Quick summary: A therapeutic companion in Buenos Aires explains that recovery support for people with serious mental health conditions depends less on clinical technique and more on consistent, non judgemental presence, sometimes built over many hours through the night. Trust with a patient rarely forms in the first meeting and instead grows through small, repeated acts such as arriving exactly when promised, tolerating silence, and staying nearby even when a patient initially refuses contact. For healthcare practice and family caregivers, this points towards a practical lesson, that steady, humble companionship can make medication more effective, ease family strain, and help psychologists work with calmer, more settled patients.
Every beginning is hard for a patient who is starting with a new mental health professional. I did not learn this from books. I learned it from nights in CABA, sitting on the floor next to a patient who did not want to speak.
I am a Therapeutic Companion from Buenos Aires. In Argentina, our role is different from a psychologist or a psychiatrist. We are the ones who stay. We stay for 8 hours, 12 hours, sometimes through the night when anxiety will not let a person sleep. And in that staying, everything depends on one invisible thing: trust.
There is no trust in the first hour
In the first hour, there is only fear. The patient looks at you and thinks, “You are another person who will judge me, who will leave.” The family looks at you and wonders whether you will really be able to handle this. And you, as the companion, feel your own fear too, because you know that technique means very little if the person does not let you in.
I remember a patient I will call M. He had a diagnosis of schizophrenia and had not left his apartment for three months. When I arrived, he did not open the door. He shouted from inside, “Go away.” My coordinator told me to wait, so I sat in the hallway. I did not knock again. I just sat there for 40 minutes. After that, he opened the door a little and asked, “Are you still there?” That was the beginning of trust, and it had very little to do with anything I said.
How trust actually forms in therapeutic companionship
Psychology tells us that trust is built in small moments, and in therapeutic companionship, those small moments are the work itself.
The first is consistency. If I say I will arrive at 9am, I arrive at 9am. If I say I will not use my phone, I do not use my phone. Patients living with mental illness have usually met many people who promised things and then left: doctors who changed, friends who disappeared. Simply showing up when you said you would is already a form of therapy.
The second is not judging. One night a patient told me she wanted to break everything in her house. A traditional professional might have reached for a coping technique in that moment. I said only, “I understand you have a lot of anger tonight. I am here with you, and you are safe.” She cried. She did not break anything. What she needed most was to be heard.
The third is respecting silence. In our culture, we tend to fill silence with words, but in companionship, silence is often where trust grows. Sitting next to someone in a plaza in Palermo, both of you looking at the trees, without needing to speak, can be a genuinely therapeutic act. It communicates that you can sit with someone’s pain without needing to escape from it.
When does trust really begin
In my experience, trust rarely starts on day one. It tends to begin around day three or four, with a small gesture. The patient offers you a mate. The patient asks what time you are coming tomorrow. The patient shares a small story from childhood. These are the signals that the door, which had been closed, is opening a little.
Once that happens, the shift is noticeable. Medication tends to work better because the patient is less anxious. Families can rest a little because they know someone is there. The psychologist can work more effectively because the patient arrives at sessions calmer. In this sense, the companion becomes something like a bridge between the patient’s daily life and their treatment.
Trust is fragile, and that shapes the work
Trust built this way is also easy to disturb. One late arrival, one glance at your phone, one sentence that comes across as judgment, and you may find yourself starting again almost from scratch. This is part of why the work demands a great deal of humility. A companion is not there to heal the person. The role is closer to that of a witness, someone who walks alongside the patient until he or she can walk a little more independently.
In Buenos Aires, therapeutic companionship is recognised by law and is, in many ways, a beautiful profession. But its real foundation is not something taught at university. It is learned in a hallway, waiting 40 minutes for a door to open. It is learned in realising that your most useful tool is rarely what you say, but simply that you stay.
For many patients, trust does not begin the moment a professional arrives. It tends to begin once they sense, over time, that this particular person is not going to leave, and for a number of them, that is the first time in a long while that they feel safe.
Roberto Fiuza is a therapeutic companion based in Buenos Aires, Argentina. He works alongside patients with mental health conditions, often through the night, to provide the steady presence that helps trust and recovery take hold.
