Entries in listening (7)



One of my patients said the above as he was reflecting on how much he has benefited from attending alcoholics anonymous meetings. He felt that he had recieved a lot from others attending the meetings and had also gained a lot by sharing his story with others. I then said that I believed that it was not possible to worry about the past if you are sharing your life with others. My patient said that this seemed right to him and yet I wasn't sure about it. So, why would sharing our lives with others make worrying about the past impossible?

Maybe it is because if you are sharing with others you are listening to them without your own reactions and this allows you to feel connected to them and you are more likely to share with them as they listen to you. It could also be that listening is like sharing as you are sharing the othe person's life experience as you listen. So, maybe if we feel connected to others it is harder for us to worry about the past. If that it so, does it mean that we worry about the past because we feel isolated from each other and the worrying is our effort to feel connected to others? Yet worrying does not seem to actually connect us to others.

What do you think?



A better question might be if giving advice is ever helpful. Now that might sound radical and yet in my experience with a few thousand people I have never noted that advice was helpful to anyone nor actually accepted by anyone. If it seems to be that people seek advice and then reject it. What is that about? Also, if the above is true then what about my attempts to help people? Am I not at least fairly frequently giving advice and then are my patients also frequently rejecting my advice?  

I have seen repeatedly in my treatment of people that it is critical that they decide what to do and then take responsibility for themselves and their actions. Can advice help that? Since advice is so frequently rejected it seems that advice does not help. There seems to be a wish for advice and for answers to problems and for solutions to problems with others and yet this does not seem to be helpful. When we give advice what message is that sending? It seems to be received as a lack of faith in the person's ability to problem solve for themselves and manage their lives. This may not be an intended message and yet giving advice does not seem to reinforce their being able to problem solve for themselves and to take reponsibility for themselves. Of course, the intention of the advice giver might be to have their advice help the person to start being more responsible for themselves and to take responsibility for their lives. Yet, I have never seen advice giving be helpful for either party as it risks separating the advice giver and receiver. This separation may be related to the stress for the advice giver who feels responsible for the advice receiver [which is the reason that advice was given] and need that the receiver has to be responsible for themselves. This appears to be a basic need and the receiver will likely feel that the advice giver does not have faith in the receiver's ability to manage for themselves. 

So what is the alternative? It is to encourage and support the person you are tempted to give advice to. What is encouragement and support? It requires listening without our own reactions and thus allowing ourselves to see the strength in the other and then share this with them. Listening by itself is supportive as we are with others and therefore are supporting them when we are listening. The support is emotional support and often does not require any words. This encouragement and support is what I try to do with my patients as I listen and have an opportunity to reflect back what I have heard and to encourage them to trust themselves and see what happens.

Does any of this make any sense?



I have recently been thinking about the idea that wisdom is connected to knowing that we don't know anything. I was aware of this idea from reading that after Socrates was called the wisest person in ancient Greece he at first doubted this until he realized that his wisdom was because he knew that he didn't know anything. The socalled Socratic method involves asking quesions and listening to the answers until an understanding happens. The person asking is not reacting to what is being said or correcting, giving advice, but merely asking questions to clarify the responses that are being given. There are no conclusions drawn based on previous experience nor any judgement made about what is being said. So, it is like knowing that you don't know anything as you are listening to learn about someone and refusing to think you know them. Thinking you know them allows you to judge or criticize them. 

So, if you listen to someone without your own reactions, judgments or criticisms, isn't this being empathic? Isn't this like being with someone and sharing their experience without substituting your own experience. Isn't it hard or even impossible to do this and also judge them or compete with them or reject them. So if we all listen to each other without judging or criticizing then we will all feel and be connected to each other and will all get along.

What do you think?



