I confess defeat at the very outset. I can not tell you what listening is, because listening is not a what, because listening is never the same from instant to instant, from person to person, from pair to pair, from stage of life to stage of life, because, in short, I do not know.

Yet, listening is what I do for a living, what I devote so much of my living to, as do so many of you. Listening is that particular set of mysteries in whose thrall, body and soul, we, psychotherapists, find ourselves. My purpose is to share with you both my fascination and my frustrations with the process of listening, the promise of listening, as well as the perils of listening, which are considerable.

Nor should we fail to notice that listening, whatever it is and is not, is what is going on right now, as you listen to me, as I listen to myself and whoever else is in me, as you listen to yourselves and all the others within you, as I listen, imaginatively and intuitively and inaccurately, to your listening to me.

We are together and apart in the predicament of listening. Neither of us knows where it will take us. We do know, though, that it is an embodied experience. You and I are both putting ourselves on the line, being open and closed in a variety of different ways that change from instant to instant. You fade from zone to zone in your mind as I do, looking at the world through filters of different emotional color. You are distracted in your mind. You change the subject and you, the subject, are always changing. Of course, what we take on and in will not only stay with us, but work on us and in us over the days months and years to come. Words are biological operators of great power and range

Listening seems to proceed by cycles of formless receptivity and provisional formulations, which are themselves goads to reformulation, challenges to accepted orderings, problems and solutions all wrapped into one. We listen in different modalities all at once, musically, semantically, somatically. Listening possesses us and dispossesses us all at once, so that, if we let ourselves, we become people without a country, emigrants and immigrants to the land of what was and what is not yet.

Now I am a middle-aged person, a middle-aged psychiatrist, a middle-aged psychotherapist. I have less energy than once I did, less optimism, a few more inklings about my own character and limitations, how insecure I am, how critical, how forbidding sometimes to others when, consciously, I least want to be. As the dancer Bill T. Jones said, “Personality is like the back of your head. You don’t see it much, but the people around you do. “

I might even have a few more inklings about others, about the world around me, enough to know that, however I think the world is, it is not that way, but much more vast and chaotic, much more intricate and ambiguous.

As part of being a middle-aged person, a middle aged psychiatrist, a middle aged psychotherapist, I consult, in one way and another, with a number of colleagues who, like me, do this work. I have been quite struck with a common refrain among them, sometimes sung over great periods of time with great trouble of mind and heart and soul. I have been struck by the way each one has his or her own version and yet the melodies and lyrics are recognizably kin

This refrain is they are not sure what they are doing, whether it works, whether it is perhaps just beside the point, whether it may in fact do harm, whether they have perhaps erred by choosing this life over other possible lives and so forth. By their work, they are charmed and appalled, enticed and repulsed, crushed and inspired and much else that they find hard to categorize, too. I have heard this refrain sung not just outside me, but also within me, from before the time of residency, during residency, afterwards, too.

Somewhere in just the last two or three years, with the help of these colleagues who come to me for help, but provide me, I think, with more than they or I can know, I found a new way of listening to this refrain. I was not seeking this new way. Rather, it surprised me, because I had no idea that it was there to be found. This, too, is a fundamental characteristic of listening, that it changes us and changes itself as we go along. Listening is one of those processes that let us surprise ourselves, disorient ourselves, refresh ourselves, redefine ourselves, that take us apart and put us together in new ways.

One day, quite apart from any intention, I began to hear this refrain as a song of openness, a music that evoked the difficulty and despairs, the indeterminacy and agony of being available on many different levels to others who are very complicated in their distresses, in their styles of communication, in what they enact and inflict and confound and withhold. I had the image that psychotherapy is a form of surgery where the therapist has to make an incision in himself or herself if the operation is to have a chance of success. Not only does the psychotherapist have to make this incision, but the psychotherapist must keep it open. Psychotherapy, too, insofar as it is on the side of feeling, proceeds without anesthesia.

We often hear it said that psychotherapists do not do anything, that, we just “sit there.” Now, there are many problems with this view. First, actually listening is a job of enormous internal industry, one that involves resonating and responding at least internally on so many different levels.

