Every thought, feeling, memory, emotion and wish in the human mind is connected to every other thought, feeling, memory, emotion and wish. They are connected either directly or indirectly by associations, much as all of the molecules of water in a swimming pool are associated with each other.
When listening to a patient, the therapist does not use a linear type of thinking. Instead, the therapist listens with an open, relaxed ear and lets the patient’s thoughts go where they may. By listening and not interrupting, the patient is allowed to share his thoughts and feelings freely, as he associates from one idea to the next. This is important because as time progresses in a session, the patient gets deeper into his story. This method of active listening allows the patient to listen to himself speak and experience what he is saying and feeling. The job of the therapist at this point is to accompany the patient as he dives into his thoughts and encounters feelings and experiences that he has trouble with. As the therapist helps him navigate around emotional obstacles, the patient can dive further.
Freud saw himself as an archeologist who helped people dig up their past to shed light on their present problems. Psychoanalytic psychotherapy as it is practiced today is very unstructured, which allows psychological space for the patient to occupy and grow. The therapist must not fill the room with his own ego or experiences unless it is in the service of helping the patient. The patient has to feel that the therapist is listening in order to keep talking. The therapist is the basket into which the patient unravels himself. This is why the most important skill for a therapist to have is the skill of listening.
It is very hard for listeners who are not trained as good listeners to keep themselves from talking.
As the patient speaks more and more and the therapist listens attentively, the patient starts to make connections between his own thoughts, feelings and experiences. He becomes more insightful. This process is so gentle that the patient does not feel it happening. The goal, to a certain degree, is to make the patient his own therapist so that he can have insight into his own behavior after he leaves therapy.
Another goal of therapeutic listening is to make the patient feel he is in a safe, non-judgmental space. How? Many things patients say would usually be met with a judgmental response in any other setting. However, when the therapist does not respond at all and keeps listening, the patient learns that he does not have to be so hard on himself for having the thoughts that he does. Over time, this allows for a softening of the punishing guilt that most people subject themselves to for thoughts and feelings that we all share. In this way, what the therapist does not say is as important as what the therapist does say.
As patients are freed up from guilt, they can devote more of their mental energy to other things, such as problem solving, making new choices and living their lives. Again, this process, which grows out of therapeutic listening, is so gentle that the patient will not realize it is happening.
Most of this process occurs outside of the patient’s awareness.
Finally, patients can tell when therapists are not listening. A therapist that just says “Aha” but is not really listening will not keep patients very long.
Jonathan Bellin, LCSW received his BA from Yeshiva University in 1989 and his MSW from Yeshiva University in 1993. He has a tele-therapy practice where he sees patients 18 and older. He treats ADHD, depression, anxiety, Obsessive Compulsive Disorder, PTSD, Trauma and relationship issues. Jonathan studied psychotherapy at Harvard, The NY Freudian Society, The William Alanson White Institute, and worked at FEGS and JBFCS. He can be reached at [email protected].
