Shirah Vollmer MD

The Musings of Dr. Vollmer

Do We Talk So We Don’t Have To Listen?

Posted by Dr. Vollmer on July 28, 2015

Talking and listening are different skill sets. Some people talk to stimulate conversation, whereas others talk so they do not have to listen. This art of conversation borders on the art of psychotherapy. When should I speak and when should I listen? This is the basic technique question of therapy. The rule of thumb is that listening kicks off a session, but when the talking seems to go to a defensive place, a place of boredom or cliché, then my job is to probe deeper into why the patient has lost his meaningful narrative. “I want to ask you something,” Ashley, sixty-nine, says. “I want your medical opinion about my friend’s cancer,” she continues. Why did she start off by saying that she wanted to ask me something, as opposed to  just asking me something. Is she anxious about her friend, or she avoiding other, more meaningful things on her mind. She wants my “medical” opinion, but she knows I am a psychiatrist and not an oncologist, so the internet, likely has more information than I do. What is with this formality? I wonder. I have known her for many years and I see her frequently, yet the formality persists through time. Am I rude to avoid her question and ask her about her question, or does she know that I am going to do this, since we have done this dance for years? With Ashley, the opening remarks speaks volumes about her mental state; she and I have come to understand. She treats me like a boss that she has to interrupt in order to get her attention. She wants to flatter me by asking me my opinion. She does not know how to mine her mind for the internal gears which churn out pain and despair, and so she avoids the deep work by engaging me in a discussion about cancer. She avoids her fear of loss and her own mortality; issues which are bound to come up when a friend is facing a potentially lethal diagnosis. Like a good book, the first sentence sets the stage, but in this case, for Ashley, at this moment, it is all unconscious.

2 Responses to “Do We Talk So We Don’t Have To Listen?”

  1. Shelly said

    Perhaps Ashley is really, really worried about her friend and that is how she opens the session, expressing and phrasing her anxiety in the form of a medical question? How did you answer Ashley? The phrasing, perhaps was a lead in to her internal torment, but instead of getting right to it, maybe it is easier for her to know the physical aspects of the disease first? Not everyone knows that when doctors specialize in one specialty, they have little or no experience in another. The lay person thinks that all physicians have been to med school and therefore know about everything.

    • Yes, absolutey true….I was highlighting that the style of conversation, the opening comment, the medical inquiry, was indeed a slow path to understanding her anxiety. I think it is endlessly fascinating how this conversation unfolds and how unique it is to each individual. Ashley, in this case, was not in touch with her anxiety about her friend until we discussed this openly. The anxiety was not conscious, but it could be felt as the conversation deepened. Thanks.

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