I Need My Patients as Much as They Need Me

My wife Susan said something to me a few years ago that stopped me in my tracks.

We were sitting at dinner, and I was telling her about a session — I won’t say with whom, but it had been one of those rare hours where something profound happened. I was animated. Lit up. Talking with my hands. And Susan looked at me with that expression she has — the one that means she’s about to say something I’m not going to be able to unhear — and said:

“John, you need your patients as much as they need you.”

I sat there for a moment. And then I said: “You’re absolutely right.”

No psychiatrist I know would admit that. The professional stance is supposed to be one of benevolent detachment. You care about your patients, sure. But you don’t need them. That would be codependence. That would be boundary confusion. That would be the kind of thing you process in your own therapy.

Except it’s the truth. And pretending otherwise is a lie that weakens the work.

What I Mean by Need

Let me be specific about what I mean, because I’m not talking about dependency. I’m not talking about patients who feed my ego or fill some emotional void.

I’m talking about purpose.

I’m 88 years old. I’ve been doing this work for fifty-five years. I’ve outlived friends, colleagues, even some former patients. My body is slower than it used to be. The world moves faster than I can follow. And every morning, I get up and go to my office, because there are people counting on me to be there. People who trust me with the most private parts of their lives. People who have, in some cases, spent years building something with me that matters to both of us.

At 88, I want to continue to feel purposeful and like I’m making a difference. My patients give me that. They give me a reason to keep showing up — not just for them, but for myself. That’s not weakness. That’s what being human looks like.

— Dr. John S. Tamerin

That mutual investment — the fact that the relationship matters to me, not just to them — is what makes it real. It’s what makes it different from every other professional relationship in their lives, where they’re the client, the consumer, the patient, the problem to be solved.

With me, they’re a person I care about. And they know it.

The Thing My Analyst Never Did

I spent years in psychoanalysis. It was, to put it charitably, a complete waste of time.

Here’s what my analyst never once said to me: “John, I admire that about you.” Or: “That was brave.” Or: “I feel moved by what you just told me.”

Not once. In all those years. He just sat there and made interpretations. He translated my feelings into theories. He maintained professional distance like it was a religion.

I learned a lot about Freudian theory. I learned almost nothing about myself. Because the relationship — the thing that was supposed to be the vehicle for healing — was missing the one ingredient that makes any relationship real: honesty about how you feel.

That’s not flattery. It’s clinical conviction. And it lands differently when it comes from someone who has no obligation to say it — no social contract, no family loyalty, no ulterior motive. Just a person who has sat with you long enough to see you clearly and has the courage to tell you what he sees.

Tearing Up in Session

I cry in front of my patients. Not often. But when something moves me, I don’t hide it.

There was a patient — a man in his fifties who had spent his entire adult life convinced he was fundamentally unlovable. His father had told him so, more or less directly, starting when he was about six. He’d built a successful life on the outside, but inside he carried this conviction like a stone in his chest.

After about a year of working together, he told me about a moment with his daughter. She’d come to visit him, and as she was leaving, she turned back and said, “Dad, I just want you to know — I think you’re the best person I know.”

When he told me this, I felt my eyes fill with tears. I didn’t fight it. I let him see it.

He stopped mid-sentence and stared at me. Then he said: “Are you crying?”

I said: “Yes. I’m tearing up because I’m so happy for you.”

He reached over and handed me a Kleenex. And then he started crying too.

My analyst never told me he admired anything about me. I do. Turns out that’s helpful. Not because patients need to be praised — but because they need to know they’ve been felt. That their life has registered in another human being.

— Dr. John S. Tamerin

That exchange — the Kleenex, the shared tears, the two of us sitting there in this ridiculous, beautiful, undignified moment — that was more therapeutic than a hundred interpretations. Because it was real. It wasn’t performed. It wasn’t strategic. It was two human beings having a genuine emotional experience together.

Why This Matters for AI

Here’s the thing about artificial intelligence that nobody wants to say: AI will never need you.

It will never sit across from you and feel its eyes well up because something you said touched it. It will never go home at night and think about your session. It will never wake up in the morning feeling purposeful because it gets to sit with you again today.

And that absence — that fundamental lack of mutual need — is not a feature. It’s a flaw. Because the therapeutic relationship works precisely because both people have something at stake. The patient risks vulnerability. The therapist risks being affected. Both are changed by the encounter.

When someone tells me their deepest shame, and I respond with genuine feeling — not programmed empathy, not algorithmic validation, but a real human response — something happens that cannot be replicated. They learn, at a cellular level, that they are worth caring about. Not because I told them so. Because they felt it.

The Spiritual Moments

I’m not a religious man, but I’ve had moments in my office that I can only describe as spiritual.

Moments where the connection between me and a patient is so deep, so real, so completely stripped of pretense, that I’ve said — out loud, to the patient — “You know, this may strike you as crazy, but I feel like God is in the room.”

I don’t mean that literally. I mean that what’s happening between us is bigger than either of us. It’s beyond technique. Beyond theory. Beyond what any training program could produce. It’s two human beings meeting each other at a level that most people never reach — and both of them knowing it.

If you’ve been in therapy that felt transactional — where you showed up, talked, paid, and left without feeling that the other person was truly in it with you — you know there’s something more. And if you’re looking for a relationship with someone who doesn’t just listen to you but is genuinely affected by you, I can tell you: that kind of therapy exists.

Because I do it every day. And it keeps me alive.