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Learning the language of therapy: Part 1
On the lost but crucial art of listening
(This is part 1 of 2 of my introduction:)
Hello and thank you for reading. I am a psychoanalyst and writer in Los Angeles who really enjoys discourse around ideas related to psychoanalysis and psychotherapy, especially in relation to language. Everyone has their own personalized style of expression, or idiom, calling upon the lost art of listening.
I try to write in a clear and accessible way, because I believe good ideas need not be convoluted or cloaked in jargon. If you are curious about any of this, you are my ideal reader. If not, let’s talk about your resistance (kidding…though I hope you’ll give this a chance.)
What is psychotherapy as I see it? How do I help people find relief? Note I said relief and not “cure,” a tricky word in therapeutic circles, often used by newer patients.
Many patients do hope for a cure, understandably. I am after all a doctor and use the title proudly (I worked hard for it, plus it makes my mother happy.)
But I am not a medical doctor and there are no pills or prescriptions at hand. And one reason I am reluctant to talk of cures is that it implies one is sick. But the definitions of sickness and health, as in determining mental health, are not clear cut. Sometimes a disorder is actually a long-building reaction to family or sociocultural mistreatment or neglect. Is it any wonder so many people are seeking help for ADHD, in a culture where our devices go with us everywhere and never stop beeping, flashing, or buzzing?
Young adults may go wide-eyed in jumping into a society that demands they stay productive, pay bills, find a passion and career, look after our kids or partners or aging parents, respond to those emails, texts, posts, and what took you so long (thirty minutes) to reply?
Is a person of color suffering from an anxiety disorder in fearing the police? Is a woman “sick” in being depressed at a lower pay scale than male colleagues, or being frequently passed over for promotion? Such scenarios can also sync up with earlier suffering also invalidated.
Imagine a patient telling me that as a child they were neglected or abused, and now struggle with depression and anxiety. I would see this as a human reaction to chaos and violence, just as anxiety about global warming is not pathological to my ears. (Our sizzling planet should be keeping us all up at night.)
Pain is not pathology, to quote one of my teachers, Robert Stolorow.
But back to the question: how does this shit work? If not a physician, what kind of doctor am I?
At the risk of sounding too therapist-y, it is hard to answer without knowing more about the person before me. My expertise involves, in part, knowing what I do not know but want or need to know in order to help.
So much is revealed in how a person talks, thinks, and feels about what bothers them, what it evokes in me, and how the person responds to me, and vice-versa (especially the latter.) “It’s the relationship that heals,” Yalom emphasizes.
It is also often a relationship that wounded, as with many wounded healers. And the therapist too changes, amidst changing relationships, in any treatment of depth. For it is ourselves we also listen to, in our experience of a patient, to understand what the patient might be experiencing, but not expressing: the seeds of our co-created language. (More on this next time.)
On a micro level, toxic families and cultures often colonize the weakest in the system, most often children (in the case of families) forced to responsibility and be accountable for problems often ignored or denied by the powers that be. The scapegoated or parentified kid is then tasked with distracting from or, in parentification, fixing the problem, magically perhaps, without the means or power to do so.
Such gaslighting, as it is often called—the flat denial of one’s emotional reality—turns out to be far more destructive than I realized when I first got into this. More on this in future.
Many patients are terribly ashamed of their challenges. We are obsessed with the myth of the individual strength. It runs far deeper than I first realized. Needing help is a bit less shameful than before, but we have a ways to go.
There is so much western emphasis on resilience, courage, blah blah blah. This creates dissonance as much of our circumstance is beyond our control. No one “signs up” for depression, addiction, physical challenges, neurodivergence, racial profiling, and so on. Still, for many patients the vulnerability of needing guidance is terrifying, especially if it was so scarce or forbidden the first time. The first step in treatment is my trying to understand all of the above, and why thoughts of change might be enticing and edgy both.
What I am aspiring to do, in my listening and sifting for meaning, is help patients listen more deeply to themselves. Each of us sees and speaks uniquely, from within a distinctive world; this includes therapists, as each relationship develops its own language.
This kind of subtle listening, to another’s personalized expression, or even our own, is increasingly challenging in the din of our clamorous era, increasingly Vegas-like in the attempt to grab eyeballs. We are also under tremendous pressure to make a living, run a household, do our homework, show up for our bosses, partners, families, kids, friends, debtors, and so on.
In all this, dramatic online confrontations—my own guilty pleasure—is a diversion, far more compelling than open-ended conversations or reflection; french fries for the soul.
Yet it is also depressing that much civic or online dialogue, even in my field, becomes a contact sport. This lands me back at family Thanksgivings, where my father would point and ask for yes or no responses to political questions of the day. Ambivalence was a no-no. “Capital punishment, yes or no?” he would say, pointing at a startled guest. The person might respond, “Well I suppose in some cases—” “YES OR NO?!” he’d bellow.
Pass the stuffing.
Is it naïve to think a different way of communicating is possible? I hope not, because behind or beneath the minutiae of so many of our daily worries are deeper anxieties never addressed, heard, or recognized, that more of us struggle with than one might realize, in such uncertain times.
Most new patients are trapped, running in circles. So many of us are trained to listen to everything but our intuition. Or we’ve needed to strictly adopt the language of the powerful for the sake of survival. The anxiety one feels, in embarking to develop a mind of their own, often takes the form of conceptual questions, intellectualized reassurance, to bypass the deeper feelings no one has asked about or heard. This is why the tone and music of the question is often more significant than the content.
It is common even for therapists to reach for certainties at anxious moments, provide a yes or no, when we might want to sound expert, competent, or helpful to patients or peers. It also stirs the psychic pot when patients challenge our comfortable point of view, though any treatment worth its salt does exactly that: in feeling disordered, I get a flavor of the person’s disordering world.
A tricky matter, as I grew up in a family where words were weaponized, where even I might mock another’s misstatement or grammatical error, as we all did if we felt hurt or insulted, which only happened every few minutes. It was like growing up on Twitter. But actually the real work begins when I too feel stuck in the Matrix.
It is on the whole more difficult but satisfying to at least try to understand the variety of personalized idioms and word-usage of those around me, and certainly those of my patients; each of us speaks the language of our world, our own psychological dialect.
This takes time to decode, as all patients are smart and capable, so much more than a diagnosis, the problems that seem to run the table of their lives. I wish therapy did not take so damn long, but…it just does, much of the time, for these reasons and more. Of course, knowing this versus experiencing it are not at all the same.
It is with a hopeful spirit that my experiment begins, in seeking to bring clarity to the din, and some din to the clarity (in cases of oversimplification), as the number of therapy patients increases.
Next I will talk about the either/or dilemmas (yes or no!) that embroil therapists, at least this one. Until then, pass the stuffing…and please leave a comment below.