The Presence That Fosters Growth

Reflections on Psychotherapy and Parenting

There is a question that has quietly accompanied me throughout my years as a psychotherapist. More than any theory I have studied or any technique I have learned, it has become the reflection that most consistently guides my work.

What does this person need from me now?

The answer is rarely found in technique alone.

 It begins with presence.

The answer is never fixed. As human development unfolds, what fosters growth at one stage of life may hinder it at another. As adults our mind states can also shift- sometimes rapidly- in response to changing emotional circumstances. Whether we are sitting with a patient or comforting a child, we are continually invited to ask not only What does this person need? but What does this particular moment require of me? The answer is rarely found in technique alone.

It begins with presence.

Presence is more than attentiveness or empathy. It is a way of meeting another human being with an openness to reality as it unfolds from moment to moment. It begins with receptive awareness—the willingness to remain present to what is emerging within ourselves, within another person, and within the relationship between us. Awareness creates space, yet on its own is not enough. Presence also requires discernment: the capacity to recognize the developmental, unconscious and relational meaning of what we encounter and to respond in a way that genuinely serves growth.

Presence is therefore not something we do as much as a way of being. It asks us to remain flexible enough to move between observation and participation, silence and words, validation and interpretation, holding close and creating space.

Mindfulness and psychoanalysis, though arising from different traditions, each illuminate an essential aspect of this way of being.

Mindfulness teaches us to remain open to experience before we rush to change it. Psychoanalysis invites us to wonder what unconscious meanings, relational expectations, and emotional histories are quietly shaping the present moment. Together they cultivate a presence that is both receptive and discerning.

One of the deepest questions in psychotherapy therefore becomes surprisingly simple:

What form must my presence take, at this moment, if it is to foster this person’s growth?

When people first enter therapy—particularly those whose lives have been marked by neglect, chronic shame, trauma, or emotional misattunement—the first task is often not interpretation or insight. It is to offer an experience that has been painfully absent: to be deeply seen, emotionally understood, and held within the mind of another.

Before patients can question long-standing assumptions about themselves or relinquish ways of protecting themselves that once ensured survival, they often need to discover that their inner world can be received without judgment, without dismissal, and without abandonment.

This capacity to hold another’s experience has long been recognized as one of psychotherapy’s most healing qualities. Yet healing does not arise from being understood alone. As trust deepens, the therapeutic relationship itself begins to evolve, and the therapists find themselves asking a different set of questions.

Is this a moment to remain silent?

To validate?

To wait?

To interpret?

To gently challenge?

There is no formula that can answer these questions. The response emerges from listening not only to the patient’s words but also to the emotional process unfolding between therapist and patient.

Years ago, I worked with a man who repeatedly asked me what career decision he should make. Each session I felt the quiet pull to answer. I could have helped him weigh the advantages and disadvantages of each choice, and perhaps he would have left feeling temporarily reassured.

Gradually, however, another question began to take shape.

The deeper issue was not which career he should pursue. It was why trusting his own mind felt so difficult.

Had I answered his question, I might have relieved his immediate anxiety while unintentionally reinforcing the belief that the capacity to make decisions always resided somewhere outside himself. What he needed was not another opinion but the experience of remaining with uncertainty long enough to discover that his own mind could think, reflect, tolerate ambiguity, and eventually choose.

Sometimes growth depends less upon receiving answers than upon discovering one’s own capacity to live the questions.

Validation, too, changes its meaning over the course of therapy.

Early in treatment, feeling deeply understood creates the safety from which deeper exploration becomes possible. It softens the vigilance that has protected people for years and allows experiences that have remained hidden to gradually emerge.

Yet there are moments when the therapeutic task changes:

A patient reaches a painful realization and begins to cry. As the tears deepen, another voice suddenly appears:

“I’m pathetic.”

“I should be over this by now.”

Our first impulse is often to reassure—to soften the harshness of the self-attack, to remind the patient that she is not pathetic.

But sometimes the self-criticism itself is serving an important psychological function. It interrupts vulnerability at the very moment something more tender is beginning to emerge. Shame rushes in before the feeling can be fully experienced.

In those moments, reassurance may inadvertently rescue the patient from the very experience that holds the possibility of transformation.

Instead, the therapist might gently observe:

“I notice that just as you began to feel something deeply painful, another part of you immediately began criticizing you.”

The interpretation does not rescue the patient from the feeling,

It preserves contact with it.

Rather than interrupting the emotional experience, it allows it to continue unfolding. What is being interpreted is not simply the patient’s self-criticism but the function it serves: protecting against a vulnerability that feels almost impossible to experience directly.

Again and again, psychotherapy asks us to move fluidly between different forms of presence. At times healing requires that we hold another person close. At other times it asks us to step back so that we can discover capacities we did not know we possessed.

Over the years I have come to believe that emotional transformation depends on our ability to hold space for our emotions, bodily sensations, and impulses before reacting to them. Awareness creates space. It allows us to witness experience without immediately becoming identified with it.

