Psychodynamic Psychotherapy

Learning to Listen from Multiple Perspectives

Jon Frederickson

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780876309629
• eBook ISBN: 9781135825911
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychodynamic Psychotherapy is the first book designed to teach therapists how to listen and intervene from multiple perspectives. Through study and analysis of session transcripts, the reader learns how to listen and formulate interpretations from four different perspectives: reflection, analysis of conflict, analysis of transference, and analysis of defense. Each listening approach is introduced with a brief chapter illustrating the rules of intervention followed by therapy transcripts, which the reader studies and analyzes. By studying the transcripts, answering the questions in the material, and comparing his answers with those provided by the author, the reader will learn how to reflect, analyze conflict, interpret the transference, and analyze the defenses.

Beginning therapists can use this book to acquire listening and intervention skills. Advanced therapists will enjoy studying and comparing listening approaches from a meta-theoretical perspective. Psychodynamic Psychotherapy provides a framework for studying how each approach focuses on a different analytic surface, and uses different rules for timing and content of interpretation.

1

CHAPTER

Introduction: What Do We Do When We Listen?

To be sure, not every ear does all this in the same way, nor does any individual ear do it in the same way at all times: still, the human ear itself does it in one way or another. Those who distrust the testimony of a highly developed and refined ear because they cannot keep up with it beyond a certain point by the same token demonstrate the reality of what prevents them from going beyond this point: the reality of a resistance which can be accounted for only by the fact that musical works differ in their structural complexity, and by a particular ear’s ability or inability to keep pace with increasing complexity (Zuckerkandl 1973:195).

In my second week of graduate school, without any previous experience, I was supposed to be a therapist for schizophrenic patients just released from the hospital! Terrified, my classmates and I pulled our teacher aside and asked for advice. “Don’t worry,” she said, “whatever social skills you’ve acquired so far will pull you through.” Unfortunately, that was not true. Social skills never prepared me for the patient who hallucinated the devil tempting him in my office.

Psychotherapy is a strange field. The musician practices in the privacy of a room at home, making all her mistakes outside the hearing of others. Years of lessons, rehearsals, and concerts take place before anyone actually pays to hear her. And all this time, the difficulty of the pieces she performs increases gradually according to her skills. In contrast, psychotherapy is a trial by fire. Without any experience, the therapist meets with a patient, all mistakes are made within hearing, and the patient is often paying. Not only that, but the therapist often sees the most difficult patients as a beginner. What student orchestra of beginners would ever be asked to perform Beethoven’s Ninth Symphony for a paying audience?

When We Listen, We Focus Our Attention

Obviously, we need more than social skills—but what skills do we need? Are psychotherapists really able to listen differently? Listening means different things to different therapists. A cognitive therapist listens for distorted cognitions in the patient’s associations, while a Jungian therapist listens for archetypal patterns in the patient’s associations and dreams. A self psychologist listens for fluctuations in the patient’s self state that arise from the interaction between the patient and the therapist.

So what do we mean when we say we listen? Everyone claims to listen, but if five people listen to the same person, they would often come away with five different impressions. Why? Because we listen for different things. What we hear when we listen depends on where we focus our attention. For instance, imagine you are listening to your favorite singer at an orchestra concert. You might let the sounds wash over you and remember a general impression without many details. If you are poetically-minded, you might listen primarily to the words. If you are a singer, you might listen to her tone quality and phrasing. If you are a composer, you might focus on the relationship between the harmony and the emotional meanings of the words. If you are an arranger, you might listen for the sonorities created by the way the instruments are combined. Each of these qualities comprises parts of the whole: lyrics, singing, harmony, and orchestration. As a listener, you heard the part of the musical experience on which you focused your attention.

One might counter that these listeners were biased since they were focusing on only one thing instead of the whole. That’s true because all listening is biased. Any listening experience, be it a concert or therapy session, is too complex to be grasped in all its detail at once. Out of an overwhelming amount of auditory information, we have to pick and choose. The question becomes whether we are aware of our bias and can shift from one focus to another.

The same is true of vision. What we see depends on where we look. To see a landscape we have to look around, taking several views in order to get a sense of the whole. In fact, our awe while gazing at a landscape is partly derived from knowing that we cannot grasp this view in a single glance. Simply staring in one direction won’t be enough. If we are curious about a bird we hear in the distance, we might exclude the entire landscape except for the minute area with the bird which we can see through a pair of binoculars. The use of the binoculars is a bias and a useful one as long as we are aware of the bias and can shift to other means of seeing when necessary. For example, we might use the extreme bias of a microscope to examine bacteria in the soil of that landscape but put on our glasses so we don’t trip over a log.

