How We Miss Our Chance to Help People We Care About

“Have a seat,” I said. “How can I help you?”

“Well,” my patient began, “it’s kind of embarrassing to admit this, but—it’s elevators! I’m deathly afraid of elevators.”

I should have noticed the oddly calm expression on Sabrina's face as she said this, the lack of sweat on her brow. After all, she must have either endured a panic attack or a five-floor walk-up just moments ago to reach my office. But I was a newly trained psychologist, and after five years of classes and supervised practice, I was attuned mostly to problems for which I knew the answer. “Specific phobia” was one of them.

Treatment for phobias was supposed to involve “graded in-vivo exposures” and would be highly effective. I explained this to Sabrina, who accepted my treatment plan. We practiced deep breathing and relaxation techniques, working up to our fourth session, which we spent on the elevator. She whimpered a bit, but it all came and went without a lot of theatrics. It seemed oddly superficial.

Afterward, she asked to meet again the next week. Having no further ideas for how to treat this patient, I sheepishly sought consultation from a supervisor, a veteran psychoanalyst whose dimly lit office resembled a canyon constructed from stacks of folders, legal pads, and dog-eared psychology journals.

As I described the case, Dr. M chuckled and crossed his loafers up on a chair piled high with envelopes. “Elevator phobia?! She doesn’t have an elevator phobia. I could have told you that. She’s used that one with the last five interns. They all ride up and down with her, and then she disappears.”

I cringed, embarrassed to be stereotyped as just another inexperienced therapist.

Dr. M took pity on me. “How did she seem, though? What were your impressions?”

This was his method of analytic supervision, very different from my prior diagnosis and action-oriented training. Dr. M would invite me to hold the patient in my mind’s eye and paint a verbal picture of the session, including any and all details I could recall.

Then we would gaze at this imaginary portrait together, as if sitting quietly in an art gallery, noting which details captured our attention and wondering what it all meant. By the end of the supervision hour, I wouldn’t necessarily know what to do in my next session with the patient, but I would have a fresh and vivid sense of the person, which seemed somehow to help.

And so, when Sabrina returned the following week, rather than focusing on how I would help her, I simply asked her how her day had been. And she began to talk. And talk. And talk.

For nearly three years, I saw her every week. She talked about her father’s addiction, his charisma, and her yearning for his approval, even after his death. Her sense that she and her siblings had failed to launch, all still living in their childhood home, frozen by grief and a creeping sense of inadequacy. Her shame about using food to soothe her stress and her feeling of being too much, too dark, too soft, too big, and too emotional. Her envy of other women, who seemed effortlessly confident. Her embarrassment that her family didn’t have a Pinterest-worthy house or eat nightly dinners together, or even particularly like each other half the time.

Sometimes I felt like the therapy was slow-moving and repetitive; I wasn’t doing enough. I wasn’t sure how much Sabrina was benefitting, despite having logged well over a hundred hours with her. Until one day, a research psychologist stopped in front of my open office door.

“I bumped into Sabrina leaving your office the other day,” she mentioned. “Are you still seeing her for therapy? My goodness, she looks like a different person! When we had her in a study years ago, she could barely leave the house.”

I blame my initial fumble with Sabrina on what psychologists call the righting reflex, the impulse to help a person by fixing their problem, giving them advice, or minimizing their issue. The righting reflex stems from good intentions, but it often gets in the way of actually being helpful. By slowing down and working to understand the nuances of another person’s dilemma, we learn how we might eventually be of service. We also help by listening, which is often the most useful and generous act we can offer.

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When I first met Sabrina, I was so eager to prove that I was smart and useful that I didn’t listen particularly well. Although some people do benefit from learning relaxation techniques or confronting phobias, what Sabrina needed was a safe place to sort through her shame and self-doubt. Her problem wasn’t elevators, and my job wasn’t to fix her.

We make this mistake in all kinds of relationships, not just in therapy. Think of the last time your spouse complained about a noxious coworker or your friend worried about their love life. You may have pointed out potential solutions or wished you were able to fix the situation for them. But your friends don’t really expect you to solve their problems. They may not even want your advice. What they want are your interest and understanding.

The righting reflex shows up in all relationships where we care about another person. As a family therapist, I spend a lot of time observing the righting reflex wreaking havoc on parent-adolescent relationships. When young people encounter problems or express distress, parents are quick to jump in with advice or assistance. But teens are often annoyed by this reaction; they interpret their parents’ interventions as meddling, condescending, or critical.

They wish that adults could be patient listeners, not fixers. They might be willing to accept advice, but not from people who undermine their competence and autonomy. I write about this in my book, The School of Hard Talks: How to Have Real Conversations with Your (Almost-Grown) Kids. The first step is simple but difficult: As Buddhist psychotherapist Sylvia Boorstein put it, don’t just do something, sit there.

To find a therapist, visit the Psychology Today Therapy Directory.