One of my most cherished aspects of my work as a psychiatrist is the privilege of “sitting with” my patients — slowing myself down and intentionally creating a space of listening and seeking to understand their stories and experiences. This concept of “sitting with” may sound simplistic, but I believe it’s quite the opposite. Some of my most memorable patient experiences and positive outcomes have come not from the efficacy of a novel medication, or from finding the right medication regimen, or even from knowing the right words to say — they have come from “sitting with.”
Sadly, “sitting with” is becoming an endangered art: In our current medical landscape, so much is hurried — appointment times are getting shorter and shorter, documentation poses a burden, clinicians face pressures for medication “quick fixes,” and more. And yet, it’s also a necessary art, one that harbors simple transformative power. In our increasingly atomized era, loneliness/isolation has been deemed a “significant public health challenge,” per this 82-page 2023 U.S. Surgeon General’s Advisory report. Taking a few extra minutes to really sit with our patients and nurse the inherent human need we all have to connect can help alleviate some of this loneliness. No matter our specialty, I’d say that those few minutes are well worth our and our patients’ time.
For me, the fact that “sitting with” has the potential to be in and of itself therapeutic was intriguing about practicing psychiatry. I regularly encounter patients who remind me of this simple act’s power. For instance, I once cared for someone who struggled with schizoaffective disorder. Throughout this patient’s chart, she had been labeled “non-compliant,” having frequently missed appointments and struggled to adhere to taking her medications. After being terminated by various other clinicians, this patient made her way to my office, where those behaviors continued — a missed appointment here, a skipped medication there ... we trudged along, however. I was able to engage her in supportive psychotherapy techniques and learned a lot about her.
Over time, it became clearer that the missed appointments and difficulty with taking her medications consistently stemmed not only from her underlying psychiatric disorder but also from a general mistrust of medical professionals rooted in trauma. This patient was also very lonely. Most of our appointments were me “sitting” — making my best attempts to listen to her, to work with her, to offer guidance and ask good questions. I was thankfully able to slowly build a rapport over time with her. The missed appointments became few and far between and we even found a medication regimen that was therapeutic and that she trusted taking. I am certain that the time spent building rapport and trust with this patient was the catalyst for her improved engagement in treatment. I don’t believe success would have been possible without first sitting with her and giving her time to tell her story.
Though it makes most sense in terms of relationship building, “sitting with” can be a crucial therapeutic tool even in some acute situations. In the book “The Will to Meaning,” the psychiatrist and Holocaust survivor Dr. Viktor Frankl describes an encounter with a patient who called him at 3 a.m. stating that she was suicidal. Frankl writes that he talked to her for 30 minutes, giving her all of the arguments he knew against suicide and finally convincing her to meet him at the hospital. Frankl then states, “But when she visited me there, it turned out that not one of all the arguments I offered had impressed her. The only reason she had decided not to commit suicide was the fact that rather than growing angry at having been disturbed in my sleep in the middle of the night, I had patiently listened to her and talked with her for half an hour, and a world, she found, in which this could happen must be a world worth living in.” This is a powerful example and one that truly inspires me to continue in the sitting, even if I don’t know the right words to say.
While the latter example is a more extreme and rare case and is not meant to replace sound judgment and decision-making and use of standard of care practices — and may not actually be possible or appropriate in scenarios where, say, a patient is agitated or acutely psychotic — my desire is to illustrate the endangered art of simply being present for our patients. While psychiatry comprises a lot of medication management, the additional practice within the specialty of holding a sitting space with patients has been a significant and productive part of my work.
Sitting with, nonetheless, can prove challenging. Barriers to it include but are not limited to: a multitude of administrative tasks, working within a managed care system, and if a clinician is feeling burned out. Additionally, I frequently find that some patients don’t want to be sat with; I recall one patient stating “I don’t want to talk. Just give me the med.” At the end of the day, whether it’s in the sitting with or prescribing a medication (or most commonly, both), I’ve learned that it’s ultimately about meeting the patient where they are — that’s the most therapeutic place.
What have you learned about patients from simply “sitting with” them? Share in the comments!
Dr. Mallory Grove is a psychiatrist in Seattle, WA. In her spare time, you can find her enjoying time with her family, thrifting, adding to her houseplant collection, baking, playing her flute, or learning to sew. Dr. Grove is a 2023–2024 Doximity Op-Med Fellow.
Illustration by April Brust