We catch affects, bodily states, complex fields of cognitive bending and twisting. We mind so much and are reminded of so much. To stay still in the face of a barrage of such diverse stimulation is no small task. In listening we use everything we know, everything we have felt, everything we have learned, not all at once, but in the most imposingly complex sequences. There are vast territories in whose remote reaches we must be able to resonate. If we listen to the patient, we are well beyond the realm of algorithms and into the realm of more vital rhythms. Nor can we capture the experience with process notes, with videotapes, even with electrodes implanted in the brain or continuous functional MRI recordings.

Nor do we listen to any two patients in the same way. One of the things that keeps me loyal to psychotherapy is that it is, in many regards, the art of the reinvention of the psychotherapist as psychotherapist over and over again, time and time again. We start at the beginning each time no matter how experienced we may be. With some patients, too, we fail in the project of inventing out of ourselves for them a suitable psychiatrist, a suitable psychotherapist, so that we must acknowledge with chagrin that we were not able to find what we were looking for in ourselves. Even while we grieve this shortcoming, we have to hope that both we and the patient have learned something that can be carried with us, addressed in new ways in new places. I despair, happily, of the standardization of psychotherapy

Let me tell you the story of an encounter that has been in my mind for more than twenty-five years. It alerted me to how peculiar an activity listening was. Before I went to medical school, I was the director of a small alternative high school for teen-agers who did not thrive in regular schools. One muggy spring afternoon, a family came in to talk with me because they wished to enroll their son, who had some psychiatric problems, in the school. As I recall it, I was not very interested. They were all three, mother, father and son, fairly rotund people, with smooth faces, slow moving, slow talking. The son was not very forthcoming, not at all an unusual characteristic in a teen-ager during such an interview.

They did not seem agitated, not even anxious. The son did not have much to say. The parents did not have much to say. I recall feeling sleepy. Then something happened inside me that stunned me and brought me to a full emergency alert. I saw the blue ocean stretching off in every direction, rolling in placid waves. A white shape broke through the surface, breached and splashed back down. In this visual hallucination, incidentally, the only one of its kind and quality I can recall having, I recognized Moby Dick.

Given the level of malevolence and violence in Moby Dick, the number of casualties in the novel, this frightened me. I started to pay intense attention not just to what was going on with these three strangers in my office, but to what was not going on, namely any free flow of feeling or information. We were all four locked together and also locked apart. The more I sat there, the less communication took place, the more fearful I became about what was not being said or heard. When they left, having said that they would like to enroll their son in the school, I was so disturbed that I called up this young man’s psychiatrist.

I outlined my worry, its diffuse quality, how this little family grouping had detonated a dread in me that was unfamiliar to me. Or perhaps it resonated with something buried terribly deeply in my own experience, something I did not say to this psychiatrist. I said that I was worried about the teen-ager’s safety and that enrolling him in the school was a step that made me uncomfortable for reasons I could not specify. In a tone dripping with the condescension of the expert, the psychiatrist replied, “Don’t let your imagination run away with you.”

The next day this teen-ager wreaked havoc on himself and was hospitalized for the following year and a half. I was saddened and frightened when I heard this, but not surprised. For me, this had been there when I sat with him and his family, although I did not know what it was. One of the great quandaries in listening is whether, when our imaginations run, they are taking us to a useful place or to a place that is not useful. This is analogous to the problem posed by the Greeks about dreams, some of which they saw as reliable guides issuing from the Gates of Horn and others of which they saw as follies that issued from the Gates of Ivory. One of our jobs as psychiatrists is to let our imaginations run, to open up space, to allow for the story that has been so long suppressed to crystallize and learn to tell itself. Yet, we can not only be misled but mislead. We need always to be troubled by the need to discriminate between horn and ivory.

When the psychiatrist told me not to let my imagination run away with me, he was probably telling me just what he had to tell himself over and over again, as he listened to the strange and dramatic tales that were told him by his patients every day. Our patients work on us, work in us, work through us. This is not a polite and well-behaved process, but much more like an encounter in the wilds, one in which we are very much at risk if we are engaged in a real way. So many psychotherapists give up in horror after a certain number of years of being involved with listening to patients. None of us fails to imagine a career in which we are not so impinged upon, placed so at internal risk.

