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Chapter: Essentials of Psychiatry: Listening to the Patient

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Listening to Oneself to Listen Better

To hold in mind what has been said and heard after a session and between sessions is the most powerful and active tool of listen-ing.

Listening to Oneself to Listen Better

 

To hold in mind what has been said and heard after a session and between sessions is the most powerful and active tool of listen-ing. It is a crucial step often overlooked by students and those new at listening. It is necessary to hear our patients in our thoughts during the in-between times in order to pull together repetitive patterns of thinking, behaving, and feeling, giving us the clos-est idea of how patients experience themselves and their world. In addition, many of our traumatized patients have not had the experience of being held inmind, of being remembered, and their needs being thought of by significant others. These key experi-ences of childhood affirm the young person’s psychological be-ing. It is important to distinguish this kind of “re-listening” to the patient – an important part of the psychiatrist’s ongoing process-ing and reprocessing of what has been heard and experienced – from what some may leap to call countertransference. One way of identifying this distinction would be to differentiate listening to oneself as one reviews in one’s mind the patient’s story versus

 


 

becoming preoccupied and stuck with one’s thoughts and feel-ings about a particular aspect of a patient.

 

As the verbal interaction with the patient occurs, psychi-atrists may find themselves expressing thoughts and feeling in ways that may be quite different from their usual repertoire. The following case is an example.



This sort of listening to oneself in order to understand the patient requires a good working knowledge of projective iden-tification (Ogden, 1979). Projective identification, first defined by Melanie Klein, describes a defense mechanism in which the patient, in an effort to master intolerably terrifying emotions, unconsciously seeks to engender them in the therapist and to identify with the psychiatrist’s ability to tolerate and handle the feelings.

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