It is impossible to see or hear everything at once. Each bias, precisely because it excludes some things from our attention, allows us to focus more easily on things that might otherwise escape our notice, like the bird and the bacteria. This seems obvious with vision, since we use glasses, binoculars, telescopes, x-rays, MRIs, and other visual aids to expand the range of what we can see. But what about listening?

Listening seems to occur naturally without any bias. People are usually unaware of their listening biases because they do not take a physical form as visual biases do. There is no physical corollary to the use of the microscope when we want to listen to something in detail. Hence, our listening biases are invisible although potentially perceptible.

How can people learn to observe their listening biases? To understand this question, it would be helpful to turn to the music profession, an occupation where listening skills must be highly trained. Music students take courses that train them to listen. In these courses, actually labeled “ear training,” students learn to identify chords and intervals. Out of what initially sounds like a complex sound, students learn to pick out the notes that are being played. Having learned to distinguish one chord from another, students then learn to hear and write down a series of chords that are played. Finally, they learn to write down several lines of music being played simultaneously. It is one thing to hear notes, but quite another to be able to listen, identify them, and write them down. Musicians must train their attention to focus on and identify patterns in sound.

Applying this analogy to the field of psychotherapy shows that each theory implies a kind of listening. Each type of listening focuses one’s attention on a pattern that can be interpreted. For instance, a rational-emotive therapist listens for irrational thoughts that are identified and challenged. A cognitive therapist listens for specific kinds of irrational thoughts and counters them with more rational alternatives. A Rogerian therapist listens for the patient’s stated thoughts and feelings and reflects them back. Although all therapists listen, what each of them listens for depends upon their particular theory. Since therapists cannot hear everything, they have to decide what to listen for based on what they think would be the most helpful. Each theory posits a different focus as being most helpful—e.g., irrational thoughts, stated feelings, etc.

In addition to the foci proposed by different theories, we recognize another source of biases in our listening style. Each of us, due to personality and preference, has a customary or habitual listening style. We have our own personal, often unstated theories about why people are the way they are. And these personal theories about people dictate what we listen for. You may have noticed therapists who seem to say the same things about all their patients. This may not mean that their patients really are all the same. It may mean that that the therapists’ listening focus allows them to see only one kind of thing over and over again. It’s like wearing rose colored glasses or aggression colored glasses or separation colored glasses.

Another problem arises when we listen in the way we wish people would listen to us. This is fine, as long as the patient is you. Unfortunately, the patient isn’t. What never ceases to amaze us as we gain experience is that patients require very different kinds of listening and responsiveness. What may be responsive for you may be overstimulating for one patient and depriving for another. We wish that we could find a “one size fits all” kind of listening that would be healing for all patients, but instead find that we need to become flexible in the way we listen and respond.

Hopefully, we learn in supervision what our innate listening style is, what it allows us to hear, and what it prevents us from hearing. Then we become free to shift our listening attention so we can hear other parts of the auditory “landscape.” Remember that with two eyes, the slight difference in perspective gives us depth perception. The same is true in listening. Only by being able to listen in at least two different ways can we develop depth perception. The more ways we learn to be responsive, the more patients we will be able to help.

What If I Don’t Want To Change the Way I Listen?

Learning to be flexible in our listening focus can be frightening. We may equate who we are with how we listen. Changing listening styles can feel like an assault on our identity. This is partly because our listening biases are invisible. Let’s imagine the same problem in visual terms. If you were looking at a landscape and someone said that you would need to use binoculars to see a bird, you would not say, “That’s not how I look at things.” If you were invited to look in all directions around you to get a feel for the landscape, you would not say, “Looking straight ahead is how I am.” You would distinguish between who you are and where you focus your attention. Let’s suppose you habitually focus your attention in only one direction. That habit is not you. A driver who goes only north or east is not the direction in which he is headed. There is a difference between the driver and the direction in which he drives his car.

“If I learn a new listening focus, I feel I have to give up the natural style of listening that feels right to me.” If you learn a new listening style you can add it to your natural style of listening. Don’t give up your habitual style of listening. Add listening styles to your repertoire. Then you can choose which approach would be most useful, rather than be the prisoner of the only approach you know. It is similar to having the option of using binoculars, telescopes, and MRIs to augment your eyesight. You still use your eyes, but they are enhanced by the tools you allow yourself to use.

In this sense, psychodynamic theories are aural aids. They are tools that direct our attention to certain patterns that we ordinarily wouldn’t notice. Just think of when you first read about cognitive therapy and suddenly became so much more aware of irrational thought patterns and understood better than ever why they were irrational.

Psychodynamic Listening

“Ok. I grant you that we use theories and that we should be aware of the assumptions that operate when we listen. But you still haven’t told us what listening skills are. Are listening skills in psychodynamic psychotherapy so different from social skills? Maybe your teacher was right: do psychodynamic therapists really listen in ways that are different from the man on the street?”

