The Patient’s Wish to Know Their Therapist
Curiosity, fantasy, and the therapist’s inner world
By Santiago Delboy
“Giorgio, Chicago (2023)” by Alejandro Yullo.
“I know you’re bored listening to me,” Dominic told me in the middle of a session. “I feel like I’m wasting your time—I don’t know what to talk about.” I also didn’t know what to say in that moment. I did not want to rush into an unhelpful reassurance, and an interpretation of his displaced aggression seemed out of place. I asked him to tell me more about what he imagined I might be feeling, why I was bored, or what he thought I expected of him. I tried my best to listen despite feeling somewhere between exposed and misunderstood. As he elaborated, he became increasingly frustrated because he was “making stuff up” about how I felt. I noted that he seemed unsure about asking me directly. After a brief silence, he said, “I don’t know if I want to know.”
Over the years, some of my patients have felt unsure, conflicted, or anxious about whether it is appropriate to want to get to know me. By knowing, I don’t mean learning about aspects of my life, my background, my preferences, or my past. While those questions come up from time to time, I believe they tend to be proxies masking a deeper and more anxiety-provoking wish: our patients’ wish to know their therapist’s inner world as it engages with their own. How do you feel about me? Will you judge me or hurt me? What are you thinking about when we’re silent? What is it like for you to see my most vulnerable parts? Can you relate? What do you struggle with?
Therapists, on the other hand, can also be guarded and ambivalent about being known and seen by their patients. Arguments like “it’s about the patient, not ourselves,” while reasonable, can be used defensively against the anxiety of being deeply seen, or as an expression of the therapist’s conflicting feelings towards their own needs and wishes. In contrast, other therapists might actually resort to oversharing for similarly defensive purposes. Disclosing aspects of our identity, values, attitudes, or personal struggles—often done in the name of authenticity—can be a way to define how we want to be perceived and, by extension, how we don’t want to be seen.
These thoughts were coming to mind after discussing, with the therapists at my practice, a classic 1991 paper in contemporary relational psychoanalysis, “The Patient’s Experience of the Analyst’s Subjectivity” by Lewis Aron. The paper explores how patients’ wishes to get to know and engage with the inner world of their therapists are not only appropriate but can also be seen as efforts to understand and connect with us. Welcoming that possibility may open the door for the development of a mutual relationship that can be useful and generative.
What follows are some reflections and associations elicited by this important paper. I believe Aron’s ideas can be useful for clinicians from any theoretical orientation, particularly for people who label themselves as “relational,” and especially for those of us who identify as psychoanalytic psychotherapists. They help expand our understanding and use of transference and countertransference, encouraging us to be open not only to our own subjectivity, but to the possibility of learning something new about ourselves that can be helpful for our patients.
The Wish to Get to Know
Over the past few decades, neurobiology and infant research have shown the ways in which we are “wired for relationships.” We need relationships not only to ensure our psychological and physical survival, but to understand and organize our internal experience, make sense of the world, and develop a sense of self, identity, and possibility.
These processes go beyond observable behaviors or conscious thoughts, involving a complex array of underlying dynamics, what some authors have called “implicit relational knowing.” This form of knowing is always embedded with unconscious wishes, conflicts, fears, longings, hopes, and expectations involving ourselves and others. The need, value, and use of relationships, the drive to engage and connect with the other, continues through our lifetime. As we grow up, these longings can be thwarted by trauma or defended against through ambivalence, denial, or dissociation.
The therapeutic relationship, Aron notes, engages the patient’s long-standing desire for connection. That desire may serve different purposes: seeking safety or comfort from internal distress, testing the contours of the relationship to ensure it allows for creativity and play, or expressing a wish for mutuality, recognition, and reciprocity. Drawing parallels with our earlier relationships, Aron posits that most patients want to know their therapists, not merely the superficial aspects of their life and experience, but the depth and complexity of their humanity.
This wish is often unspoken and never free of ambivalence, especially if our patients’ attempts for connection during childhood were responded to with rejection, engulfment, violence, or indifference. Some patients are intensely guarded against these wishes, disavowing any conflict, longing, or desire. People organized around narcissistic or schizoid defenses, for example, can reject, diminish, or feel terrified about the notion of being in relationship with another person. I remember a former patient angrily telling me, “Why do you keep saying ‘relationship’? I just come here and then leave—this is not a relationship!” The possibility of being in “relationship” can be laced with fears of disappointment, rejection, enmeshment, humiliation, or abuse.
