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Just ListeningJames Tobin, Ph.D. April 14, 2016

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Listening: Short-Changed as a Concept in Clinical Psychology and Psychotherapy

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The Graduate Student in Clinical Psychology

• Enters training to become a “helping” professional with an early developmental history of emotional deprivation/trauma.

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“The Drama of the Gifted Child” (1979)

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Ross Rosenberg’s “Human Magnet Syndrome”

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The Narcissistic/Codependent Continuum

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The Narcissistic Position

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The Codependent Position

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Characterological Tendencies of the Mental Health Professional

• Early emotional deprivation/trauma is organized in the formation of characterological tendencies: (1) the professional maintains his/her early coping style (schema);(2) the professional counter-identifies with his/her early coping style and incorporates that of the primary caregiver;(3) the professional maintains a combination of (1) and (2) above.

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Clinical Theory and Technique

• Trainees in the mental health professions learn a considerable amount about clinical theory and technique, yet do so through their own particular characterological lens.

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When the Trainee Begins to See Patients

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Example #1: The Processing of Transference

• The narcissistic trainee (to his/her patient): “I don’t know why you’re getting so angry with me …. It’s not about me, it’s about your unresolved feelings toward your father.”

• The codependent trainee (to his/her patient): “You’re so angry with me. I’m sorry I offended you. I’m not really good at this yet. I will try harder.”

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Example #2: Silences

• The narcissistic trainee: [stares at the patient, observes the patient’s discomfort, and continues to stare and say nothing]

• The codependent trainee: [as soon as a brief pause in the session occurs] “So, tell me how your week has been going.”

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Example #3: Conceptualizing the Patient

• The narcissistic trainee: the conceptualization is largely self-referential, i.e., reflecting the therapist’s identity, biases and/or personal values (e.g., the patient needs to be more assertive/the patient should learn that guys are jerks and should not be trusted/depression is biologically-based, not contextual)

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Example #3: Conceptualizing the Patient

• The co-dependent trainee: the conceptualization is largely non-self-referential, i.e., not linked at all to the therapist’s personal identity and merely reflects the identity of anybody else besides the therapist (e.g., the patient, the supervisor, the professor, an author, a theoretical approach, etc.).

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Everything I’ve said so far applies to the trainee

therapist …… what about the patient?

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The Patient’s Early Developmental History

• The character of the patient’s primary caregiver also falls somewhere along the narcissistic/co-dependent continuum.

• Therefore, it can be assumed that during childhood the patient’s “going on being” (Winnicott) was interrupted.

• This interruption determined how the patient’s characterological tendencies and defenses were organized.

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The Clinical Situation

• Features a (trainee) therapist who is characterologically narcissistic or codependent.

• Features a patient who has never been free “to be”/“to be me” (he/she has always been acted on by a narcissistic/codependent caregiver and had to adapt to this intrusion).

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Enactment and Role-Reversal Configurations in Therapy

• Enactment: the patient had a narcissistic primary caregiver (impinging/enmeshed), and finds a therapist who is similarly narcissistic.

• Role-reversal: as a child, the patient coped with his narcissistic father by being co-dependent. In therapy as an adult, the patient seeks to be the narcissist in relation to a co-dependent therapist.

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Enactments and Role-Reversal Configurations in Supervision

• The supervisor who needs to be idealized • The trainee who disagrees with the supervisor • The supervisor and/or trainee who seeks to be

liked by the other over all other agendas • The trainee who conceals information from

the supervisor

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“Just Listening”

• Unfortunately, to most people “Just Listening” implies doing nothing, sitting there, passivity, not knowing what to do; depicted merely as a foundational skill on which other moreimportant skills aredeveloped.

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“Don't Just Do Something, Sit There”

• Alonso, A., & Rutan, J.S. (1996). Group, 20 (1), pp. 43-55. • The abstinent stance of psychoanalytically-oriented

clinicians is often confused with passivity or coldness toward the patient or the group. Given the current move toward more active, shorter-term treatment, this paper offers a reaffirmation of the value of the abstinent analytic stance. The theoretical rationale for the technique is reviewed, and some specific arguments are made to illustrate the continuing importance of the method in the treatment of patients in psychodynamic group psychotherapy.

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“Just Listening”

• “Just listening” is a meta-skill (attitude and technique) that all clinicians should aspire to: it is the capacity of the therapist to restrain his/her characterological tendencies in the therapeutic situation.

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“Just Listening”• The therapist’s capacity to restrain has a vital

impact on the patient: in the context of a non-interfering parental surrogate, the patient is encouraged to resume “going on being.”

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Resistance

• Resistance can be understood from this perspective: the patient, never allowed “to be,” has learned to habitually cope to the demands of the other and seeks to continue this arrangement in all relationships, including the psychotherapy relationship.

• If the therapist manages to approach the patient without characterologicallyt-based demands (non-narcissistically and non-co-dependently), the patient will feel the excitement of being but also the anxiety of this liberation.

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Therapy as Transactional Space and Self-Space

• I view the clinical situation as organized into relational modes centering around this notion of resistance (i.e., wanting to stay in transactional space and fearing the development of self-space).

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Mode I: Transactional Space

• Either or both the therapist and patient recruit the other to transact (or achieve an enactment):A trainee therapist, largely co-dependent based on her own upbringing with a demanding and depressed single parent, aims to please a narcissistic patient (enactment); the trainee therapist avoids confrontations, does not say what she thinks, etc.; the trainee therapist is also driven to affirm her narcissistic and insecure supervisor.

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Mode II: Self-Space• If Mode I can be bypassed or overcome, the patient is

newly challenged to grow by entering “self-space”:A co-dependent trainee therapist gives up her need to be liked by her patient, and is encouraged “to be” with her patient by her healthy, encouraging supervisor; the trainee therapist is then able to say to her patient, “Whenever I make a comment you don’t seem to like, I’ve noticed that you usually then say something insulting to me.”

******Here: “Just Listening” is not only restraint on the part of the therapist but also the capacity “to be” with the patient; one depends on the other ********

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The Underlying Assumption of this View of Psychotherapy

• What psychotherapy offers over and above all other social situations and relational experiences is a context in which the patient can recognize and self-reflect on his/her characterological tendencies …. Not merely TRANSACT THEM.

• This requires, of course, that the therapist restrains his/her transactional tendencies with the patient which then promotes the therapist’s capacity "to be” with the patient: this is the essence of “Just Listening.”

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An Exercise Suggestion • Take a recent transcript of a therapy session and

evaluate the amount of material that could be “coded” as transactional (Relational Mode I) vs. self-space (Relational Mode II): determine the percentage differences.

• You may then want to look at the transactional material and distinguish what amount was initiated by the patient vs. by you.

• Identify places in the transcript where you were able to reside in Relational Mode II in order “to be” with your patient.

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James Tobin, Ph.D.Licensed Psychologist PSY 22074220 Newport Center Drive, Suite 1Newport Beach, CA 92660949-338-4388

Email: jt@jamestobinphd.com Web: www.jamestobinphd.com