James Tobin, Ph.D.

Key Points

• A spontaneous word, image, or phrase (naming) may capture something about a patient’s experience that neither therapist nor patient has previously articulated.
• The significance of such a phrase often emerges afterward, as therapist and patient explore together what makes it feel accurate.
• Sometimes naming brings a passing feeling into focus. At other times, it may reveal an enduring feature of how a person experiences themselves or relates to others.
• Naming is not necessarily interpretation. A description may become meaningful before its psychological origins or implications are understood.
• Recognition does not automatically produce change, but it may allow a person to become curious about aspects of themselves that have long remained difficult to recognize.

A patient was describing an especially troubling encounter with someone who had been critical of her and demeaning. The encounter itself might last only a few minutes, but my patient carried it home and continued it privately, for days. She would examine what had been said, reconsider her own behavior, recall a string of other unrelated failures, and search for evidence that the criticism had been justified. Eventually, the original exchange became almost incidental. What remained was an elaborate process of self-punishment in which one humiliation summoned another, until my patient found herself inhabiting a psychological atmosphere far more corrosive than anything the other person had actually said.

After hearing versions of this experience repeatedly, I remarked, “You end up taking an acid bath again.”

She looked at me and smiled. Not because the experience was amusing, exactly, but because something about the phrase I had used seemed immediately recognizable.

We lingered over it. What was it about an acid bath that seemed to fit? The corrosiveness, certainly, but also the immersion. She was not simply remembering something painful. She was entering an emotional environment in which one criticism seemed to contaminate everything else she knew about herself. And there was something disturbing about the fact that she was both the person suffering and the person perpetuating the experience.

Several weeks later, while describing an interaction with her boss, she said, “I could feel myself starting the acid bath.”

I remember being more struck by that second moment than by the first. She had begun using the phrase herself, but that alone was hardly remarkable. Patients often remember things I say. Sometimes they adopt my language because it seems useful or because they sense that I regard a particular formulation as important. But in this instance, what seemed significant was that she had recognized something about her experience while it was happening, something that had previously been difficult to distinguish from the experience itself.

I had not told her why I thought she did this to herself. We had discussed her history, of course, including experiences of criticism, humiliation, and the particular moral intensity with which she regarded her own shortcomings. The phrase had explained none of that. But it had given us a way of recognizing the experience and, perhaps more importantly, of becoming curious about its particular character.

I have spent much of my professional life trying to understand why people suffer as they do. I have listened for unconscious conflicts, explored developmental histories, and considered the ways relationships become organized around expectations established long before the present relationship existed. I still do these things, and I regard them as indispensable. Yet I have become increasingly attentive to moments when something considerably less elaborate seems to happen.

As I listen to a patient, a word or phrase sometimes occurs to me without my having consciously considered or evaluated it. I say it, often quite spontaneously. Occasionally, the patient responds with an immediate sense of recognition. And what follows can be more interesting than the original remark: we begin exploring what the word captures, what it leaves out, and why this particular description seems to fit.

Sometimes the discovery is relatively modest: a word captures a feeling that has been difficult to describe. At other times, I am surprised to find that the phrase touches something much more central—a familiar way of experiencing oneself or relating to others that has become so much a part of the person’s identity that it has never quite been recognized as something distinctive.

I have come to think of this as a kind of naming, although the term may be too simple. It suggests that something already fully formed is waiting to be labeled. What interests me more is the possibility that, in finding a name, we may also discover something about the experience that was not previously apparent.

Perhaps that is part of the difficulty. I am trying to find a name for the act of naming.

Something “Sticky”

Another patient had been describing a neighbor who had recently moved into her building. From the beginning, she had found the woman unusually friendly, almost excessively so. The neighbor greeted her enthusiastically, initiated conversations whenever they encountered one another, and seemed eager to establish a relationship. My patient was skeptical of this friendliness, although she could not identify anything particularly objectionable about it.

Several weeks later, the neighbor’s dog began barking frequently. My patient was increasingly irritated but reluctant to confront her, worried about creating an unpleasant relationship with someone she would continue to encounter regularly. Meanwhile, the neighbor remained effusively friendly, initiating conversations even when my patient was hurried or trying to leave.

