he acknowledges what he’s doing. A step in the right direction ) (Half-way through a session.
Pt is a nurse who is chronically suicidal and sometimes depressed)
