All this represents different kinds of challenges. Patients are being asked to reveal something of themselves to a stranger about whose capacity for empathy and ability to put them at their ease they are initially unsure of. They will be asking themselves whether the practitioner is a safe person to whom to show any vulnerabilities, those which all of us may wish to hide from others, but which reveal the true nature of why we are seeking help. The practitioner, too, will be trying to adapt to the many different ways patients present themselves in the unfamiliar situation they find themselves in.
There is a great skill in helping a patient overcome their natural reticence at opening themselves up to another person. We have to learn ways of convincing our patients that we are a safe repository for self-exposure of this kind. We need to know what kind of a relationship with their practitioner our patients feels comfortable with, since for each person this differs. Some, with a trust in human nature, will assume that anybody in the guise of practitioner will be worthy of this trust. Others, at the other end of the spectrum, will take much longer and request much greater evidence from their practitioner that the practice room is a safe place before lowering their defences.
The initial encounters between patient and practitioner are therefore delicate affairs, requiring great sensitivity on the practitioner’s part to all the little signs we give out indicating where others must tread warily when they approach us. If practitioners do not pick up such signals, we are very likely to act too clumsily and effectively silence our patient. Here, as with all things, a knowledge of the elements comes to the practitioner’s aid. For each element demands a different approach from us. And as we get better and better at analyzing the complex nature of each approach, this will give us increased insight into what may well be our patient’s element.