My patient wondered whether the friendliness was an effort to prevent her from complaining about the dog. She described the neighbor as annoying, intrusive, and manipulative, but none of these words seemed quite satisfactory.

As she spoke, she began searching more deliberately for a word that would capture what was so objectionable about this woman. Intrusive was part of it, but not quite right. Manipulative seemed too strong, or at least too certain about the neighbor’s intentions. Overly friendly described the behavior without conveying why it bothered her. She knew the feeling she was trying to communicate, but the available words seemed to miss something essential.

I had the impression that she was struggling less to understand what the neighbor was doing than to communicate what it felt like to be with her.

“Sticky,” I said.

She stopped.

“Yes. Exactly. Sticky.”

I had not considered the word beforehand. It occurred to me as she was speaking, and I offered it without knowing precisely why it seemed appropriate.

But her response made me curious. What, exactly, was sticky?

As we explored the description, it became apparent that the word captured a peculiar interpersonal sensation. The neighbor’s friendliness seemed to create an expectation of reciprocal warmth. My patient felt drawn into conversations she had not chosen and found it difficult to disengage without feeling unkind. Even a polite withdrawal seemed to require a small act of rejection.

The word conveyed something about the difficulty of separating herself from the encounter. The friendliness was not simply excessive; it seemed to adhere to her, creating an obligation she had never explicitly accepted.

Annoying described her judgment of the neighbor. Manipulative suggested something about the neighbor’s intentions. Sticky described the experience of being with her.

I still did not know whether the neighbor intended any of this. Perhaps she was lonely, socially awkward, or simply more outgoing than my patient. Perhaps the barking dog had altered the meaning of behavior that would otherwise have seemed harmless. All of these possibilities remained open.

But we no longer had to establish the neighbor’s intentions to understand something about my patient’s discomfort. The word sticky had shifted our attention from an uncertain judgment about another person toward the particular quality of an experience.

As we continued exploring the feeling, I wondered whether there was something familiar about it for my patient beyond this particular neighbor. Had she experienced other relationships in which another person’s friendliness or expectations seemed to leave her little room to withdraw? Was there something about her own difficulty with disappointing people that made these encounters feel especially uncomfortable?

I did not know. But the word had given us a way to become curious about whether this apparently ordinary irritation belonged to something larger in her experience.

The word itself was almost embarrassingly ordinary. It belonged to no technical vocabulary. Yet it had allowed us to articulate a dimension of the encounter that neither of us had previously described.

“Talking to Herself”

In another illustration, consider a recently retired couple, both physicians, whose youngest child had just graduated from college. For the first time in decades, their days were no longer organized around medical practice and raising children. With considerably more time together, they found themselves having difficulties they had not previously experienced.

They described their presenting problem for initiating couples therapy as “poor communication.” She complained that he did not listen; he complained that she talked endlessly without arriving at a point. She felt dismissed; he felt overwhelmed. Their disagreements seemed to follow a familiar pattern, but the usual explanations did not entirely capture what was happening.

During one session, the wife began describing an incident involving a friend. She moved from one detail to another, considered several explanations, interrupted herself to recall an earlier event, and wondered aloud whether she has misunderstood the situation altogether. Her thoughts seemed to develop as she spoke. She appeared animated by the process itself.

Her husband listened for a while before asking what she wanted him to say.

She became irritated. He looked exhausted.

The familiar disagreement is about to begin, I thought to myself. He wants clarity; she experiences his questions as impatience. But another possibility occurred to me: perhaps she does not particularly want him to say anything.

I wondered aloud whether she was trying to communicate a specific point or whether she merely wanted to be able to talk to herself in his presence.

The phrase initially sounded peculiar. Talking to herself? Why would she need him there?

But exploring the possibility revealed something about the kind of companionship she seemed to be seeking. For much of her adult life, talking had been purposeful. In medicine, she communicated to obtain information, make decisions, and coordinate care. At home, conversation revolved around raising children and managing family life. There had been relatively little room for speech that did not need to accomplish something.

Now she appeared to want to wander, speculate, reconsider, and discover what she thought in the course of saying it. She wanted to play in her talk, I said to the couple, allowing thoughts to develop without knowing where they led. And she wanted her husband there.

