Listening As Action

Why am I harping on the value of listening? For one thing, I find myself irritated when I get interrupted. Similarly, when someone has the patience to let me finish my thought, I have gratitude and calmness. My ideas, the way I construct my sentences, what I choose to say and to whom I choose to say it to, are all ways in which I define myself. I need a caring ear for me to examine my way of thinking, to hear what I say and tell me what it feels like to hear what I am saying. This is particularly true in times of great confusion and uncertainty. Few people, in my experience, can tolerate me finishing my thoughts. So often, I observe that in the middle of my idea, the subject subtly changes and I am left feeling like I could not finish my experience. I observe this witnessing other conversations, as well. Person A talks to Person B and as time goes on, maybe 1 minute, maybe 5 minutes, the conversation turns to something that Person B is more interested in talking about. Yes, there needs to be mutuality in relationships, and Person B should have the opportunity to talk to Person A, but at what point should the conversation shift? Everyone has to cope with being cut off, with people losing interest in their stories, with the inevitable self-centered pivot of Person B. Yet, in times of psychic pain, that shift can be intolerable because Person A wants to examine their thinking, their fantasies, their ideas in the context of an important Person B. When Person B can be there for Person A in this way intimacy ensues. I would venture to say that we all need people to hear our stories, no matter how trivial they may be. Now, let’s imagine that Person A feels disappointed by Person B and Person A feels there is nowhere to turn. Psychotherapy can serve as this bridge for Person A to either help Person B be a better listener, or find Person C to help her through her life’s journey. Person A may also benefit from psychopharmacology and Person A may also benefit from socialization and mindfulness, but what can really help Person A is the opportunity to examine how she thinks. This requires a skilled listener. Examining how she thinks, Person A can then come to learn how she carries forward beliefs from her past which interfere with her ability to connect with Person B so that Person B can be a good partner for her. These are the elements of in-depth psychotherapy. It is low-tech, but it is high-impact. As humans, we depend on other humans for growth and development. Technology is not going to change that.

The Fallible Therapist

Rupture and repair-that is the motto for psychotherapy where there is an understanding that both patient and therapist have difficulty listening and with this difficulty comes narcissistic injury, the feeling of not being heard, and so repair is necessary to move forward. This is the work of Jessica Benjamin PhD, and others in what they have come to call “relational psychoanalysis” which predates the more modern term of “intersubjectivity”. The challenge of deep listening comes with the inevitable failure, the inevitable intrusion of one’s own thoughts and not that of the “other”. Sure, one can think both in terms of one’s own thoughts and the patient’s thoughts at the same time, but in times of stress, this is more challenging.

Nellie, from my previous post, comes to mind. She believes the world to be an angry, bitter place, one which no one, including her family of origin, and the family that she has created, cares about what she has to say. As a patient, she also does not believe that I listen, and often, accuses me of spending time with her to “make money,” without any verbal recognition that there could be more than one reason that I try to help her. Sometimes, I, in fact, am not listening, as evidence by my comment which misses her point. Her anger rises with my shame and guilt. She is right, I realize, that I lost track of the conversation, and so now I need to apologize. This is linear, and yet, as psychoanalysis was first unfolding in the United States, an apology from a therapist was almost unheard of, because, as the thinking went, this apology shut down the anger in the patient which needed to unravel to get a clue into the inner workings of her mind. Thanks, however, to the relational psychoanalysts of the 60s and 70s, the apology from the therapist, was termed a “repair,” an act of kindness to restore the trust in the relationship. This “repair” was essential to validating that the patient was “unseen” in those moments, and that was a result of a disconnected therapist, in that moment. To express the universality of ruptures in all relationships is to demonstrate that relationships involve frustration and pain, because it is impossible for the attunement to be omnipresent. The analytic apology gives permission to the analyst to lose track, as it gives permission to the patient, to also lose track of himself, as well. Losing track is not a fatal flaw, only a temporary detour on the journey towards shared understanding. Timing is everything. I am practicing in the right era.

 

Listening As Mothering

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”.

What Are We Listening For?

 

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.

Rent-A-Friend Vs. Psychoanalytic Listening

Rent-A-Friend, was how Professor L. described psychotherapy, letting us know, he did not have a lot of respect for the field. “The days of rent-a-friend are numbered,” he used to say, hoping we would all chuckle with delight and not squirm with discomfort, as many of us did. The squirming then did not make sense to me, but preparing for my class recently, I was able to piece together the components to that squirm. Salman Akhtar MD outlines the issue.

1. There is an entirely different sort of verbal material…in other words patients say things in therapy that they are too ashamed, or too scared to talk about with their friends.