For example, the chronically suicidal patient, like Chicken Little, tells us each and every day that the sky is falling, that the world is coming to an end and that, not only is this how it is and must be, but it is imperative that we help in bringing it even more quickly to an end. I recall my absolutely charming, even seductive, suicidal patient who had seven children, had as her stated goal treating each one as an only child and had no inkling of her own hostility toward her children. How adept she was at making me picture an endless parade of orphaned children, at inducing in me the atmosphere of abandonment and violence. How foolish and vain she made me feel as she taunted me day after day, month after month with her fear, her remorseless pursuit of death, her absolute unwillingness to accept any responsibility for living in a less than perfect world, where none of us is the only child of an adoring omnipotent mother.

Across the decades, I have never stopped wondering how I knew to be so worried about that particular teen-ager. I did not know in any way I was used to knowing. There must have been enormously significant inputs on channels I am not used to monitoring consciously, perhaps even on channels we do not have the apparatus to monitor consciously. Perhaps some ancient ethologically determined menace detection apparatus, attuned to posture, to facial expression or lack thereof, to music in the voice or lack thereof, or even to smell in some subliminal way provided me with masses of data, which my mind, as in a dream, turned into a vision of Moby Dick breaching in the vast Pacific, the peaceful blue ocean which, in this case, was anything but peaceful.

Much of our listening is for what is not said, what can not yet be said, what has not yet arrived in a way that can be owned and named. I recall reminding myself over a period of many years that was what most important about what a patient said, even about what a patient did, was what the patient would say next, do next. Context is always accreting and meaning comes from context, so that listening is like traveling on a river. We have to go with the flow, doing our best to manage the dangerous turbulences as they arise.

I had a shy and silent patient, someone who came and looked stricken and fetching and appealing and did not talk, did not say more than a few words, engulfed me a silence of such vastness that it became more and more frightening, because more and unfamiliar, more and more charged with what I could not say or know. This silence deprived me of words, of thought, of my customary ways of mapping a course in therapy. This silence was charged with need and dread and shame. It was not a comfortable silence, not a silence of concord, but one quite unlike any other I had experienced. I spoke and did not speak, contemplated withholding as a defense and as expression, felt more and more baffled and inadequate, more and more incompetent, as if my pretensions were being exposed, as if I were discovering that I was someone quite other than who I presented myself to myself and others as being. I was, needless to say, very frustrated. One evening, quite dispirited about this treatment, I wrote the following poem, which came easily. Of course, now, many years after the fact, it does occur to me that her silence was perhaps not very different than my father’s about the traumas of his early life in a Europe.

Study For A Prayer To The Angels Of Silence

How many
Are the angels of silence,
Huge and smooth beyond the heft of stone,
Glacial in their beauty and menace,
Burning the tongue with cold,
Annealing pink flesh to pale blue ice,
Annexing it,
So that it can not wiggle or work,
So that, transfixed by shame, it can not name?
The angels
Of the universe of silence,
Were before the beginning,
Guarding what could not be
Deep in the weird translucence
Of their unbecoming bosoms,
Without music, without musing,
Without suspicion of themselves,
So without even a primordial whisper of regret.
The angels of silence,
Have no boons to bestow,
No tales to tell,
No gestures to permit recognition.
And yet, most ancient of all,
They live among us
Unlinked, not to be mapped,
Sentinel at the borders of a complex
Territory, soul’s constitutive exclusion.
O angels of silence,
Who numb me even as I name you,
Forgive me the passing fancy of this speech.
Sleep on, cherish the ruins
Of what has not yet been revealed to be
In your great blue unmoving bulks.
For you, there is no coming and going.
Where you stand, there you stay.
I have seen more than I can ever say.

Within a few weeks, this patient began to tell me the tale of a truly disastrous childhood, replete with both neglect and the intrusions of rapacious others. She was, as it turned out, much more frail and fragmented than either she or I would have suspected, located across the border of the realms of violence and terror. I did not read this poem to her.

