Listening to Patients

Imagining walking in someone else’s shoes.

Posted Apr 11, 2017

Xavier Sotomayor/Unsplash
Source: Xavier Sotomayor/Unsplash

Over the many years that I have been doing therapy I have learned a lot from my patients. And what I have learned is that it takes a lot of courage to cope with anxiety, depression, and relationships that seem to be crumbling. We can sit back as therapists and take pride, we think, in the techniques and tools that we have, but the first thing to keep in mind—whatever kind of therapist you call yourself—is that being able to listen and genuinely care is the essential part of therapy. So, if you are a therapist, begin with this awareness. The person who is coming to see you for the first time doesn’t know you. They may have been humiliated and marginalized from childhood to the present day, they may have felt betrayed and disillusioned from relationships and hopes that have crashed and sank, and they may believe that there is something fundamentally wrong with them, something that no one could ever tolerate, something that makes them feel different from other people. The person coming to you for the first time may believe that they are alone with their agony. They may have been told that their feelings make no sense, that they should snap out of it, and that they will get over it. And now they turn to you—a complete stranger—and wonder if they can really trust you. You are the “unknown” and the unknown has hurt them in the past.

Miguel de Unamuno, the great Spanish novelist, essayist and philosopher, spoke with eloquence and wisdom about human agony in his essay, "The Tragic Sense of Life." Unamuno contrasts the “modern man” with the man of tragic vision. He tells this simple story, borrowed from the ancient Greek leader, Solon, one of the founders of Greek democracy. An old man is sitting by the side of the road weeping. A young man comes along and says, “Old man, why do you weep?” The old man says, “I weep over the death of my son." The young man says, “Why weep? Weeping avails nothing. Weeping will not accomplish anything.” The old man forlornly responds, “Yes, I know. I weep precisely because weeping avails nothing.” Unamuno observes, “We must weep for the plague, not just cure it."

It is hard enough to suffer in life, but worse if we suffer alone. Unamuno realizes that we must be able to share suffering, to share our tears and even our moments of hopelessness with others. And who are we, as therapists, to expect this to be such an easy task for someone who has been told not to weep, not to suffer? Are we entitled to trust? Perhaps not.

One of my patients taught me this lesson years ago. She had a sorrowful history of past suicide attempts, hospitalizations, criticism from her father, and ongoing joylessness and despair. Initially I was giving her my many techniques and ideas about changing, only to hear her say, “You don’t understand." I kept coming back with more techniques, more positive ideas, only to hear the same response.

I went home and thought about what she said. I realized she was right, “I don’t understand." I looked back over my life and realized that I never felt that depressed for more than a couple of weeks—and never as depressed as she felt almost every day.

The next session went like this:

Bob: I thought about what you said and I realized that I was constantly pushing my agenda that there are things that you can do to make things better. You kept saying that I didn’t understand. And I kept pushing.

Patient: (Looking at me with distrust). Yes.

Bob: And I realized that in my entire life I have never felt as bad as you do on a daily basis. I realized that I was trying to understand, trying to convince you, but then I came to the realization. I don’t understand.

Patient: Now you understand.