The Patient Who Wouldn’t Be: The Clinical Problem of Patients who Lack Interest in their own Experience

About this training

There is a class of patients who can be difficult to treat because they present as having an absence of interest in their own subjective experience. In a way these are patients who have difficulty being patients. More generally, they have difficulty experiencing or living in what Winnicott (1954) refers to as “going on being,” a healthy flow of emotions and creative impulses that create internal vitality and the basis of thoughtful, meaningful engagement with others and the world. These patients do not present as having a problem that Killingmo (1989) would refer to as either an “internal conflict” or a “deficit,”nor do they seem to suffer from trauma, dissociation, or emotions that are overwhelming. They are neither emotionally dammed up nor emotionally flooded. Rather, they report a problem of being relatively “emotionally arid” and are authentically unclear if this is a problem for them or only for those around them. This talk discusses how such patients’ problems can be better understood psychoanalytically, paying particular attention to how their problems may be related to developmental histories that are superficially good enough but where caregivers were “soul blind” (Novick and Novick 2022) or unable to be curious about and receptive to their child’s emotions. Finally, we will discuss some ideas on how to proceed in treating them derived from the work of Ogden (2025) and also Goldberg (2025). Upon completion of this workshop, participants should be able to: Differentiate among intrapsychic conflict, deficits in emotional containment, and impairments in the capacity to experience continuous emotional being (“going-on-being”) Define the term “soul blind” as a description for some parents and how absence of interest in a child’s mind during development is often described by such adult patients who have difficulty “becoming patients.” Define the construct “soul blindness” in caregiving and explain how a caregiver’s lack of interest in a child’s mental life during development may contribute to later difficulties engaging in the patient's role in psychotherapy. Define and identify 2 clinical challenges of applying traditional interpretive interventions or affect-containment strategies to patients who are neither intrapsychically conflicted nor affectively overwhelmed but instead present with emotional constriction or aridity. Describe the importance of orienting the patient to "the frame” and psychotherapeutic neutrality for generating here and now interest in the patient’s internal world. Describe three areas of convergence and divergence, and identify two questions for further clinical inquiry, among emotionally constricted patients, individuals identifying as high functioning or mild autism, patients presenting with alexithymic features, and those conceptualized as occupying the autistic–contiguous position.