“Do you get what I’m talking about?” is one of the most difficult questions that a patient can ask a therapist. It is difficult because it goes right to the heart of the enterprise of therapy. It is also slippery.
Just what is the import of the question? Does it mean something like, “Do you wholly and without reservation not only understand what I’m saying, but resonate with it and agree one hundred percent with me?” In thinking about the slipperiness of the question, it helps to keep in mind that so many of a child’s complaints that “it’s not fair” really are complaints that the child has not gotten his way. Of course, it is not simply children who reason this way.
Also, what are the criteria for a therapist’s knowing that the therapist “gets” what the patient is saying? If the therapist feels that the therapist “gets” what the patient is saying, if the therapist is passionately of a mind that the therapist “gets” what the patient is saying, does that mean that the therapist “gets” it? Any experienced therapist knows that it is possible both to be convinced that he or she “gets” what the patient is saying and to be quite wrong.
“I would never go out with a person like that. It’s a bad fit and it just wouldn’t work. I’ve explored it enough in my own mind. It’s all wrong. Do you get what I’m talking about.?”
This young woman was very convincing and her therapist was not bothered by the fact that she was too adamant and so agreed that he “got” what she was talking about, the utter unsuitability of this young man, whom she began dating and, after considerable turmoil, ended up marrying,
The classically recommended responses to the question, “Do you get what I’m talking about?” namely, silence, and “What do you mean when you ask me that?” are perilous, each in its own way.
Silence is not necessarily either golden or helpful. In fact, silence may be depriving. It is advocated as a means for staying out of the patient’s way. It is supposed to encourage the flow of the patient’s thoughts and feelings. Silence may even go beyond being depriving. It may freeze over the river of communication. Allowing for discomfort in therapy is essential. It brings out resistances and underlying conflicts. But it has to be dosed. Patients hunger for response, for a therapy that is a two way street. It is part of the therapist’s responsibility not just to ask but also to answer, if often tentatively.
“I just want someone who talks to me. I need to know that there is someone else in the room.”
This is a sentiment that patients often express. I believe that they mean what they say.
The device of answering a question with a question may sometimes be useful. It may open things up but it may also turn the faucet the other way, even if the more graceful and more open variant , “Say more”, is used. It may close communication, shut off the flow. The impression that patients often get from being asked what they mean by their questions is that the therapist is trying to stay aloof and detached, not to be sullied or compromised by a genuine exchange with the patient. Sometimes, of course, the patient is only too happy to amplify what he or she has said.
It is true that, when the therapist responds to a question, that therapist is exposing the therapist’s inner world or a part of it. But therapy is a matter of back and forth. If we want to get to know the patient, we have to let the patient get to know us. Patients are very interested and intrigued by their therapists and always scanning for clues as to who the therapist is. However powerful transference may become, there is real search for real knowledge of the therapist as a real person.
I am not suggesting that therapists abandon all discretion or sense of limits. I am suggesting that discretion and a sense of appropriate limits are not incompatible with communicating with patients as real persons. The agenda can remain set by
the patient’s needs and problems, but the process can be enriched by communication from the side of the therapist that avows the reality of the therapist’s personality and experience.
Understanding, after all, and empathy and compassion are not instantaneous. They are most often the result of successive approximations that allow us to find our way to the neighborhood where the patient lives, if not to the patient’s particular dwelling. I have found myself saying sometimes to patients that I was not very quick about understanding them, but I tried to be a hard worker and to make myself educable. In understanding most patients, the therapist needs the patient’s helping understanding the patient.
It is also true that sometimes the answer to “Do you get what I’m talking about?” is a plain “No, I don’t.” It may be quite useful for a therapist to say just this. This may come as a jolt to a patient, but it emphasizes that therapist and patient are separate people and that communication is at something of an impasse. It lets the patient try again in another way. If a therapist wants to soften it, the therapist can say something like “No, I don’t, but I would like to.”
“Do you get what I’m talking about?” can be a bitter accusation. There are some patients who desperately want to be understood and yet do everything in their power to make it impossible to understand them, then feel bitterly that they have been ill-served and blame their therapists. The only way out of this – or into it – is to find some means for articulating the predicament that therapist and patient share. This can be a very long process and lead in the direction of noticing the patient’s need to protect against the fusing danger or need to frustrate the therapist to cut the therapist down to size because the patient has so idealized the therapist. There are many paths into and out of this kind of thicket, each one a bit different than the others.
“Do you get what I’m writing about?” It’s not systematic but I hope it has some real bearing on the practicalities of psychotherapy. I am trying to provide a map of some of the quandaries that represent containers within which psychotherapy struggles to be effective. I certainly do not hope to solve these. First of all, this does not seem possible. Secondly, if it were possible, it would deprive psychotherapy of the dynamic tension that allows it to be creative in ways that can surprise and refresh.