As the couples therapy evolved, it became clear that the problem was not simply “communication,” but a form of companionship she now desired in which her thoughts could remain unfinished without becoming a problem for someone else.

“There Is That Hesitation Again”

In the third year of her therapy, a woman described to me a persistent difficulty in identifying what she genuinely wanted. She was uncertain about her relationship, her work, even relatively ordinary decisions. She regarded herself as chronically indecisive, a characterization I had little reason to question.

But gradually I noticed something peculiar. She often did seem to know what she wanted until she began imagining how another person might feel about it. A preference would appear, sometimes quite clearly, and then disappear beneath a succession of qualifications. Was she being selfish? Would someone be disappointed? Did the other person have a stronger claim?

One afternoon, she was speaking with unusual clarity about what she wanted from a particular relationship. Suddenly she stopped, reconsidered, and began explaining why her preference might be unreasonable.

“There is that hesitation again,” I remarked.

She looked at me. For a moment neither of us spoke.

What interested me was not simply that she had hesitated. It was the particular moment at which the hesitation appeared. She had not been uncertain from the beginning. Her uncertainty emerged when she began considering the possible consequences of having a preference of her own.

We returned to that moment in subsequent sessions. She began noticing how frequently she would recognize what she wanted, only to become uncertain when she imagined how someone else might respond. This occurred with her partner, her mother, and people at work.

What she had understood as indecisiveness began to look like something more particular: an initial awareness of her own wishes, followed by a retreat from them when she anticipated another person’s disappointment.

We eventually explored a childhood in which she had been praised for being accommodating and in which disagreement could leave her mother visibly hurt. But these recollections became meaningful largely in relation to something we had already begun to recognize in the present. Her difficulty was not simply that she could not make decisions. It was that her awareness of what she wanted became difficult to sustain when another person’s feelings entered the picture.

What intrigued me most about this phase of our work together was how easily we had accepted indecisive as a description of her difficulty. It was not entirely inaccurate, but it had obscured something important. My patient was often quite capable of knowing what she wanted. The difficulty arose when she imagined that expressing her wishes might disappoint or hurt someone else.

My remark about her hesitation had been spontaneous. I had not consciously considered what I was observing or decided that it warranted an interpretation. But once I said it, we had something to examine together. We could return to the moment when she began doubting herself, consider what she had been feeling just beforehand, and become curious about why another person’s possible disappointment could so quickly unsettle her confidence in her own wishes.

The phrase had not explained her difficulty. But as we returned to it, I began to appreciate that the hesitation was not simply an occasional interruption in her decision-making. It reflected something more enduring about her relationship to herself. She had learned to experience her own wishes as potentially troublesome to others, and accommodating their feelings had become so familiar that she scarcely recognized the extent to which it shaped her identity. What had initially seemed like an ordinary observation opened onto something much more central about how she had come to live.

Finding the Words Together

I do not ordinarily sit with patients consciously searching for memorable descriptions. The process is more spontaneous than that. As I listen, I may find myself drawn to a particular aspect of what the patient is saying, or to a quality of the experience that has not yet been expressed. Sometimes the patient is struggling to find the words. Sometimes neither of us is aware that anything is missing until a phrase occurs to me.

I may offer an adjective, a metaphor, or an ordinary expression without having consciously reviewed its appropriateness. The phrase has not been carefully selected from several alternatives. It has simply come to mind in the course of our conversation.

This does not mean that the word is arbitrary. My response emerges from listening, from my familiarity with the patient, from the emotional character of the encounter, and from associations I may not have consciously considered. But I cannot always reconstruct why one particular expression occurred to me rather than another.

The spontaneous quality of the remark is important, although I would not want to romanticize it. Spontaneity is not a guarantee of insight. A word may reflect my own preoccupations, assumptions, or misunderstandings. It may sound apt to me and entirely wrong to the patient.

What interests me most is what happens after the word is offered.

When a patient responds with recognition, I want to know what has been recognized. What about the word feels right? Is it the image it evokes, the emotional quality it conveys, or something less obvious? Does it describe the whole experience or only one part? Does the patient associate it with something I had not anticipated?

In this sense, the word is not the conclusion of an interpretive process. It is a beginning.

