Paul L. Wachtel. Therapeutic Communication: Knowing What to Say When
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«One of the situations in which finding and building on whatever assets the patient has is most challenging—but also most important—occurs when the patient claims not to be feeling anything at all. One is confronted with such a state of affairs most often with obsessional and schizoid patients, and not infrequently the patient’s report of no feelings is conveyed with a tone of considerable discouragement and even despair.

An approach to this situation that I have found useful is to say to the patient something like I think that you have some idea of what you should be feeling, and because you’re not feeling that, you register it as not feeling anything.

Then, depending on the exact nature of the case (that is, depending on just what I did think the patient was experiencing), I might say something like Indifference is a feeling too. It’s not that you’re not feeling anything. You’re feeling indifference. In fact, you’re feeling a **great deal** of indifference.

Several patients have reported that this emphasis on there being something that they are feeling (albeit not what they think they are supposed to be feeling) has enabled them to avoid the discouragement and the battles that had occurred in previous therapies, where they felt the therapist was criticizing them for holding back or that he was telling them that they were less than human. (One patient said he felt “like a reptile, cold-blooded and scaly,” when his former therapist kept hammering away at how he ran from his feelings. “I didn’t know what to do, how to satisfy him. I just kept feeling more and more inadequate, unworthy, inhuman.”)»