In my memoir, The Gossamer Thread: My Life as a Psychotherapist, I describe my treatment of ‘Angie’, a young mother with horrific fantasies of killing her two young children by stabbing them through the heart with a kitchen knife. It was back in the 1980s and I was in the process of shedding my old behaviour therapy skin, realising I needed to listen to the client more carefully before embarking on any specific intervention. My therapy was a success, or so it seemed at the time. I even wrote her case up for a behaviour therapy journal under the grandiose title, Verbal methods of behaviour change. I had confidently formulated her fantasies as extreme anxiety since there was no evidence of her ever harming her children. I discovered that they had begun after she had read a newspaper account of a couple’s murder of their children in a Satanic ritual. She worried that, however much she loved her children, that she too could be taken over by the Devil and do things she would never normally do. I saw this as vicarious traumatisation and her anxiety stemmed from her ruminations about this. I was able to help her, getting her to monitor the fantasies, reframing them as anxious thoughts, and substituting more positive ones, until the fantasies declined significantly in both intensity and frequency. This was my pre-cognitive therapy days and Angie was to lead me into training as a cognitive therapist. But that is another story.

I revisited the case in my book and, looking back, I realised that, while I had listened to Angie, I had not really heard her. Or rather I had heard what I had wanted to hear. She was a young mother, looking after two very young children while her husband was away working on the North Sea oil rigs. She was living hundreds of miles from her home town and the family she had grown up with. She had relatively little money and had given up her job. She was trapped like many young mothers are. Was that perhaps what this was all about? After all, what trapped her most were her children as they needed her constant care and attention. Could her fantasies be an unconscious expression of her resentment of them? If I had trained in systemic therapies, I might have heard a different story to the one I had carefully elicited with my prototype cognitive therapy hat on. I might have heard how unhappy she was, perhaps heard her fear that her marriage was a mistake and that she no longer loved her husband. Or had I been more analytically inclined, I might have wondered about the aggression in the fantasies and perhaps linked that to infantile aggression or sibling rivalry or other possible unconscious conflicts from her past. I did none of these things because I had heard what I had wanted to hear. I prided myself on attentive listening, on my sensitivity and creativity as a therapist. I had done a really good job. But had I? Listening is not a passive matter. It always reflects what we expect to hear. Hearing, on the other hand, is something else altogether as I later went on to learn. To hear properly one has to suspend one’s preconceptions and be prepared to question one’s own thoughts and beliefs. It is important to give a space to the client and not fill it with one’s artful questions, ideas or interpretations. It is to take a step back for a moment and wonder. We all listen but how much do we actually hear?



File under: The Art of Psychotherapy, Musings and Reflections