Within therapy

One of The School of Good Listening’s intentions is to bring what we find useful in therapy to people outside therapy. This is not because we are angling for a career change and want to become teachers, but because there is so much that happens within therapy that can actually be implemented outside the therapy room to improve people’s day-to-day lives.

Getting your foot in the door of a therapy office is not always easy. Finding the time and the money to commit to regular sessions can be tricky when your typical day is overflowing with things to do and numerous expenses. Even if you have the time and can afford therapy, therapists are often overbooked and not available to see you. If you are lucky enough to overcome all of these hurdles, you might still carry fears around what therapy entails, which can hold you back from pursuing it.

The concept of therapy can feel somewhat obscure, sometimes even shameful. This can prevent people from sharing what actually happens in therapy. It also perpetuates secrecy around a process that could just be viewed as a very ordinary learning process that, like many others, can involve moments of discomfort, like going to the gym or to the doctor. This is certainly the notion we would like to convey: There are aspects of therapy that could just become ordinary daily processes, benefitting our well-being in the same way as healthy eating or regular exercise would.

A central part of therapy is learning to truly listen, to really pay attention to your body and your thoughts with a compassionate caring mindset towards yourself and other people. Good listening is a fundamental skill that we can all benefit from learning. It can substantially improve our lives and is both as straightforward and as complex as learning to work with your breath. Much like breathing, listening is something we all do reflexively. We can go through our whole life without really thinking about how we do it. It’s just something our body does automatically. But if we start to pay more attention to fine tune our listening, it can become something we do more deliberately with the intention to help ourselves and others feel better. Learning to listen well, choosing what to listen to, and deciding how to respond are essential tools in therapy.

One of my first classes on the clinical psychology doctoral course at Oxford was ‘Listening 101.’ Among the many expert-led classes I attended, this is definitely the one that taught me skills I continue to use daily.

So what is it that we therapists are listening to in therapy? That’s not easy to answer. Breaking down the secrecy around therapy would help give some nuanced examples to answer this question. It would help to normalise mental health difficulties and help us all realise we are not the only ones struggling and that our experiences are shared. And yet the confidentiality around what therapists listen to is crucial; it is the cornerstone of therapy. Knowing that our therapist is bound by rules of confidentiality ensures a sense of safety essential for us to express fully and freely what is on our minds and on our hearts. Most people have a sense that ‘getting things off your mind’ is what you do when you go to therapy because doing so is generally thought to get said ‘things’ out of your way. This way you can ‘move forward’ with your life. The reason problems keep getting in our way (and not off our mind) is perhaps due to a distinct lack of listening around us. Often because these very things are considered too painful, too shocking, or too embarrassing. Our reactions feel inappropriate and are sometimes labelled as such by others. We are ‘too sensitive’, ‘too angry’, ‘too defensive’, ‘too arrogant’, ‘too quiet’, ‘too emotional’, ‘too stupid’. We should ‘know better’. Often, we do know better and that is precisely why we often feel embarrassed and why we don’t like listening to it ourselves!

However, dismantling some of the secrecy around what happens within therapy can allow important lessons learned therein to become helpful to a much larger number of individuals who will never engage in therapy and might be suffering in silence. The stories we hear as therapists are rich in detail and vividly distinctive and it is often these very details and their singularity that are crucial to untangling and understanding what has gone awry and caused a given person emotional pain. Without the unique details, it all remains very theoretical, and theory rarely really speaks to people’s hearts. At the same time, sharing such details risks eroding the trust that is absolutely essential for us to do our job. I lack the creative-writing skills to recreate the intricacy and poignancy of the life stories I have been witness to. Fictionalised stories would not do justice to the resilience and the life force real people have demonstrated in my therapy room.

