Shirah Vollmer MD

The Musings of Dr. Vollmer

Listening And Vulnerability

Posted by Dr. Vollmer on October 24, 2013

In-depth listening, the work of the psychotherapist, mandates a vulnerability to uncomfortable feelings. Listening to trauma, difficult and sometimes horrendous experience, determining the meaning of this difficult experience in the context of the patient’s prior experiences, requires an openness to the imagination of terror, fear, sadness and a disintegration of the ego, or the complete inability to formulate thought, in the face of a traumatic event. Salman Akhtar MD, says that the therapist cannot be “manic,” meaning they must provide a calmness, which allows the patient to pour their experiences into a welcome receptacle.  He further explains that this receptacle is a “maternal” function, analogous to the sexual organs of receptivity. This vulnerability in the therapist, as in the vulnerability of motherhood, means that the therapist must tolerate whatever uncomfortable experiences or feelings the patient brings into the consultation room. Once again, I am reminded that my argument against the “T” therapies, those that are manual-based, never address this necessary vulnerability, critical for the patient to feel heard, understood and important. Lesley, forty-two, had a long childhood history of cruel and unusual treatment by her uncle. Her terror, withdrawal, dissociative, at times, leading to anger, resentment and self-hatred, were just a few of her experiences through her psychotherapeutic journey. My psychological pain in listening to her story is real, and profound, and Lesley knows and appreciates my emotional resonance. This therapist-vulnerability needs to be preserved as we go through this major transition in our health care delivery system. There,  I have said it again and so I will keep saying it. The patient/therapist relationship deeply matters.


6 Responses to “Listening And Vulnerability”

  1. Ashana M said

    I think that kind of vulnerability is a requirement of being alive, of being a person who exists among other people. It isn’t the specific domain of therapy. It’s something you need in order to be a good friend, a good parent, or a good spouse. You can get through life without it, but it is a life half-lived. You can listen in this way in the course of any form of “talk therapy.” You can listen this way to a stranger on the train.

    But I also think Salman Akhtar fundamentally misunderstands the what is actually happening in therapy. The client can never give their experiences to the therapist. Those experiences remain with the client. The therapist is merely entering into that experience, and even then usually only in glimpses. It is much more like looking through a window into the world where someone else lives.

    I have actually learned to titrate my experiences so that the therapist can stand it. If it is too much, they become overwhelmed and can no longer help me. I can only handle so much, but what I can manage is more than anyone else can, so it isn’t my limits that are defining in therapy, but the listener’s.

  2. I’m not going to comment globally….for others. In my personal experience only (others will have unique and varied situations), I have consistently found that the great majority of people enormously underestimate the complexity of the mind…our brain and neural pathways…our soul. Scientists have shown that the human brain is the most complex thing in our known universe that we know of. I have found that there are layer upon layer upon layer in the mind, of defense mechanisms covering knowledge and feelings that open up access to more defenses, then more understanding, realization and yet more emotions that cover yet other systems of defenses and on and on and on. (The analogy I like to use is “like peeling an onion” or maybe “peeling an artichoke to reach it’s heart”.) Discoveries yield a plethoria of conflicting feelings branching our in all directions, many which contradict one another and ambivalence can be massive. The mind and our “feelings” are incredibly intricate and there is no one “truth” and it is vitally important to “understand” both our defenses and feelings, which results in the ability to make more mature well thought choices. (Note my emphasis on the word “feelings” :-). It’s been my experience that this kind of “listening” takes someone highly trained and skilled and kind, that has ideally received a thorough self analysis as part of his or her training. It takes an understanding of transference and countertransference and the ability to recognize when to make an interpretation and when to hold off. It takes professional boundaries one doesn’t have with family, friends, and acquaintenses. The talking and “listening and understanding” (again in my experience) must be done often enough so defenses stay pliable and don’t take hold too firmly to limit the treatment’s effectiveness. Oh….one last thing…it takes a willingness and maybe a little compulsiveness 😉 from the patient (I dislike the work “client”…too “corporate”) to stay with the process long enough to make lasting changes (ie: no T “counseling”.)

  3. Shelly said

    I understand that the therapist is a vessel into which the patient pours his/her experiences and feelings. I get it that he shares his stories with you. What I don’t get is what you do with the stories? If someone tells you of unspeakable traumas and terror, besides asking how the patient is feeling or how the patient got to that situation, what else do you do?

    • I try to understand the meaning of their trauma to them. It is important for me to try to see how this traumatic experience (or experiences) got integrated into his mental state. For example, if a mother sees her child run over by a car, is she filled with guilt and/or anger at the driver. Each person will find different aspects of the trauma that they focus on to create a meaningful narrative for themselves. The ways in which they obtain this narrative has a lot to do with their past history and their biologically based temperament. The narrative suggests both conscious and unconscious aspects of their psychic interior, and as you suggested previously, I guide them through their interior, trying to shed more light on some deeply held beliefs. Thanks.

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