Shirah Vollmer MD

The Musings of Dr. Vollmer

What Are We Listening For?

Posted by Dr. Vollmer on October 28, 2014

 

The fundamental rule, Freud stated, was free association. The patient is mandated to say whatever comes to mind, like he is on a train and describing the scenery as the train rolls on. There is an inherent contradiction to mandating free association, as the mandate makes it “unfree”. Having said that, the notion that the freedom to speak in a consultation room, with the promise of privacy and time, opens the speaker and the listener to a unique view of the mental state in that moment, and perhaps, many previous moments. The production of a story requires creativity and imagination which lends itself to interpretation, both by the storyteller and the listener. Both parties have now experienced the narrative, and it is the therapeutic challenge to work with the words to make meaning out of both the current story, as well as the underpinnings to the story, which might, in turn,  be contributing factors to the patient’s  mental suffering and distortions. So, we, as therapists, listen for both what is said, when it is said, and what is not said. Ezra, twenty-three, comes in each session, which is almost daily, by saying “well, not much to report.” This opening line, as we have discussed, is so rich with meanings. He is telling me, I hypothesize, that he wishes there was something to report, but he is very stuck in his life, and in turn, he is very frustrated. This speculation is derived both from his tone, and from the repetitive nature of this comment. “Not much to report,” is also, it seems to me, his way of easing into our session. He is unfamiliar with the therapeutic process, so he assumes that his job is to report to me, as if I am his boss. Ezra, as he has explained to me, comes from a family of business people, and so many interchanges are filled with, what feels to him, are  “reports”. Finally, “not much to report” is a way in which Ezra preempts, what he perceives, is my disappointment with him, for not doing more with his life. “Not much to report,” stops me, by his way of thinking, from asking him, or pressuring him, to account for his time. Ezra and I bat around these ideas, with a playful tone, one that allows for reflection, with minimal defensiveness. The persistence of his comment. That is what I listened for.

2 Responses to “What Are We Listening For?”

  1. Shelly said

    Perhaps, as you say, Ezra really doesn’t know what he’s supposed to talk about? Where to start? What are the important things in his life that need introspection and discussion? Free association may be fine and good but if one doesn’t know how to get started, it can be daunting. Since you have so much experience, perhaps your job is to ask leading questions so that Ezra gets started talking and he won’t feel like he’s wasting your time and his?

    • I have no problem asking “leading questions” as you say, but the fascinating part of my work, is to wonder why does Ezra feel like he is wasting my time? What about that? Is that not a reflection of his self-esteem and his feelings of profound emptiness? Some people feel like they cannot get enough time, whereas others, like Ezra, feel guilty for taking up my time. This difference in approach to “my time” is so revealing of their internal experience of their world. Thanks.

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