Contrary to what many people believe and to my clients self-deprecating jokes about how awful my day must be listening to the likes of them, again and again I am humbled and inspired by the richness of people’s experiences and the wisdom that lies behind idiosyncrasies they think are ‘crazy.’ Often they have forgotten the context within which these first emerged and how, in the past, these ‘crazy’ responses actually made good sense. These reactions may even have saved them.

In the absence of providing this all-important context, I ask you to keep in mind the spirit in which this writing is intended: When you listen well and with benevolence to the rich singularity of your own thoughts and feelings, you might discover that your behaviour actually makes more sense than you think and that there is a similarly rich and understandable singularity that explains other people’s behaviour too. Your angry neighbour, the sullen cashier, your estranged brother, even your boss.

So, to give you a flavour of the mechanics of therapy and in an attempt to normalise this process as best I can, I’d like to invite you to bring your own detail to the following questions, which often form the scaffold around which therapy is built.

Please try and answer these questions in your own mind as honestly as you can to flesh out the theory with that all-important personal detail:

• What’s the problem?

What is actually getting in the way of a more peaceful existence? The things that bring us to therapy are most often regular struggles in our day-to-day life. Even if people have experienced seriously traumatic things, this is very rarely what brings them to therapy. It is the panic attack at the supermarket, the nightmares, the unexplained bursts of rage or tearfulness, physical pains, momentary lapses of reason, repeated problems at work or glitches in a relationship... These are the things we generally need relief from, so it’s important to start here. The past is the past and what happened before can’t be changed in any case, right?

• When you think about this problem, what happens in your body?

Rather than jumping straight into trying to find practical solutions (if it’s in the past, you can’t change what happened after all) or spending all your time ruminating about what brought you to this point, circling around past traumas like a haunted merry-go-round, just pause for a moment. Perhaps even make yourself a cup of tea (‘Cups of tea’ being the title of another memorable lecture during my training). Stick with the problem for just a few minutes and really listen to the signals from within as you think of it:

Your body might feel tense, numb, tingly, queasy, restless, constrained, pressurised, hot or cold? Are you holding your breath? How easy is it to breathe? Your jaw might be clenched or chattering nervously? Something might be stuck in your throat or tears well up in your eyes. Perhaps you feel a weight drop into your stomach or your brain starts fizzing, unable to think. These sensations are your autonomic nervous system trying to contend with the problem that you’re thinking about. Your autonomic nervous system cannot tell the difference between what’s real or imagined, present or past (so the past is not really in the past after all, at least not for our nervous system).

This is where training your attention becomes really important, because modern life pulls our attention into a myriad of directions. To get by in the day-to-day, we often end up ignoring the signals our body is sending us, unaware of how listening to it could guide us. Our body tells us what is actually the problem: we feel unsettled, unsafe, angry, paralysed, powerless, weak, rigid or chaotic... And our thoughts and behaviours tend to fall in sync with our feelings. This is often what leads us to believe we are ‘mad.’ Our reactions to whatever is happening can feel a tad on the overenthusiastic side. Think of the exaggerated fury rising in response to a spouse’s comment about the dishes or the paralysing panic over the presentation you have most probably over-prepared for.

Try not to judge your feelings and thoughts. Allow them to just be what they are, and become curious about them.

• Have you felt like this before?

Can you think of a time (or times) when this reaction actually made sense? Your reaction probably doesn’t make sense now. You wouldn’t be bringing it to therapy if it did.

Perhaps it made sense at some point in the past (yep, I’m afraid the past often really is relevant). There are as many possibilities here as there are humans on earth. They can vary from being called upon by a slightly scary teacher in primary school to some of the most horrific human experiences.

How you have been affected by whatever you have experienced most likely makes absolute sense if you take the time to really listen to yourself. If we could only learn to listen to our own story compassionately and understand our unique biological make-up, we’d learn to trust ourselves again, and move forward more authentically and with confidence.

• What else was going on then?

