There’s a kind of difficulty that doesn’t look like difficulty from the outside, and is hard to name from the inside. You know what you should feel. You can describe it accurately. You understand why it would be there. And it isn’t there.

This is not the same as numbness. Numbness usually has a quality of suppression, something pushed down. This is different: the feeling doesn’t arrive. The person isn’t withholding it. They reason about their emotional life with considerable clarity, and what they’re reasoning about never quite becomes experience.

People arrive who can describe, in detail and with genuine insight, what their grief about something is like, why it’s present, what it means. And then tell me, equally genuinely, that they don’t feel grieved. The understanding is real. The affect is absent.

Psychoanalytic thinking would call this affect isolation: a defensive structure in which the cognitive content of an experience is split off from its emotional charge. The thought is permitted. The feeling that belongs to it is not. It developed, almost certainly, because in some earlier environment the feeling was too much, or was not responded to in ways that allowed it to be felt, or both. The defence is not weakness. It was a solution to a real problem.

But it costs something. Relationships feel at one remove. Moments that should register as significant don’t quite land. There’s a quality of watching your own life from a slight distance, understanding it well, not quite inhabiting it.

What therapy offers is a different kind of attention: one that stays close to what is actually happening in the moment rather than what is being thought about it. What is present as the person speaks. What arrives in the room, however briefly. Not the understanding, which is already considerable. The thing underneath the understanding, which has been waiting a long time to be encountered differently.

Knowing what you should feel and actually feeling it are different capacities. The gap between them is not a character flaw. It’s something that formed for a reason, and something that can change.