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How Conversation Sparks Therapeutic Change

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SO2012-2The Search for the Unspoken Self

By Ron Taffel

When we trust ourselves to follow the signals of life that the patient emits in seemingly casual conversation, we increase our chances of stepping outside the confines of our theoretical models to enjoy an unexpected encounter.

 

I sometimes think I became a therapist not only to make a difference and help people, but because I was starved for conversation growing up. In the world of my childhood, a tight-knit, working-class neighborhood in New York's Washington Heights in the 1950s and '60s, none of us kids, and absolutely no one in our families, seemed to genuinely talk to each other, even for a minute. Neighborhood gossip, ritualized chitchat, spirited debates about the relative athletic merits of Willie Mays and Mickey Mantle, expressions of everyday affection, occasional outbursts of emotion--sure, those happened all the time. But back-and-forth discussion with questions and responses and then more questions that went in directions you couldn't predict--not even on the radar! My friends and I played ball, ogled girls, and craved cars, but I don't remember having a single significant thought in my head, not to mention sharing a thought with anyone else, until I was about 19. We were boys, and as such, nothing more than a bunch of roving reflexes; limbic systems pretending to be human beings. It never occurred to us to inquire about what other people thought or how they experienced life.

This lasted until I met a couple of equally conversation-deprived kids in college who became my best friends. We discussed everything possible, like the annoying vagaries of our parents, the foibles of friends, and, unbelievably, our values and evolving political beliefs. On all fronts, those shared discoveries of "Hey, I've felt that same thing, too!" was the most satisfying human exchange I'd yet experienced, until I actually found a girlfriend and discovered that conversation combined with sex was even better. Talking with her about all the same things, but on a deeper emotional level, like "What do you think he meant by that?" or "You're saying this hurt your feelings?!" or "I'm not sure whether going to this rally might offend my friend who doesn't believe in this issue--what do you think?" was astonishingly absorbing. When I mustered the courage to move out of my parents' house after college (albeit a mile away), I did so with two major purposes in mind: to become independent with all the grown-up adventure that entails (while still able to bring laundry home) and in search of more conversation.

When I decided to become a psychologist, I figured conversation would be an essential part of my professional life. What was "talk therapy," after all, except a specialized form of revealing conversation? But as far as my psychotherapy training in grad school went, I was dead wrong. Of course, in the hallways and between classes we "processed" anything that moved--nothing about what we saw, heard, felt, thought, or imagined seemed too trivial to discuss for hours. But once a therapy session began, that all changed. Free-flowing, spontaneous conversation was verboten. It wasn't OK to communicate in anything other than the strictly proscribed, impoverished language of therapy-speak.

What was important back then, in the Golden Age of Rogerian psychotherapy and American psychoanalysis, was a mix of unflinching positive regard and in-depth therapeutic interpretation. We were taught to hold back, to be blank screens, to answer every question with another question, and, at the right moment, to deliver insights that would cut right through the bulwark of resistance and get to the core of the inner psyche. I'll never forget a classmate of mine speaking to me before a session as he girded himself with the armor and weaponry of the psychoanalytic warrior. His last words as he went off to battle were, "I've been thinking about this great interpretation all week. I'm gonna absolutely nail her!" Forgetting for a moment the sexualized nature of this, my friend's strategy was clear--he wouldn't utter a single word until he saw an opening in his unsuspecting client's psychic defenses through which to launch his therapeutic missile.

Even supervision was an exercise in "conversation-deprivation." Most of my extremely well-regarded mentors would say almost nothing for hours at a time, as I rambled on incoherently about my cases. I do remember one of my first supervisors rousing himself from his usual state of inscrutable impassivity to mumble, "Well Ron, that's another mess you've gotten yourself out of." I learned a lot in the process of countless supervisory hours, but it could be summed up in variations of that one phrase we've all used and abused thousands of times, "How does that make you feel?"

So here we were, therapists-in-training at the beginning of the psychotherapy explosion gabbing endlessly together as peers, seeming to understand the centrality of conversation in love, human exchange, and development, but learning absolutely nothing about conversation in treatment. Quite the opposite, in fact: much like the neighborhood I grew up in, there were strict taboos and proscriptions against it. In therapy, we were "severely" nonconversational.