The patient and I may discover that we understand the phrase differently. A word I intended to convey discomfort may evoke shame, resentment, longing, or something entirely unexpected. Sometimes the patient revises my description, replacing it with something more precise. Occasionally, the original phrase proves inadequate, but the attempt to understand why it does not fit leads us somewhere useful.

I have come to value this movement from spontaneous expression to deliberate exploration. Something is first said without being fully understood; then, together, we try to understand what has been said.

The process reminds me of Michael Chekhov (1891–1955), the Russian-born actor, director, and influential acting teacher who developed an approach to performance emphasizing imagination, expressive movement, and the relationship between physical form and psychological experience. In To the Actor, Chekhov (1953) described the psychological gesture, an expressive bodily movement through which an actor might discover aspects of a character’s inner life rather than merely illustrate an interpretation already formed.

The analogy is suggestive of naming in psychotherapeutic process, although the two activities are not equivalent. In Chekhov’s approach, an expressive form can help generate psychological understanding. In a therapeutic conversation, something similar may occur when a word emerges spontaneously. The word or phrase does not necessarily express an understanding already achieved; rather, its meaning may become apparent only after it has been spoken and explored.

There are also important psychoanalytic antecedents to this way of thinking.

Donnel Stern’s (1997) concept of unformulated experience seems especially relevant here. Stern describes aspects of subjective experience that have not yet acquired a form in which they can be clearly recognized or thought about. What interests me is that these experiences are not necessarily remote or unfamiliar. Sometimes they are so deeply woven into a person’s ordinary way of living that they scarcely attract attention. A spontaneous word or phrase may bring one of these experiences into view, and the subsequent conversation may reveal how much of the person’s life has been organized around something neither of us had previously been able to describe.

Thomas Ogden (1994), in his account of the analytic third, offers a complementary perspective. He describes how the analyst’s subjective experience, including reverie and seemingly incidental mental activity, may provide access to aspects of an experience generated within the analytic relationship. The analyst’s impressions are not treated as transparent knowledge of the patient. They become material to be considered and understood within the encounter.

Neither theory provides a complete explanation of the clinical activity I am describing, and I would hesitate to claim that every spontaneous phrase represents some profound intersubjective discovery. Sometimes a word is simply a word.

Still, these perspectives help me understand why a description may emerge before I can explain it, and why its significance cannot be established by my conviction alone.

There is a difference between offering a word because I believe it is correct and offering it because I wonder what it might reveal.

The latter leaves room for the patient’s experience to surprise me.

The Experience of Being Found

There is another dimension to these moments that is harder to describe.

Occasionally, a patient becomes quiet or unexpectedly moved after I offer a word or phrase that, considered simply as information, is not particularly remarkable. I have not changed the past or resolved the patient’s problems. Yet something about hearing the words from another person seems to carry a significance that exceeds their descriptive accuracy.

I wonder whether part of what matters is the experience of being recognized.

Many people have spent years surrounded by others who know the facts of their lives without knowing how those facts are experienced. Parents may know their children’s accomplishments and difficulties. Spouses may know each other’s habits and preferences. Friends may know the stories that have been told for decades. Yet something essential about a person’s inner life—what is feared, what must be concealed, what becomes impossible in the presence of another’s disappointment—may remain unrecognized.

People can be described accurately and still feel profoundly unknown.

What may matter is not simply that I have found a description the patient recognizes, but that we are trying to understand the experience together. When a word or phrase seems to fit, I become curious about why it fits, what it captures, and what the patient recognizes in it. The patient is not merely receiving my understanding but participating in its development. Something that may have been difficult to articulate becomes the subject of a conversation in which both of us are discovering its meaning.

There is also a risk here. A patient who responds, “Yes, exactly,” may be expressing genuine recognition, relief at being understood, pleasure in my interest, or a wish to agree with someone whose approval matters. I can become attached to a particularly satisfying formulation, and a patient may adopt it without finding it useful.

This is especially important in psychotherapy, where the desire to be understood can coexist with a willingness to accommodate the person doing the understanding. A patient who has spent years subordinating their own experience to another person’s perspective may do precisely that with me.