2. The listening is for both conscious and unconscious aspects of the subject at hand.

3. The listening is done with the point of understanding on multiple levels, rather than merely providing support.

4. There is explicit consent that the listener can comment on deeper, and perhaps unsavory, motivations.

5. The mind of the analyst prepares for receptivity (I call this getting in the zone), in order to have what Freud described as “evenly hovering attention”.

When girlfriends go in a dressing room and one says “that does not look good on you,” there is love in that comment, which taken out of context would sound like a criticism. So too, with analytic discussions, “you were mean to your friend” may be unsupportive in a morning walk, but in a therapy room, that is a comment which inspires deep reflection. The courage to hold up that mirror, as the friend does in the dressing room, is the courage invested in a deeply meaningful relationship in which chances are taken in order to help the other go out into the world with consciousness and confidence. With all due respect to Professor L, who I love dearly for all that he gave me, the “rent-a-friend” comment was uncalled for, and demeaning to my other professors at the time, and now, to me, as well.

Listening To A Story

 

https://soundcloud.com/snapjudgment/most-wanted-snap-judgment-walk

This podcast speaks to the value of psychotherapy. “You showed me love,” Richard, the deceased criminal tells the chaplain who visited him one on one, every week. This is the love of listening, of hearing the pain, the suffering, the loneliness, and the fear. Richard was a man, it seems to me, who wanted to be known, and he made that happen, in the last chapter of his life. I know he was a hardened criminal, who was sentenced to life in prison, but at the same time, he was a young man who realized what he did not get, and so  he lived in fantasy, dreaming of a life he could have, as he invaded homes. As he suggests, the intrusion, gave him a substrate, in which to imagine another life; a life so different than what he had. A life, where he had stability, and consistency. He speaks to going into a home, sitting in a living room, and using his thoughts to bring himself away from his past of being cast about in the world, at an age, too young, for him to cope on his own. This is a sad and happy story. Richard found love, at the end of his short life, through a chaplain, who experienced love, in return. This brief relationship illustrates the power of connection; the power of one human to connect to another, and thereby bring, for a moment, a sense of meaning to both parties. I am moved.

 

After writing this, I saw this comment posted on the internet….by Lisa1122 “I was so touched by Chris’ account of Richard and his life story. It brought tears to my eyes and I thought – this is the reason that I do therapy! To validate those stories that are less than perfect, often times tragic. I believe they were both enriched by the time they shared together. Thanks for the great story.”

The Power of Listening

 

 

https://www.google.com/webhp?source=search_app#q=school+shooting+prevented+by+talking

http://www.npr.org/templates/story/story.php?storyId=214000118

“He told me he was sorry for what he was doing. He was willing to die,” Tuff told ABC. Antoinette Tuff demonstrates the power of human connection in preventing antisocial behavior. She approached Michael Hill, an almost school shooter, with dignity and compassion, thereby preventing an enormous tragedy. Ms. Tuff gave Mr. Hill and ear, a compassionate audience, allowing Mr. Hill to reflect on his behavior before he proceeded to hurt innocent children. This story illustrates the value of human kindness in the prevention of serious human destruction. It parallels the work of psychotherapy, where human to human understanding helps people think about their behavior, rather than act impulsively. There is no checklist, or automated treatment, but rather a sense of understanding human suffering, because, as Ms. Tuff, explained to Mr. Hill, she too, has gone through hard times. This remarkable empathy led to heroism that was celebrated by President Obama. I imagine that instinctively, Ms. Tuff knew, that if she could see this 20 year old gentleman, as a man in pain, and not a horrible murderer, then she had a chance to help him. Her instincts proved right, as she was a compassionate person, believing that with a little self-revelation, she could change the course of history. It seems to me that she saw Mr. Hill as a man looking for help, but not knowing how to ask for it, and so she supplied an ear, giving him the intervention he needed, but did not know how to elicit. This story should be our model for how to help the mentally ill. They need understanding and caring, and sometimes, not all the time, this simple modality, will prevent violent behavior.

Art Of Listening

 

 

 

“How is your marriage?” I ask. “We are getting new floors,” Nomi responds. “Am I supposed to make a connection?” I ask. “Well, we have been fighting about upgrading our house, and so now we are finally taking some action.” Nomi answers. “Yes, but does this tell me about your marriage?” I repeat, thinking that Nomi has reduced her marriage into winning a battle about floor coverings. “Well, I guess I am trying to say that my husband does compromise, but it takes a long time,” she says. “By compromise, you mean that you got your way?” I say, highlighting that she was pushing to spend money on home improvements and he was resistant. She laughs with acknowledgment. “I can understand that your marriage brings up such complicated feelings that you were searching for a way to capture the landscape and so you landed on your victory over the floors.” I say, helping her to see that her answer speaks to how unresolved she is about her feelings towards her mate.