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Chapter: Essentials of Psychiatry: Listening to the Patient

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Using Oneself in Listening

Using Oneself in Listening
Understanding transference and countertransference is crucial to effective listening.

Using Oneself in Listening

 

Understanding transference and countertransference is crucial to effective listening. Tomkins, LeDoux, Damasio and Brothers have given us a basic science, biological perspective on this proc-ess. However one defines these terms, whatever one’s theoretical stance about these issues, Harry Stack Sullivan (1969) had it right when he said that schizophrenics are more human than anything else. To know ourselves is to begin to know our patients more deeply. There are many ways to achieve this. Personal therapy is one. Ongoing life experience is another. Supervision that empha-sizes one’s emotional reactions to patients is still a third. Once we have started on the road to achieving this understanding by therapy, supervision, or life experience, continued listening to our patients, who teach us about ourselves and others, becomes a lifelong method of growth.

 

To know oneself is to be aware that there are certain com-mon human needs, wishes, fears, feelings and reactions. Every person must deal in some way with attachment, dependence, authority, autonomy, selfhood, values and ideals, remembered others, work, love, hate and loss. It is unlikely that the psychia-trist can comprehend the patient without his own self-awareness. Thus, Figure 1.1 should really look like Figure 1.2. The most psy-chotic patient in the world is still struggling with these universal human functions.

 

In this case, the psychiatrist was able to connect with a patient’s inner experience in a manner that had a fairly dra-matic impact on the clinical course. That is the goal of listen-ing. The art is hearing the patient’s inner experience and then addressing it empathically, enabling the patient to feel heard and affirmed. There are no rules about this, and at any given point in a clinical encounter there are many ways to accomplish it.




There are also many ways to respond that are unhelpful and even retraumatizing. The skilled psychiatrist, just as she/he never for-gets that it is the patient’s inner experience that is to be heard, also never stops struggling to find just the right words, gestures, expressions and inflections that say to a patient, “you have been understood”. The most clever diagnostician or insightful inter-preter who cannot “connect” with the patient in this manner will miss valuable information. This issue has been addressed by writers who have pointed out how little understood are the con-cepts of support and empathy (Peteet, 1982).

 

Being human is also to be a creature of habit and pattern in linguistic, interpersonal, and emotional realms. The skilled psychiatrist listens with this ever in mind. What we see in the interview, what we hear in interactions, may be presumed to be repetitions of many other events. The content may vary, but the form, motive, process and evolution are generally universal for any given individual. This, too, is part of listening. To know what is fundamentally human, to have a well-synthesized rigor-ous theory, and to hear the person’s unique but repetitive ways of experiencing are the essence of listening. These skills “find” the patient in all his/her humanity, but then the psychiatrist must find the right communication that allows the patient to feel “found”.

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