Aron reminds us that it is essential to keep in mind that intersubjectivity requires the ability to truly recognize the other as a subject, an in(ter)dependent center of experience that is not a mere construction of our own needs, wishes, fantasies, and projections. This is a developmental capacity that cannot be taken for granted, even among patients who appear to be functional in their personal and professional lives, let alone with those experiencing significant trauma or severe psychopathology.
Many people come to therapy without being fully able to truly see their therapist as a separate subject, and it may take time for this capacity to emerge. This process of negotiation and discovery is often a central part of therapy, one the therapist can inadvertently undermine or distort through their investment in being perceived as a good object. While a positive transference (more on this concept later) can be essential to develop a sense of safety and trust that can deepen the treatment, it needs to emerge organically from the dyad, not be engineered by the therapist’s self-presentation.
Aron emphasizes that therapists need to tolerate not being seen as full subjects, sometimes for a long time. This can take many forms: patients who ignore or minimize anything we say, leaving us feeling hurt, rejected, or insecure—or patients who work very hard to be compliant and agreeable, leaving us feeling confident, valuable, and “good.” In both cases, it can be difficult for the patient to fully consider the possibility that the therapist is more than the degraded or idealized version they hold in their mind. The therapist needs to approach these dynamics with curiosity. Pushing too hard to assert our own subjectivity, prematurely seeking recognition, or inserting our experience, feelings, or perspectives might impinge on our patient’s process
I can hear some patients balk at the premise of “wanting to know” their therapist’s inner world. If you feel that way, I invite you to consider what comes up for you if you think about the possibility of knowing what is really in your therapist’s mind as they listen to you. Whether your reaction is Yes, please, tell me now! or Eew, no thank you! or anything in between, chances are that you would not be indifferent. Desire, ambivalence, or rejection inevitably hold implicit fantasies, assumptions, hopes, or fears about the therapist’s inner world.
These kinds of fantasies, Aron suggests, may arise as part of the wish to feel closer, to understand, or to make contact with the therapist. Patients develop beliefs, whether vague or precise, about what we think or feel. Sometimes they communicate these directly, by commenting on something they have noticed in us. I’m thinking here of a patient who noticed (accurately) my sadness during a session right after I received devastating news; and of another patient who (also accurately) realized how my expression and tone of voice revealed my level of emotional engagement with the material they shared.
More often, patients communicate these observations indirectly, perhaps by speaking about others or about themselves. It is common practice for psychoanalytic therapists to attend to ways in which their patients’ comments, reactions, and feelings involving people in their life might be attempts to communicate aspects of their experience of the therapist. Often what’s being said beneath the surface when talking about others are our patients’ understanding of and fantasies about us, becoming material for inquiry and exploration. Our unconscious always finds ways to convey what is too threatening, shameful, or anxiety-provoking to put in words.
At times, patients will probe more directly, sometimes insistently, but usually with questions about our “external” life—our background, interests, opinions, or experiences—and rarely about our internal world. The challenge of how to make use of these invitations or demands for self-disclosure is beyond the scope of this article. I’ll just say that always avoiding or always responding, without interrogating the meaning, fantasies, or wishes behind the questions, is probably unhelpful. Many patients will say they’re “just curious,” which is usually a way to foreclose exploration and a cover, conscious or not, for deeper questions, hopes, dreads, and fantasies about the therapist in relation to the patient.
Sometimes those questions might feel uncomfortable, aggressive, or intrusive. For some patients, the route to closeness involves challenge or confrontation. For others, curiosity may take a gentler form, yet still have a defensive quality. Being curious about the therapist can, at times, be a way to avoid being curious about oneself; in some cases, particularly when the therapist feels pressured or coerced, “curiosity” can be a way to control the therapist or the process. However, Aron reminds us not to reduce these moments to simple expressions of resistance or attempts to derail the treatment, but to also consider them as potential bids for connection and mutual recognition. There are many paths toward intimacy and not all of them are smooth.
