Shirah Vollmer MD

The Musings of Dr. Vollmer

Why We Listen

Posted by Dr. Vollmer on October 27, 2014

We, the psychotherapeutic community, particularly the psychoanalytic community, listen to patients because we understand that to create a narrative, a deep understanding of oneself, someone else needs to listen and provide feedback. Children grow up dependent on their parents to interpret their world, and so adults and children in crisis, struggling with conflicting feelings, need to have someone listen to this conflict and help them sort out deeply rooted dilemmas. Listening, time, and privacy, are the three legs or our stool, all of which are threatened in today’s age of electronic records, hasty clinical contact and limited number of sessions. This change in the delivery of mental health care contradicts the fundamental principles of how mental health intervention becomes mental health. I am not tired of saying this, because not enough people have heard me yet. So, I will continue to teach and  to blog in order to advocate for in-depth listening as a means to promote well-being.

6 Responses to “Why We Listen”

  1. Jon said

    We listen so that we can learn. We learn so that we can become knowledgeable. We become knowledgeable so that we can become wise. We become wise so that we can listen.

  2. Shelly said

    You make it sound so simple. Health insurers may say that they don’t need to pay for psychiatrists, who cost them so much, to listen, but rather, can pay social workers, or lay therapists to do so. It will cost them less. In addition, you will have to convince them that inner conflicts are medical conditions that need treatment and that patients don’t need to “man-up” instead of empathy and being listened-to. I know this war has been going on a long time and that part of the stigma of mental illness is that health insurance doesn’t pay for touchy-feely subjects like these.

    • With all due respect, I hope to make it sound complicated and simple, at the same time. The simple part is that listening is key to healing. The complicated part, as Jon alludes to, is that the skill of listening is honed over many years of training and experience, and as such, justifies reimbursement. Having said that, the current state of insurance rejects this notion, and hence band-aid treatments are given, which, in the long run, will prove ineffective, or temporarily effective, at best. I am not in the business of convincing insurance companies to reimburse interventions which are helpful, but I am in the business of telling the public that the best bang from their mental health buck comes from someone who is well trained professional, and can take time with them. My hope is that if this point lands in the public psyche, then maybe, just maybe, reimbursement will follow. Thanks.

      • Shelly said

        Shirah, perhaps you should focus on convincing them that it is only with a combination of a deep understanding of the human body and pathology, pharmacology, the interactions of other medications with those you prescribe for the mental illnesses, etc… those are the things that separate psychiatrists from psychologists and social workers and that is why insurers should pay you and not the others? Perhaps then psychiatrists won’t be the black sheep of the medical profession?

        • I have so many thoughts to your comment, Shelly. Psychiatry has lost its way, and as such, we, as a profession, need to establish our utility beyond prescribing medication. This is a major theme of my posts, but to articulate and demonstrate utility is complicated by the fact that our field is in its infancy, and we need to be able to grow, rather than resign ourselves to pill pushers. Exactly how we can grow is the challenge. For now, listening is our best tool, there is no doubt. However, in the age of big data, listening is not quantifiable and hence invisible to measurement. Having said that, I will continue to ponder your point. Thanks.

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