Sheldon Bach, et. al. in their article " The Empty Self and the Perils of Attachment," (Psychoanalytic Review, Volume 101, No. 3, June 2014) write about working with patients who feel empty, depleted and alone. They feel that "something is wrong with them," but they don't know what. For these patients, their early scaffolding (basic developmental functions) have never been provided or are distorted. They have difficulty feeling comfortable; they can be destabilized by noise, temperature, light or tone of voice. They have trouble sleeping and waking, eating regularly, drinking moderately. They often suffer from psychosomatic complaints such as gastrointestinal problems. These patients also have a difficult time deciding what to talk about in a session. Traditional psychoanalysts may fail with these patients because they hold to the view that the patient starts the session. But helping the patient discover what he or she wants to talk about and facilitating the patient's ability to use the interaction is actually a major part of helping the patient build a sense of self.