Empathy is good and shame is bad.  So why is this a big deal?  It may be because shame is so destructive and empathy is so helpful. What makes shame so destructive? If you have ever experienced shame [and it is possible that everyone has experienced shame] then you know how bad it feels.  Shame makes people feel alone and separated from others.  We have our unique ways of responding when we feel shame and yet certain patterns of response have been identified by Linda Hartling,Ph.D. Director of Human Dignity and Humiliation Studies, that she calls "strategies of disconnection" [from the pain associated with feeling shame] that include: 1. moving away from people by disappearing into ourselves; 2. moving toward others by people pleasing behaviors; and 3. moving against others by anger and fighting back.

What causes shame?  Some people connect shame with traumatic experiences.  So when we feel overwhelmed we feel shame?  Being overwhelmed does seem to separate us from others and likely from ourselves.  This makes being empathic or responding to empathy from others difficult, if not impossible.  What can we do?  Brene' Brown in a TED Talk about shame indicated the importance of being able to identify things that will cause each of us to feel shame.  These triggers, when we are aware of them, can be avoided at times and our awareness can allow us to cut short the shame response before it becomes powerful.  Our awareness can allow us to stop ourselves from responding in our usual and negative way, substituting a self-affirming response.  Sounds good but how do we break a pattern that often has been established over years? 

Dean Smith [long time coach of the North Carolina Chapel Hill basketball] is quoted as saying that if you make a mistake you should "recognize it, admit it, learn from it and forget it." Maybe this could help us deal with feelings of shame.  It also may be related to recommendations for how people who have been traumatized can help themselves [with the support of a therapist] by choosing to think about the past trauma and tell themselves that they don't need to be stressed by the event anymore and why, then move on and let it go [forget it?]. It also helps if we are able to calm ourselves and clear our minds and then choose to think about past traumas.  So, as I have blogged about previously, to help people recover from traumatic experiences research indicates that it is good to combine mindfulness practices [calming ourselves and clearing our  minds]; Trauma Focused Cognitive Behavioral Therapy [like what I described above] and interpersonal therapy [working with someone that you trust so you are willing to risk trying out new skills to let go of worries about past stresses].

So, what about empathy?  According to Brene' Brown, shame can't survive empathy. So, why is that?  Well, empathy connects people and shame disconnects people.  To respond empathically we need to listen to others nonjudgementally and communicate our understanding of what others are feeling. This invites responses from others and creates a sense of connection and support.  To be empathic we need to be present with others and not be reactive or judgemental.  This seems like a good way to relate to others all the time.  




One of my children asked me about how I help people who come to see me.  I began reflecting on the different ways that I provide support and encouragement for my patients. I was able to identify a number of different things that I attempt to do.

I believe that my first effort is to help my patients feel that they can trust me to listen to them and value their participation in their own treatment.  Their treatment is a collaborative effort and I need their input to be able to help them. I believe that my willingness to take the time required to listen to them, helps to develop the trust that is required to be able to help them.

After listening, I will ask questions to try to further define the specific nature of their symptoms as they experience them.  I also will be sure that I ask about any stressful events in their lives and what they remember about them as well as whether or not they think about them now. I also carefully go over all of their experiences with medications and supplements.  I will then go over their responses to checklists that I asked them to fill out before beginning our time together.  

After I have a beginning understanding of some of their symptoms and stresses as well as how they cope and their strengths, together we will talk about possible diagnostic understanding and options for beginning treatment. 

I feel that it is important that any initial diagnostic understanding be linked to specific symptoms they are having and the treatment I suggest is also specifically targeting some or all of their symptoms.  We then discuss how they can use their coping skills to reduce their symptoms and to improve their quality of life.  We also discuss new skills that they can develop and what symptoms they are focusing their skills on reducing.  

At every appointment, we review progress in reducing symptoms and improving their quality of life.  I listen carefully to what they report about how they are doing and I am careful to encourage them to pay attention to everything they are experiencing regarding their treatment as I have often seen that even things like unintended missing medication doses can represent their brain telling them something important about their medications.

I also write down suggestions and possible ways to use specific coping skills that we have discussed and give this to my patients at the end of each visit.