As trust grows and the relationship matures, our patients’ questions might become more direct and vulnerable, but that doesn’t make them easier. Honest vulnerability can become more difficult the closer we are to each other. Over the years, patients have asked me things like “Are you mad at me?” or “Do you love me?” or “That hurt me—why would you say that?” These questions are always difficult and disorienting for a wide range of reasons. We might feel exposed, ashamed, or confused, pressured to be helpful or tempted to deflect. In my view, the value of our response lies less in how articulate our answer is and more in our capacity to remain open to our patient’s experience and to their desire for connection.
If the therapist is able to recognize and gently make room for these strivings, patients will attempt, consciously or unconsciously, to make inferences about who we are. Aron suggests that these are not always idle speculations or defensive projections. Rather, they represent a meaningful attempt to grasp something about the therapist’s subjectivity. At times it is the therapist’s own anxieties and resistance that get in the way. Aron believes that people drawn to our profession “have particularly strong conflicts regarding their desire to be known by another, that is, conflicts concerning intimacy.” That rings true for me: I believe that some of my patients’ ambivalence about getting to know me is entangled with my own ambivalence about being known.
Aron posits that most patients want to know their therapists, not merely the superficial aspects of their life and experience, but the depth and complexity of their humanity.
Why Does This Exploration Matter?
The exploration of a patient’s experience of the therapist’s subjectivity is, Aron argues, an important and underutilized part of the analysis of transference. Transference is the term psychoanalysts use to describe the ways in which we “transfer” relational experiences from the past into the present. Examining the transference involves exploring all the patient’s feelings, thoughts, and fantasies (conscious or not) that arise in the context of the therapeutic relationship. These experiences are shaped by the patient’s history, providing a unique opportunity for understanding and working through old relational patterns. Transference, Freud suggested, is a playground where past and present meet, an expression of how people repeat as a way to remember.
One of Aron’s main points is that transference dynamics are not only expressions of the patient’s history and intrapsychic processes. They are also shaped by the therapist’s conscious and unconscious participation in the present relationship. When patients reflect on or engage with their perception of who we are, what we feel, think, want, or need, they are not only expressing unconscious fantasies rooted in the past, but also revealing how they experience us. Aron suggests that the analysis of the transference ought to include an exploration of the patient’s perceptions and fantasies about the therapist’s countertransference, which includes all our own feelings, thoughts, wishes, and fantasies in relation to our patients.
It has been a long time since psychoanalysis stopped considering countertransference as only an obstacle or distortion, recognizing its usefulness, inevitability, and necessity for clinical work. Within a relational or intersubjective perspective, transference and countertransference are understood as co-constructed: They involve both the patient’s contributions (as in the classical view) and the therapist’s contributions. The idea of the “objective” therapist is brought to question, and our subjectivity can be seen not as an intrusion but as part of the fabric of the therapeutic relationship.
Being open and curious about our how our patients experience us can open space and create possibilities for a deeper exploration of their own inner world. Reflecting on how they relate to their therapist, what they imagine, anticipate, fear, or hope we might feel, can deepen their understanding of other past and present relationships. How they imagine us may echo how they once experienced their parents or other caregivers. The therapeutic space becomes a setting in which these inner templates can be reencountered and reflected upon.
Aron encourages therapists to not rush to connect “here-and-now” dynamics to the past, which can be done defensively by therapists to curb the anxiety of being in the spotlight. I have found it helpful to slow down and stay a bit longer in the present, inviting patients to tell me more about what they see. For example, at times I have followed Aron’s suggestion to ask patients to describe anything they have observed in me that may have contributed to their experience in the relationship or their perception of me. This is not about “making it about me,” but about supporting the patient’s capacity to trust that their experience and observations are not only important but helpful.
Further, when we receive the patient’s curiosity with openness and interest, we can help cultivate their own curiosity about themselves. Our responsiveness models a kind of reflective stance that can be internalized over time. When a patient alludes to the asymmetry of our relationship, noting that they know “nothing” about me, I sometimes gently challenge that notion and suggest that they might, in fact, know more about me than they give themselves credit for. They have access to my facial expressions, my tone of voice, my accent, the way I dress, the way I sit in the chair, my office décor. What do they make of all that?