Then suddenly in the late '60s and early '70s, the world changed in every way imaginable, including the treatment room. Out of nowhere, R. D. Laing began disentangling the psyche in The Divided Self and Knots. Beyond the precincts of therapy, the country had quietly entered into a "sharing-caring" mode, spearheaded by 12-step programs of every variety. Werner Erhard began his first iteration of est. Sensitivity groups proliferated; self-actualization and relatedness became our watchwords. The formal therapy universe was profoundly affected by the writings of Heinz Kohut, Alice Miller, and such object-relations theorists as D. W. Winnicott, Harry Guntrip, and Ronald Fairbairn, who opened the window onto a new world of "inter-subjectivity." In what was now acknowledged to be "the therapeutic relationship," a genuinely mutual connection between therapist and client was beginning to be seen as a critical ingredient in treatment.

But even this new awareness of relationship somehow morphed into therapies that, while different from the old, hard-nosed analytic model, soon became just as rule-bound in their own way. Now, rather than being a neutral presence, we were enjoined to turn every clinical exchange into an achingly authentic, existential moment of truth, fraught with capital-M meaning about fateful choices and agonizing doubts. Sometimes in the therapy circles that defined my postgraduate professional life, it was as if we were actors in a particularly solemn Ingmar Bergman movie. I remember vividly one discussion at a diner during which colleagues and I discussed with great intensity what it "meant" to a waiter or waitress when one left the proper tip--not the correct amount to leave, mind you, but what it meant psychically.

The field had indeed moved into a new "I-Thou" era. But without seeing experienced clinicians modeling a more free-flowing style of interaction, we still didn't know what such a thing might look or sound like. Besides fleeting pleasantries at the beginning and end of a session, having a conversation with a client meant you were probably wasting good clinical time on chitchat. Therapy was supposed to be about something--something serious. Weren't the unpredictable vagaries, the ebb and flow, the sheer accidental quality of conversation beside the point of "real" therapy?

Since I wanted to work with kids and teens, I chose to train in family therapy at the Philadelphia Child Guidance Clinic under the watchful eye of the legendary Salvador Minuchin. With this move to Philadelphia, any brief foray of mine into the let-it-all-hang-out school of conversation was over. You might think family therapy would encourage a natural back-and-forth, but, officially, it didn't. While Minuchin created unforgettable poetry and drama in sessions, the approach he taught was grounded in a highly disciplined technique that offered little room for casual or spontaneous interchange. Mimicking Minuchin, we'd make pronouncements, trying to sound as suavely Argentinean as we could. We'd move people around the room. We learned how to create enactments, which, while they did get conversations going between family members, were mostly intended to build up enough tension to shift the family structure. Sure, these wrestling-kids-to-the-ground sessions were a hoot to watch, but they also left many of us without words.

Similarly, Betty Carter, another clinical superstar with whom I trained, was a genius at demonstrating Bowenian family systems therapy--virtually an entire theoretical worldview that also allowed no idle small talk. As soon as the camera started rolling, Carter was all Bowenian business, albeit with a decidedly feminist perspective, asking questions that shook any taken-for- granted family assumptions. But, then again, you wouldn't watch these videos for conversational pointers either.

Only years after working with Minuchin, when I met several of his old patients, did I learn how much they valued his wonderful gift for connecting, as he warmly discussed the way they felt or dressed or spoke--all of which was left on the cutting-room floor. It was the same with Carter. What I recall as vividly as her clinical brilliance was the silky warmth of her voice as she seamlessly talked with clients before or after sessions. Once when Carter met a family I'd brought in for a consultation, the mother said how much they'd heard about her. Carter effortlessly replied, "Well, I hope it wasn't all bad!" and then launched into a spontaneous exchange about how being videotaped was difficult, and made her as uncomfortable as it might make them. This easy chitchat also never made it to the audience of trainees.

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  • Comment Link Saturday, 15 September 2012 07:39 posted by jeffrey von glahn

    This is quite profound. I started well before the manualized era began. The belief I had then about therapy hasn\'t changed. I still start each session with some form of, \"So, how\'s it going?\" If there\'s an important issue from the last session, I\'ll ask about it. Otherwise,I have absolute trust in the client\'s implicit sense about where to start. Invariably, clients - and even very experienced ones! - start with what initially seems to my senses to be the most therapeutically irrelevant incident imaginable. But if I adopt the attitude that \"this must be really important,\" the client eventually - and which may take many minutes - relates this present issue to an upsetting incident from her past and has a healing emotional release (See my piece on \"therapeutic crying,\" May/June 2012.)