I hope I’m not insulting anyone with this.
As helping professionals, we have amazing diversity in our theoretical understanding of how the mind works, a cornucopia of concepts for conflicted clients. Is our client unhappy because of childhood trauma? Poor reinforcement schedules? Substance abuse? Oedipal guilt? Inadequate interpersonal skills? Should we help with ACT? DBT? CBT? IPT? It can be pretty daunting!
If you’re learning a racquet sport like tennis, pickleball, or ping-pong, different coaches may give dramatically diverse directions to help you improve your game. But I guarantee that there is one piece of advice that will come from each and every one of them: “Watch the ball!”
I play several racquet sports, and when my game is off for some reason, the first question I ask myself is always “Am I watching the ball?” Because if I’m not, no amount of skill in footwork and spin will help. It is the universal fundamental of racquet sports.
So here is the potentially insulting part.
If your psychotherapy clients aren’t improving as quickly as you would like, or if they don’t complete homework assignments, or if they keep talking about the same set of issues week after week, have you asked yourself about the universal fundamental of psychotherapy: “Am I listening?”
Am I listening?
“Of course I am!” you may say, wishing I could see the glare in your eyes. “That is the first thing they taught me in graduate school. If I weren’t listening, I wouldn’t be able to give my client the interpretations/advice/deepening questions that I am giving!”
But please hear me out, because I may have misspoken. The fundamental isn’t really “Am I listening?”; it would be better phrased as “Am I conveying, convincingly, to my client that I have heard them, and that I completely understand what they are saying, and that I know how they feel right now?” We may have heard every word, and been two steps ahead of them in knowing how they feel, but if this hasn’t been conveyed adequately, that knowledge is useless. You were listening, but it didn’t look like it.
What does it mean when your client doesn't seem to be making progress in therapy?
When your cell phone signal is sketchy, you may find yourself saying something like “Hello? Can you… Hello? Can you… Hello?” You are repeating yourself because you aren’t sure you were heard. Similarly, a client will signal that they aren’t sure you are listening via repetition, from sentence to sentence and from week to week. They are not going to listen to your excellent interpretations/advice/deepening questions until they feel that they have been heard. You will be casting your pearls before swine! It is only after they say “Yes! Exactly!” that they will switch from talking mode to listening mode.
How to convey you are listening
So, back to basics. I was taught that you convey that you are listening in three different time slices of their conversation: at the phrase level, at the sentence level, and at the paragraph level. You acknowledge hearing a phrase by a subtle head nod. You acknowledge a sentence with a subvocalization: “Uh-Huh” or “Oh.” Those two are easy: if you really are listening, you will probably be doing those automatically.
The listening skill at the paragraph level is the crown jewel. It is a very brief summary of what they have said that almost always conveys understanding of their emotional experience. “Wow! That must have hurt!” Or, “Sounds like a lonely experience.” Or, “Congratulations! What a victory for you!”
Your reward for a successful paragraph summary is silence: a fleeting moment when they are primed to listen to you. That is when you can draw upon your theoretical understanding of how their mind works. “So that reminds me of what we talked about last week, about how you are so easily triggered by…..”
This is where all the rest of your graduate school training and post-graduate experience as a therapist comes into play. This is when you can give the gift that they can’t receive anywhere else.
Now, if only I can remember to keep my eye on the ball…