Shirah Vollmer MD

The Musings of Dr. Vollmer

Listening As Mothering

Posted by Dr. Vollmer on October 29, 2014

The mother listens and the father guides. This gender stereotype is a way to describe that listening is a way of holding the patient, caring about what is on their mind, which is followed by fathering which is giving them ideas about their mind, that perhaps are unconscious thought processes. The latter intervention is termed an “interpretation,” which by this way of thinking is a more masculine behavior than listening. The oscillation between listening, holding, and offering ideas, intervening, is the dance of psychotherapy. Patients who have had early traumatic experiences, and/or who suffer from tremendous anxiety. often need to be listened to, but they cannot tolerate new ideas about their thoughts. The challenge to their thinking is met with defensiveness and more anxiety, as their mental fragility becomes more apparent.

Elie, thirty, male, comes to mind. I have worked with him for many years, and yet, each time I have an idea, he quickly, before I finish my sentence, says “I know, I know.” When I ask him what I am going to say, he says, “oh something about my anxiety.” “Why is it so hard for me to finish my sentence?” I ask, trying to work with his defensiveness. “I just do not want to be told that I screwed up my life,” Elie says, with sadness and despair. “Is that what you think I am trying to tell you?” I ask, understanding that for Elie to change his life, he has to mourn his previous decisions which landed him unhappy with his work and his relationships.  “Of course, you want me to fix things. I know that, but I just cannot deal with feeling so bad about my choices,” Elie says, moving me to feel a lot of compassion for him. “And yet, you come and you want to struggle with me about how to move forward,” I say, highlighting his ambivalence about change. “Oh, yes. I look forward to coming, and I look forward to telling you what is going on with me, but it is hard for me to hear your thoughts.” Elie says, illustrating this dance between listening and thinking. He is comfortable and soothed by my listening, and challenged, threatened, by my talking. In this way, he is a textbook example of a man who needs “mothering” but is not quite ready for “fathering”.

2 Responses to “Listening As Mothering”

  1. Shelly said

    Great post. I still always wonder how you know how to do the guiding, that is…how you know where to lead? Is it from your personal perspective? Medical perspective? Analytical ones? Do you link experiences and say, “Well, those didn’t work out so here’s where you go wrong?” If the issue is ‘mothering’ and ‘fathering’ roles, do female psychiatrists have an easier time doing the mothering, and male ones fathering?

    • Yes, the art of interpretation, identifying the salient points, is the challenge, the art of the work. This is the major thrust of my classes. Reading and discussing cases expands one’s ideas and thoughts about how to intervene. That, combined with clinical experience, creates the clinician. The mother/father dilemma is a way of saying passive versus active, rather than gender determined. Having said that, I do think that women, in general, have an easier time transitioning between passive and active roles. Thanks.

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