In everyday speech, we don’t think about how we will listen or even choose a particular mode of listening. We simply listen in the manner that seems natural to us. As a rule, we listen only to the content of what a friend says and our responses are based on what we are both aware of. Psychodynamic listening is different. When we listen psychodynamically, we are listening for what patients are aware of and for what they are not aware of. We are interested in both conscious and unconscious feelings and thoughts. Each psychodynamic listening approach focuses on feelings, thoughts, and processes that are outside the patient’s awareness. In this book, you will learn four different psychodynamic listening approaches, each of which focusing on a different aspect of what the patient says in order to hear unconscious material.

Psychodynamic listening differs from “natural” listening in the following ways:

1. Psychodynamic listening focuses on both conscious and unconscious feelings and thoughts; “natural” listening focuses on only conscious thoughts and feelings. Ever since Freud’s early writings, we have known that feelings and thoughts outside our awareness can influence our daily lives (Freud 1900,1915a). As therapists, we need to be trained to hear them in the patient’s associations. Each psychodynamic listening approach focuses on the patient’s words in ways that help us hear unconscious feelings and thoughts at work (Freud 1912c). This is not to say that we are interested only in the unconscious feelings and thoughts; rather, we are very interested in the interaction between the patient’s conscious and unconscious feelings and thoughts (Freud 1923, 1926).

2. Psychodynamic listening involves a conscious choice of how to listen; “natural” listening involves little or no awareness of how one is listening. Instead of just letting the patient’s words wash over us and listening in our usual way, as psychodynamic therapists we add other listening approaches to our “natural” approach. And by choosing to listen in a particular way, we are aware of how we are listening and what we are focusing on. Since we are trying to infer feelings that are implicit and unstated, we follow guidelines for making those inferences (Freud 1912b, 1913; Gray 1995; Greenson 1967; Langs 1973a; Searl 1936). We consciously try to make sense of the patient’s associations.

3. Psychodynamic listening involves attention to both the content of what patients say and the processes of how they say it; “natural” listening is unaware of process. In “natural” listening we simply listen to the content of what people say. Although we may be somewhat aware of the process (how they say it) we cannot be aware of process in the same depth and subtlety as in a psychodynamic approach. In a psychodynamic approach, one’s attention may be completely focused on the process (Freud 1915b; Gray 1995), as demonstrated in the section on defense analysis.

4. Psychodynamic listening focuses both on what the patient has spoken and what is implicit, what the patient has not yet been able to say; “natural” listening focuses only on what the patient has said. In “natural” listening you easily hear your friend’s conscious thoughts and feelings. In a psychodynamic approach, we add to that our perception and understanding of the patient’s unconscious thoughts and feelings (Freud 1912c). Whenever the patient speaks, we try to discern what further meanings and subtleties are yet to be spoken. In contrast to “natural” listening, psychodynamic listening hears every word of the patient as a vehicle of a dynamic quality, an intention, a direction, a feeling, an experience. Every sentence is heard as the living motion of spoken and unspoken meaning.

5. Psychodynamic listening understands the patient’s motivations, both as the patient reports them and also as grounded in conflict (Brenner 1976, 1982; A. Freud 1926; Freud 1923); “natural” listening understands the patient’s motivations only as the patient reports them. Psychodynamic listening focuses on the functions our feelings and thoughts can serve, functions of which the patient may be unaware.

6. Psychodynamic listening assumes that there is always more meaning than has been stated; “natural” listening assumes there is no more meaning than what has been stated. “Natural” listening assumes there is no such thing as emotions and thoughts outside our awareness. Psychodynamic listening assumes that our mind operates like an orchestra. We have many feelings and thoughts simultaneously, some in the foreground, some in the background, and some almost inaudible, but all sounding together to create a very complex sonority (Waelder 1936). We are a bundle of multiple experiences and feelings interpenetrating and influencing one another. We may have conscious feelings, preconscious feelings, and feelings that are unconscious, all at the same time, and all influencing us. Psychodynamic listening does not assume that any person can be summarized as a single musical note. In fact, psychodynamic listening assumes that no matter how much we understand a patient, there is still more to know that lies outside our awareness and that of the patient.

7. Psychodynamic listening focuses on movement from one state of experience to another; “natural” listening focuses on what is static. Henri Bergson (1946) once said that “our personality is precisely that: the continuous melody of our inner life.” Psych...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgments
• Preface
• 1 Introduction: What Do We Do When We Listen?
• 2 Theory of Reflection
• 3 Reflection Studies
• 4 Theory of the Analysis of Conflict
• 5 Conflict Studies
• 6 Theory of the Analysis of Transference
• 7 Transference Studies
• 8 Theory of Defense Analysis
• 9 Defense Analysis Studies
• 10 Studies in Flexibility of Listening
• 11 Harnessing Thinking and Intuition
• References
• Index