Yet, it was very useful to me. It moved a chaos of impressions and impingements into the realm of form and language. It relieved me of a burden by moving it outside me so that I could make room for it within myself in a different way. It summed up an experience of living in a way that changed how I looked at a broad variety of experiences. Years afterwards, when I gave a presentation on the topic of trying, someone in the audience asked the very astute question, “What do you think we should do to help those patients who are simply too shamed to talk?” I did not have an answer, but this patient and this poem went through my mind.

Listening produces illusions, which can usefully be thought of us a psycho- physiological enzymes, that is, agents of transformation. By illusions, I mean provisional summaries, shapings, impressions, visions, complex integrations of what is diverse and difficult into something meaningful, but not necessarily in an easily specifiable or reductionist manner. The following wise statement has been attributed to Goethe, “Who mistrusts illusion, nature will punish.” What I take this to mean is that we must accept and value the way in which we are, on a moment to moment basis, artistically active in shaping experience from the chaotic flux of living.

The illusions we produce in our listening are dynamic, that is, they enter into an inner dialogue with a whole host of other illusions, with our systems of surmise and, since we react to them affectively and physiologically, they change how our bodies are, how we breath, how our intestinal motility proceeds, how our hearts beat and so forth. I have had patients, especially enraged ones, make me so sleepy, when I had not been sleepy before they came in, that I had to pinch myself to stay awake. I have had patients make me so tight and tense that I could not take a deep breath until I did something physical to shake off the constraints they had installed in me. I have had patients induce states of terror in me that were immediate and also unrelenting. We take patients in and carry them around with us, just as they also take us in and carry us around with them, for better or for worse. Therapy is a twenty-four hour a day, seven day a week experience, however arbitrarily we may chop it into billable sessions.

It follows from what I have said that I believe there may be numerous ways of organizing a therapy for the same patient, numerous styles of illusions, numerous pathways that can be walked from the current distress to a place that the patient finds richer and more satisfying. In focusing on the inter-subjective intricacies of listening in psychotherapy, I do not mean to imply that anything goes, but rather that many things can go. Nor do I have clear answers as to what the family resemblances of what goes may be. Certainly, devotion, an honest effort to be open to the patient, respect for the patient’s own efforts, experiencing of affects, genuine practical thinking, an awareness of how past impinges on present and of how present need can shape the construction of the past, seem to be important. The going is collaborative and the going is rough, not smooth, with periods of crisis where both parties may lose their maps. Clarence Schulz has said that part of what is so interesting about psychiatry is that we are in quest of trying to understand what the right questions might be.

In the days when long term hospital care was practicable, a time I mourn because it made much possible that is not possible today in treating severely ill patients, I took care for a number of years of a manic-depressive patient whose psychotic process was quite intractable, but who was also warm, personable and, in his own way, winning. I have written about him at length in Creative Collaboration In Psychotherapy, describing there our long journey towards understanding why things were so difficult for him and why he had such a hard time with other people. Often, I felt utterly baffled by him, as if we were lost together in a torrent of uncomfortable verbiage, fear and fancy

Once again, at wit’s end, I tried to summarize for only myself how this work felt, its intimate existential texture. This, of course, is rarely spoken about in our professional discourse, rarely rendered, because it is too private, too personal, too free of the numbness of numbers, not open to the public kind of consensual validation that our science values. What, after all, is a poetic report worth? Perhaps a great deal, but in an authentic rather than authoritarian way. When I present you this poem, I am appealing for response, not stating a fact, but providing an opportunity. “Can you recognize this,” I am asking, hopefully, in accord with Sullivan’s dictum that we are all more simply human than otherwise.

Doctor And Patient: Conversation, Convergence, Conversion

He sits, this afternoon of vernal equinox,
great and bulky opposite me in the white chair,
the sun deploying behind his heavy head
shifting patterns of dapple on the cream wall.
He speaks, seeks, beseeches, stops, sighs, stares.
What would he say if he knew how eerie empty
I was, how between the words, in the pauses,
I fall and fall and experience a weightlessness
that has no name, no time, no stop.¬ ¬Of what he says,
I understand nothing; I understand the nothing.

