Therapy

Learning to Listen: Lessons From the Clinical Trenches

What my clients taught me.

Posted Apr 27, 2020

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Source: Pixabay

“Whoever fights monsters should see to it that in the process he does not become a monster. And if you gaze long enough into an abyss, the abyss will gaze back into you,” wrote the philosopher Friedrich Nietzsche.

Therapists know well the risk of being pulled into the very darkness from which they labor to help their clients extract themselves.

On the brighter, flip side, we have the famous biblical sentiment from Saint Luke: "Give, and it will be given to you. A good measure, pressed down, shaken together and running over, will be poured into your lap. For with the measure you use, it will be measured to you.”

In other words, to give is to receive, to teach is to learn, and to help is to be helped. 

I’ve been seeing adult clients in individual psychotherapy for over 25 years now, in different settings and various locations around the country. Here are several things my clients have helped me learn:

1. Shut up and listen.

Many years ago, I served in the special forces of the Israeli army, where most activities took place at night. There, I discovered that you learn much about whatever is going on in the light by sitting quietly in the dark. Years later, my clients have taught me a similar lesson about the practice of therapy: You help much more when you shut up and listen.

This appears a bit counterintuitive. After all, therapists work with words, don’t they? Hence, "talk therapy." Yet what I’ve found is that the words we need to work with are mostly the client’s. As a therapist, my clients have taught me that they value my attention more than my wisdom. And I have more of the former than the latter, anyway.

My sister, who’s a massage therapist in Israel, likes to say that the two things people need most are to be touched and to be heard. Her clients come to be touched. Mine come to be heard.

No one enters therapy to hear a lecture, as learned and well-intentioned as it may be. Clients are there to discover, tell, and revise their own stories. Much more gets done in therapy when my mouth is closed and my ears are open. It’s a little bit of a lesson for life as well.

2. If the client bores you, you’re failing them.

Years ago, while working as a journalist for an Israeli newspaper, I sent my editor an interview I’ve conducted, only to be told that it was not publishable on account that it was boring.

“I just wrote down the answers,” I said, “it’s not my fault they’re boring people.”

“A boring interview means you did not ask the right questions,” my editor said. “If an answer is boring, the question was bad.”

My years doing therapy have taught me a similar lesson. Every person is their own country, and every country has beautiful spots—if you can figure out where they are and how to get there. Therapy allows people to dispense with small talk and delve into what matters to them. In the territory of things that matter, everyone has an interesting, dramatic, and compelling story.

Alfred Adler once said that the only normal people are the ones you don't know very well. Same for boring. Everyone knows something you don’t. Everyone has done something you haven’t. Everyone can show you something you haven’t seen before. If a client is boring you, it means you are failing as their therapist.

3. The self is relationships.

George Vaillant, who ran the longitudinal Grant study—a seminal project in developmental psychology following a group of young men for since the 1930s—has summarized the findings thus: “Happiness is love. Full stop.” My data, admittedly, are not as extensive or systematic as those collected by Vaillant and his team, but by way of analogy, I’d summarize my experience with clients thus: The self is relationships. Every “I” is a “we.”

This is not a new or original insight. It is expressed, for example, in the sociologist Charles Horton Cooley’s turn-of-the-twentieth-century theory of the “looking glass self,” in 1960s feminists’ famous slogan, “the personal is political,” and in the great Russian developmentalist Lev Vygotsky’s contention that the mind is socially constructed. The work of therapy, I think, affirms this notion.

No one grows up in isolation from others. It’s impossible for humans to do so. Our sense of self is largely acquired through interacting with, comparing ourselves to, and receiving feedback from others. Our well-being is intimately tied to our intimacies or lack thereof. Our mind is made in the cast of culture, and culture is made up of the behaviors of many people. Other people’s behaviors, voices, and images are internalized in the formation of our individual minds. The very concept of "alone" presupposes the existence (and meaning) of contact with others.

Therapy deals with individuals, and the individual is communal. Therefore in therapy, all problems are relationship problems. True, on its face you may find clients who wrestle with an issue that has nothing to do with others—for example, their feeling of failure to achieve a career goal. But probe a bit, and you’ll find that here too, the career goal was internalized in the context of relationships, and the failure is assessed in comparison to others’ achievements and expectations. To reshape the self, one must reshape relationships.

4. Therapy is an act of dissent.

In my practice, I see mostly anxiety clients. They come in bothered and bedeviled by all sorts of fears, phobias, compulsions, haunting trauma, and worries. Yet when people come to therapy to deal with their anxieties, they manifest another aspect of their internal architecture—their courage.

All of us have both fear and courage. Yet these do not inhibit the same continuum. Just as your debts and assets are not inherently dependent on each other, more courage does not denote less fear, and vice versa. We can have both great courage and great fear at the same time. And we can exhibit great courage in one context and great fear in another. The aforementioned George Vaillant once said that fever is not a sign of disease, but of coping. What I see in therapy are not clients being scared, but clients being brave.

Anyone who’s listened closely to the stories of people who deal with mental health challenges—or who’s dealt with one on their own—knows well that the internal demons we battle are just as scary and dangerous as any enemy or calamity we may face in the external world. The choice to enter therapy is an act of dissent, a fight for freedom, internal freedom, against internal voices and long-term habits that are often as oppressive, cunning, and lethal as any world tyrant. That is courage.

5. Change is action.

As I’ve written before, actions may not speak louder or more eloquently than words. In fact, our actions are often halting, imprecise, or convoluted. Yet actions tend to speak more profoundly than words. If you run over me with your car, I’d care whether that was accidental or intentional, and it’ll matter to me how you felt about the event. Yet the action itself is most consequential for both of us. The action is the original text. Everything else is commentary.

Clients come to therapy for many reasons, yet as a rule, those who end up improving and benefitting most are those who manage to translate the words of therapy into action in the world. It is true that theoretically, one can experience great internal change—a change in perspective, in feeling, in point of view—sans any outward change in behavior. The Copernican revolution embodies that fact—a change in worldview (in Copernicus’s case, the new realization that the earth revolves around the sun) that changes nothing in the world. Yet more often than not, true changes in perspective, perception, or feeling will be brought about, manifest, and strengthened by concrete actions in the world.

In my youth, I was an athlete. At one point, I was invited to play for the Israeli national handball team. The coach told me that I had potential, but that someone who has potential is merely someone who hasn’t done anything yet. Likewise in therapy, having insight into a problem does not a problem solve. Usually, problem-solving action is required. The beauty of action is that it honors the here-and-now. Without action, we can easily become stuck in the past or future, the places to which our agile mind affords easy, cheap travel. Such travel may bring about insight, but not change. Change is action. And we act in the present.

This, for example, is why the old AA notion, that alcoholics who are no longer drinking are still alcoholics, is problematic. On one level—that of the risk of relapse—alcoholics are indeed different than non-alcoholics. But on another, more important level—that of their daily experience, decision making, relationships, and health—they are not. The history, family, and liver of someone who quit drinking 30 years ago resemble much more those of a non-alcoholic than those of someone who’s continued drinking all this time. Behavior tells the central story. Action is the pudding. It’s where the proof is.

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