Psychoanalysis asks a complementary question. It invites us to wonder about the unconscious emotional meanings that quietly organize experience—the wishes, fears, expectations, conflicts, and relational patterns that have not yet been fully thought or put into words. Christopher Bollas described this beautifully as the unthought known: aspects of our emotional life that are lived long before they can be reflected upon.

Mindfulness and psychoanalysis illuminate different dimensions of the same human experience. One strengthens our capacity to observe what is happening; the other deepens our understanding of why it may be happening. Together they help us remain present without becoming captive to our assumptions or our impulse to act prematurely.

Psychoanalytic thinking offers another important perspective. Melanie Klein observed that throughout life we move between more integrated and more fragmented ways of organizing experience. Under the pressure of shame, fear, grief, trauma, or relational threat, even psychologically healthy adults may temporarily lose their capacity to hold complexity. Reflection narrows. Anxiety intensifies. Our capacity to mentalize diminishes. In those moments, the therapist’s response must change accordingly. Our intervention depends upon our capacity to discern what is being communicated beneath the surface of experience.

An interpretation that facilitates reflection when a patient feels emotionally integrated may feel intrusive when that same patient is overwhelmed by shame or fear. Silence that offers space in one moment may feel abandoning in another.

Presence therefore requires more than empathy.

It requires discernment.

As Philip Bromberg reminds us, we do not inhabit a single, unified self. We move among different self-states, each carrying its own emotional reality. The therapist’s task is not to pull the patient toward a preferred state, but to recognize the one that is present and create the conditions in which reflection can gradually re-emerge.

The question is not simply,

What intervention usually works with this patient?

The more important question is,

What does this person need right now?

The same question guides parenting, although it is expressed differently.

When our children are distressed, should we comfort them, protect them, encourage them, or step back?

There is no single answer.

Donald Winnicott understood that the form of a parent’s presence must evolve as the child. develops. The“good enough mother” is not one who loves less than the “perfect mother”, but one whose love changes in response to the child’s developmental needs. During the earliest months of life, nearly complete adaptation to the infant’s needs provides the continuity from which a sense of self begins to emerge. At this stage, the infant does not yet possess the capacity to regulate distress independently. Presence is therefore experienced through protection, soothing, and reliable responsiveness.

As development unfolds, the same loving presence begins to take a different form. The child who once needed immediate comfort gradually benefits from small frustrations, manageable disappointments, and opportunities to discover that difficult feelings can be survived-and that they have the inner resources to do so.

Love has not diminished.

Its form has changed.

John Bowlby’s work beautifully complements this understanding. Secure attachment is not only about a parents’ capacity to hold space for a child when that presence is needed. It is the foundation from which autonomy gradually emerges. Children venture into the world not because they have learned to do without relationship, but because they carry within themselves the enduring experience of having been reliably held.

In my clinical work with parents, I have found that the greatest challenge is rarely understanding these ideas intellectually. Most parents already know that children benefit from learning to tolerate frustration, solve problems, recover from disappointment.

The deeper difficulty emerges when a child’s distress, anger, disappointment, or helplessness places emotional pressure on the parent to rescue. The child does not have to ask. Their emotional state alone can evoke an urgent wish to relieve not only the child’s suffering, but also the parent’s own fear of losing connection, provoking rejection, or being experienced as uncaring.

The child’s distress may also awaken self-states within the parent that carry their own history of fear, helplessness, or longing. Without awareness, it becomes difficult to distinguish what belongs to the child from what has been stirred within ourselves. Parents therefore, must cultivate the capacity to remain compassionately present to their own historical pain when triggered in this way.

Discernment asks something difficult of us as parents. It asks us to distinguish between responding to the child’s developmental needs and responding to our own anxiety about the relationship.

Sometimes stepping in is exactly what love requires.

Sometimes love requires remaining present without removing the obstacle.

The challenge is not simply deciding whether to help. It is discerning what form of help best serves growth in this particular moment. This is where psychotherapy and parenting ultimately meet.

Neither asks us to follow a formula. Both ask us to cultivate the capacity to recognize the emotional reality of the person before us while remaining aware of what is unfolding within ourselves.

In both, our task is not to become less emotionally involved, but more emotionally discerning. Presence is neither passive nor intrusive. It is an active, deeply attuned way of accompanying another person while resisting the temptation to relieve our own anxiety through premature action.

Perhaps this is one of the quiet paradoxes of growth. We do not foster it by always making pain disappear, nor by demanding premature independence.   We foster it by remaining sufficiently present to discern what we ourselves, as well as the person in front of us, truly need in this moment.

Whether we are sitting with a patient or standing beside a child, the question remains remarkably simple, though never easy to answer:

What does this person need right now?

References

Bollas, C. The Shadow of the Object: Psychoanalysis of the Unthought Known.

Bowlby, J. A Secure Base.

Bromberg, P. M. Standing in the Spaces.

Klein, M. Notes on Some Schizoid Mechanisms.

Siegel, D. J. The Mindful Therapist.

Winnicott, D. W. The Maturational Processes and the Facilitating Environment.