How Conversation Sparks Therapeutic Change

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…