By taking our patients’ observations seriously, we support their ability to attend to their own perceptions, trust their inner experience, and develop a deeper capacity for mentalization, that is, the ability to understand how thoughts, feelings, and mental states underlie behavior, others’ and our own. In this way, their engagement with our subjectivity becomes a path toward increased psychological complexity and self-understanding.
Keeping an Open Mind
For this process to be useful and generative, Aron emphasizes that therapists must be genuinely open to learning something new about themselves through the patient. I find this vitally important but incredibly difficult. My internal defensive reactions, my anxieties about being drawn into self-revelation, and the ways in which being seen can turn into being exposed can lead me to hear my patient’s perceptions as just “their stuff.” Aron warns against the tendency to hear our patient’s observations about ourselves as distortions, as only a reflection of their past displaced onto us.
I read his ideas not as an either/or choice, but as both/and. If we anticipate that everything a patient sees in us is based on their past relationships, we may miss the opportunity to learn something true or useful about the patient (and about ourselves) or to engage in a mutual relationship that can be transformative. The work depends on holding a deep sense of openness and humility, a willingness to consider that the patient might, at times, be seeing us in ways we did not see ourselves. If we are to believe that we are not masters in our own house, as Freud said of the ego, we might consider that others, including our patients, can hold some of the keys to the doors we cannot open, or even see.
This kind of openness is not always easy to sustain for the therapist, leading to resistance for such exploration. We may feel exposed, judged, or vulnerable about being seen. Some patients’ observations can be difficult to hear, unsettling, or painful, evoking shame or defensiveness. We might find ourselves pulled toward self-disclosure, not because it would serve the patient, but because we want to correct or control how we are perceived. At times, we might worry about being too visible, too intriguing, or too seductive. The boundary between meaningful engagement and overexposure can feel blurry and fragile. There are no predefined rules of engagement for this kind of practice. Aron highlights that each dyad will need to negotiate, navigate, and co-create its own journey.
There are, of course, real risks involved in the exploration of the patient’s experience of our subjectivity. This process can become subtly (or not so subtly) self-serving. We may begin to impose ourselves on the patient’s process, insisting on being understood, demanding recognition, or forcing our opinions and perspectives. This can be especially problematic when the patient has not yet developed the capacity to see us as separate subjects. In such cases, what begins as a legitimate exploration can quickly become an attempt to meet our own narcissistic needs.
I believe this risk is heightened when those needs are dissociated, disavowed in the name of self-sacrifice and in the service of being a good object: all loving, all understanding, always empathic and attuned. In these cases, a focus on how the patient sees us can easily become a preoccupation with how we want to be perceived. If we are not careful, our own hunger to be known, to be heard, or to be right can distort the therapeutic frame, leading to a pleasant but sterile treatment at best and causing real psychological and emotional harm at worst.
There is also the danger of collapsing space for uncertainty and ambiguity, undermining what Keats and Bion termed negative capability, an essential aspect of clinical work. If we rush to confirm or deny the patient’s perceptions, if we answer every question or provide too much information, we may rob the patient (and ourselves) of the opportunity to sit with the unknown. Ambiguity, though often uncomfortable, is part of what allows depth and complexity to unfold. The therapeutic process requires room for not knowing, for wondering, for grappling with competing meanings. Too much clarity, too soon, can flatten the work.
Aron invites us to hold all of this with care. The patient’s experience of our subjectivity is not a distraction from the work, but a central part of the work. Addressing this experience is a delicate, layered process that requires thoughtful attention. We must stay open to being seen, while also tolerating misrecognition. We must listen for the patient’s fantasies without rushing to correct them. And we must be willing to learn something about ourselves, even, perhaps especially, when what we learn is uncomfortable.
By attending to the patient’s experience of us, we make space for them to attend more fully to themselves. In this way, the mutuality of the therapeutic relationship becomes a space for growth, not only through what we offer, but through what we are open and willing to receive.
Santiago Delboy, MBA, LCSW, is a psychotherapist in private practice in Chicago. He is clinical adjunct faculty at the Chicago Center for Psychoanalysis. His work has been published in Psychoanalytic Dialogues, Psychoanalytic Inquiry, and Revista de la Sociedad Peruana de Psicoanálisis.
Potentially personally identifying information presented that relates directly or indirectly to an individual, or individuals, has been changed to disguise and safeguard the confidentiality, privacy, and data protection rights of those concerned.
Published November 2025