This question often brings up information you already know and which many people use to dismiss or criticise their own reactions, fuelling feelings of guilt and shame. For instance, you might tell yourself that your parent was struggling financially or with a mental health issue of their own so it is understandable they were unavailable and preoccupied (followed immediately by the thought that you should have been less of a burden on them); the bullies were children from difficult backgrounds with their own problems (accompanied by the idea that you should have stood up for yourself better, or been less awkward, more confident). Even in circumstances like rape and incest people will often feel they might have encouraged it or let it happen in some way, that somehow it was their fault.

Rather than using this contextual information as an additional stick to beat yourself with, we invite you to slather your perspective with liberal amounts of benevolence and to use this information to shed a light on what was influencing your behaviour and the behaviour of other people at the time. Often this will lead you to realise that other people’s behaviour had very little to do with you or your intrinsic value as a human being.

This is perhaps the point where it is most important, and most difficult, to use a healthy dose of self-compassion and remind ourselves that we are made of complex, unsteady minds in bodies bound by biological processes that developed over millennia. Evolution has not had the time to adjust our bodies to the complexities of our modern society. Unfortunately, our nervous system has not yet learned to differentiate between personal admin overwhelm and facing a sabre-toothed-tiger. In times of stress, our nervous system activates age-old processes to promote survival: fight, flight, or freeze. This is just as true for ‘us’ as it is for ‘them.’ Acknowledging our imperfect brains can help us better understand our behaviour in times of stress, being kinder to ourselves, and, perhaps, others too. Our brains encode the sensory information of stressful situations to ensure we apply the same survival response should we encounter something similar in the future. So it could make sense that we froze rather than fighting back when we felt attacked as a child or ‘played dead’ like a rabbit might when hunted by a fox. And when someone is rude to us in the queue at the post office, we do the same, because our nervous system instinctively wants to protect us from the possibility of ever being attacked again.

So if you can really listen to what you thought was a negative, perhaps even humiliating, response, and discover how your body encoded it to be an appropriate or necessary response in that context, you are halfway there.

Next, you can nudge your nervous system to realise that the conditions have changed. The signals that alerted it to danger then (e.g. the click of the front door, people turning to look at you, letting your guard down) are no longer alarm signals now.

The hope is that you feel less ‘mad’ by now, though you would be forgiven for feeling a tad ‘primitive’. When it comes to our instinctive behaviours our functioning remains more similar to our animal friends than we might want to admit. And when we are stressed, we tend to resort more to instinct.

• What else is going on now?

Consider what else might be leaving your nervous system on the defensive, priming it to resort to instinct rather than a considered and intentional response. Have you been eating and sleeping well enough? Do you have supportive relationships around you that you can access? Do you feel safe in your current life situation? Are you worrying about how to manage financially until the end of the month? Or about international politics? Climate change? The influence of the latest TikTok craze on your teen’s well-being? We won’t always be able to fix these things, but paying attention to the situation and the system we are embedded in can highlight what eats away at our resources and our resilience. What is leaving us less able to cope intelligently and with the nuance that our evolutionary status as ‘sapiens’ suggests we can?

Again, we need to listen carefully to our current context to learn what this means about our immediate needs, so that we can help our nervous system return to a state of calm. Through remembering or reconnecting with supportive friends, moving our body, deep breathing, or paying attention to cues of safety in our present-day environment, we can create little islands of calm within the storm. Finding your way back to inner calm, a felt sense of safety, the ability to slow down and pause, reflect rather than react, purposeful considered action, and rewarding social connections - this all helps to achieve what we refer to as self-regulation.

With greater self-regulation and self-awareness, listening non-judgmentally to your answers to the questions above becomes easier. You can create a psychological space to recognise your reflexive survival responses and learned behaviours and acknowledge our shared humanity. You can clearly see whatever survival responses you developed in the past and how their intention was and still is to keep you alive (albeit a little overenthusiastically at times). With these insights you can feel safe enough to recognise that you no longer need them now. This ability to step back from them finally frees you up to respond differently and ‘move forward’