The art of waiting
On timing as a therapeutic craft, and on what critical instability can teach us about it.
In medicine, timing is a somewhat underestimated art. Antibiotics work best when they match the phase of an infection, and pain relief calls for a feel for the rhythm of a body in recovery. Something comparable plays a role in the consulting room, although it is less easily captured in a protocol.
Complexity science has the notion of critical instability: a phase in which a dynamical system appears to let go of its old ordering without yet having found a new one. The system hesitates. The variance increases, the coherence becomes more brittle, and recovery after a setback takes longer. From the outside this may look like dysregulation. Those familiar with the phenomenon also see a window in it: a period in which change becomes possible.
Günter Schiepek, who has studied these phenomena for more than three decades, argues that much therapeutic effect appears to take place around such windows. What would count here is not only what the clinician does in such a phase, but also what she refrains from doing: the willingness not to intervene at once with a protocol, and not to pass her own unrest on to a patient who might arrive at something new precisely through that unrest.
Haken's generic principles
The German physicist Hermann Haken spoke in this connection of generic principles: conditions under which self-organisation in complex systems becomes possible. Examples are stability in the environment, energy in the system and a certain freedom to let go of the old pattern. From this perspective, therapeutic work is less about direct steering and more about carefully maintaining those conditions, so that a new outcome becomes possible without being forced.
This asks of a clinician a refined sense of when a system is ready for change, and when it first needs stabilisation. Intervening too early, before a system is open to it, rarely brings lasting change and may sometimes undermine the trust from which change could later arise. Waiting too long carries the risk of missing an opportunity, or of a patient becoming demoralised and the system getting stuck in a less favourable state.
"Critical instability is not an illness. It is a condition under which illness can make way for something else." (freely after Schiepek)
What research can add
No protocol can replace this craft, but research can support it. With daily measurements, as in the Synergetic Navigation System of Schiepek and colleagues, the signs of critical instability are sometimes visible before they can be felt in a session: an increase in daily variability, a slower recovery of mood after a setback, or an autocorrelation that persists longer than the week before.
Such signals do not tell us what should be done, but they do indicate that the moment calls for attention. Sometimes that means a quiet conversation about old certainties that no longer hold. Sometimes it is an intervention that would not have landed in an earlier phase. And sometimes it is precisely a silence, a patient waiting together for what presents itself.
Chronos and Kairos
Greek had two words for time. Chronos was the time of the clock, the time that passes. Kairos was the time of the right moment, the moment at which something can happen. Much of what proves effective in the consulting room seems to take place around this second notion, although it is rarely captured in an evaluation form.
What remains is an invitation rather than an instruction: to regard waiting, which in our culture is sometimes quickly taken for passivity, as a form of work. It is a craft that has to prove itself anew in every consulting room, and that, so it seems, unfolds mainly in the less visible part of the therapeutic process.