Feeling Our Way

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Therapy Is Almost Like Being in Love

Listen like it matters, like your happiness depends on it.

After 40 years of clinical work, I seem to be pretty good at picking up nuances in the things clients say to therapists on the DVDs I watch with supervisees. Sure, this has much to do with practice. When I first learned the advantage of summarizing a client’s story or a therapy incident in a one-line synopsis, massaged to emphasize the connection to the therapy’s focus, I realized that I needed practice. So after every TV episode, commercial, or movie I watched, after every news story, novel, or chapter I read, after every story told to me by a friend or family member, I stated my synopsis out loud (silent rehearsal produces retrospective revision–cheating). After thousands of muddled attempts, I got to the point where I could confidently summarize what I had heard or read or seen. After thousands of further attempts, I got to the where I could spin the synopsis to make a point. So no doubt practice helps. I even found that the commitment to synopsizing forced me to pay closer attention.

But none of those TV commercials, news stories, or friends’ work updates were about me. I had developed with patients the technical skill of reflective listening but not the clinical skill of “getting” it. It turns out that I already had skills for nuanced listening with my life partner. My wife pointed out to me yesterday that when we talk to each other, we immediately sense any breach in the communicative field; we understand what the other person is up to in telling a story (usually collaborative generativity around work and ideas, private jokes, problem-solving, narcissistic soothing, or entertainment). We can tell when the other person is promoting a different version of themselves, and whether this performance is defensive or experimenting with a new way of being. We can tease each other about our foibles partly because there’s an envelope of affection that the content comes in, but also because we can count on the other person to detect that the teasing is affectionate. We both have extremely sensitive antennae for picking up cues that a story contains a hidden complaint, and we are both quick to wonder if we have done something wrong to occasion it.

Besides reflecting generally on the parallels between a healthy marriage and psychotherapy, I am specifically noting how the nuanced listening in marriage develops out of the knowledge that your spouse’s moods, hidden agendas, and varying ways of connecting with you matter to you. You need to know what’s up with your spouse because your own well-being depends on it. In some, alas many, marriages, the hierarchy between what Sartre called the Lover and the Beloved allows the beloved to ignore the moods, meanings, and connections of the lover, who must suffer in silence at not mattering much or must express that suffering in symptoms. Similarly, every therapist has the option of invoking what I call therapeutic privilege, allowing the therapist not to notice the suffering that the therapist imposes on the client, or allowing the therapist to notice the distress but attribute it to something the client’s parents did wrong instead of to something that the therapist is doing.

Many clients are easy to love, and it’s no surprise that research consistently shows that psychotherapy works best with the people who need it least. When I meet a difficult client, say, the narcissistic drinker who challenges my comfort and expertise, I resist saying to myself, “He’s not likely to change and is hard to work with”; instead, I would like to say to myself (not always successfully), “It’s my job to love this man, but dang, he isn’t making it easy.” This objective of love creates the envelope of affection and play that therapy requires, but it also assures that I will be listening to whatever he says as if it matters to me, and this in turn will engage my most attuned, nuanced, and circumspect listening.

Michael Karson, Ph.D., is a professor of psychology at the University of Denver.

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