For this reason, I try to remain curious about the patient’s response rather than treating agreement as confirmation. A useful description should be open to correction. It may be revised, complicated, or abandoned. Otherwise, naming risks becoming another occasion on which someone else’s understanding takes precedence over the patient’s own.

What Becomes Visible

The woman who described taking an acid bath eventually began recognizing the experience without my assistance. Sometimes she could sense herself entering it even as it was happening. She was not necessarily able to stop. But she had begun to notice something about herself that had previously seemed inseparable from who she was.

What stayed with me was how unexpectedly we had arrived at that recognition. I had not set out to identify a particular pattern or find a memorable phrase. The words had occurred to me in the course of listening, and something about them had resonated. Only afterward did we begin to discover what they captured.

I think this is what continues to interest me about these moments. A patient may spend years describing difficulties in relationships, recurring disappointments, or feelings that seem impossible to explain. Then, in the course of an ordinary conversation, a word or phrase emerges that seems to touch something central about how that person experiences the world, other people, or themselves.

Sometimes it is a feeling that has never quite had a name. Sometimes it is a wish the person has not recognized as their own. Sometimes it is a familiar way of responding to others that has become so much a part of the person’s identity that it is scarcely noticed.

I do not always know why a particular word occurs to me, and I am often surprised by what the patient recognizes in it. We may spend the next several minutes, or return to it over subsequent sessions, trying to understand what makes the description feel so accurate. The original phrase may change as we explore it. What matters is not that I have found the right words, but that we have found something worth understanding together.

There is something particularly moving about these encounters. I may have known a patient for years, heard countless stories, and developed a fairly elaborate understanding of their life. Yet an ordinary phrase can unexpectedly bring us closer to something essential that neither of us had quite recognized.

Perhaps this is what I value most about these moments: their spontaneity, the surprise of recognition, and the experience of discovering something together that neither of us knew we were looking for.

Questions & Answers

1. Why can finding the right words for an experience be therapeutic?

A word or phrase may give a recognizable form to an experience that has been difficult to articulate. Its value may become clearer when the therapist and patient explore what the description captures, what it leaves out, and what new questions it makes possible.

2. How is naming different from interpretation in psychotherapy?

Interpretation generally seeks to clarify the meaning, origins, or psychological function of an experience. Naming may begin with an immediate impression or description, before these explanations are available. Rather than supplying a conclusion, it can become a starting point for collaborative exploration.

3. Does recognizing a psychological pattern mean that it will change?

Not necessarily. A person may recognize a recurring pattern and still feel compelled to repeat it. Recognition may nevertheless make it possible to examine the circumstances, feelings, and expectations that sustain the pattern.

References

Chekhov, M. (1953). To the actor: On the technique of acting. Harper & Brothers.

Ogden, T. H. (1994). The analytic third: Working with intersubjective clinical facts. The International Journal of Psycho-Analysis, 75(1), 3–19.

Stern, D. B. (1997). Unformulated experience: From dissociation to imagination in psychoanalysis. Analytic Press.

Disclaimer

This essay is intended for educational and reflective purposes and does not constitute psychological advice, diagnosis, or treatment. The clinical vignettes include illustrative or fictionalized material as well as experiences drawn from clinical practice. Identifying details have been altered or omitted where applicable to protect confidentiality. The interpretations offered reflect the author’s clinical observations and are not intended as definitive explanations of any individual’s psychological experience.

About the Author

James Tobin, Ph.D., is a licensed clinical psychologist in private practice in Irvine, California, with more than 25 years of clinical experience. He earned his undergraduate degree magna cum laude from Harvard University, an M.F.A. in creative writing from Indiana University, and a doctorate in clinical psychology from The Catholic University of America. He completed postdoctoral training at Massachusetts General Hospital and Harvard Medical School, where he subsequently served as a staff psychologist and Clinical Instructor.

Dr. Tobin provides individual, couples, and family psychotherapy, with particular interests in relationships, personality development, self-esteem, emotional conflict, and the enduring influence of early relational experience. His clinical approach is informed by psychodynamic and psychoanalytic thought, particularly object relations, self psychology, relational psychoanalysis, and contemporary theories of intersubjectivity. His writing explores the intersections of psychological experience, identity, relationships, and the therapeutic process.

Website: https://jamestobinphd.com/