I understand less and less. I have placed
a moratorium on understanding.¬ And yet, even so,
I elude myself. Apart from parts is there any peace?
The puns I make in my mind are a kind of mime
which shadows the inward (utter) arbitrariness of the sign.

“The whirl without end, the withering winding
that starts from nowhere and goes nowhere,
contains us and does nothing as we go to be
no more, soon,” he says.¬ I nod and do not tell
my head’s heavy as his, fading to lifeless light.

Not a minute has passed, and yet the shapes
of spirits insubstantial or the spirits of the shapes
have flown back and forth between us, possessing
and then repossessing us as their matter:
I do not tell.¬ I may not tell. There is no telling.

So far, I have used three examples that focus on the vagaries of being in touch with people who are mostly out of touch, mostly unable to mediate between themselves and someone else. One of the most in touch people I ever took care of, someone who made enormous gains in therapy and is now doing very well in his life, surprised me one day after many years of therapy by saying, “Dr. Lewin, all you have to do is to help me remember that I exist. I can do all the rest myself.” How do we help someone remember that he or she exists, that he or she is a center of feeling and experience and thought and art and value and initiative, that he or she is not required to merge and submerge himself or herself in another person?

We perform tasks of this kind by listening, by understanding and not understanding, by puzzling and being puzzled, by worrying, wondering and wandering. With that single sentence, this patient summarized ten years of intensive work on a path whose destination neither of us knew. Neither of us could have predicted the creative outcome. Both of us had to share faith and doubt in our common enterprise. So, listening is an activity, a receptivity, that commingles faith and doubt, form and formlessness, coherence and incoherence. Listening is what we do and yet we can not know with any precision what we do, what it makes of us and what it makes of others.

Another patient with quite a robust capacity to relate was talking about how much most people did not wish to listen, how they merely exchanged conventional formulas, how taxing it was to listen because what you heard was never what you wanted to hear, but something quite different. He went on to talk about how he had a tendency to make people up in order to suit his specifications, a procedure whose limitation is that it leaves you all alone, because there is no authentic contact with others. Then came the following astounding formulation, “Listening is such sweet sorrow.” It is sorrow because real listening separates us from our wishful versions of the world, sweet because it makes a more genuine contact possible. This paraphrase from Romeo and Juliet makes it clear how closely allied listening and love are, because love requires real knowledge of the other as the other actually is. If we consider the tragic history of Romeo and Juliet, we can appreciate how at odds self and other are in the mind and heart of this man in his forties, how much worry he has about the outcome of his efforts at individuation. An apprehension of tragedy haunts him. For him to listen is to lose as well as to gain. The relative proportion hangs in the balance and the losses which seem ultimate must be mourned. Of course, one of the things that listening is about is seeing ourselves and others through losses. For some, nothing short of internal metamorphosis is required.

Listening takes time. This is an inconvenient truth that puts the practitioners of psychotherapy at odds with contemporary preoccupations with efficiency. It is a characteristic of the way we live now that we are in a hurry, that we are in the habit of hurrying, that for many of us hurry is the default setting, so that we do not even register what we are missing, what we are turning into nothing but a blur by hurrying. Psychotherapy, in the sense that I use the term, in the sense that I have been practicing it, is more contemplative than prescriptive, leaves more empty spaces and unanswered questions, makes modest claims and waits and works to see what outcomes will come to be. Such psychotherapy is about mindful play and playful mind, about surprises more than certainties.

It takes into account, too, that talking can be an important part of listening. I may say what I think I have heard. I may summarize a sequence that I think I have heard. I may say something about what has occurred in my own mind as I was listening. I may be very abstemious about what I say, but not as a matter of doctrine. In fact, living psychotherapy is almost always at odds with doctrine, because it is above all a try, a trying try sometimes, but an effort towards a set of humane ends which are not known beforehand. We listen and, as we listen, listening for what listening is may be part of our preoccupations. Thinking that we know is dangerous because it can close us off to new possibilities. Listening is about the provision of openness. Often what is best about listening is that it is open to new forms of openness.

« « Previous Post: Shame | Next Post: Shame And Loneliness » »
Share This