About the Voice

On August 18, 2020 I posted, on the 100th anniversary of the ratification of the 19th Amendment, about women having fought to obtain the voice of the vote. This led me to thinking about the voice in a more concrete way, in particular, when a patient’s voice is very loud, or productive, or seemingly pressured, patients who seem not to expect a dialogue with us or to let up ‘get a word in edgewise.’ A colleague complained to me about his patient’s very loud voice, shouting in the session such that she gave him a headache. He and I talked about the possibility that she had a great longing to be heard, having had a mother who would never listen to her. My colleague chose to ‘lean into’ her need to be heard, and even sometimes to muse aloud about this need of hers.

Another colleague of mine became annoyed with her patient with whom she had to struggle to get a word in, and to struggle to go from the patient’s complaints about external events to the patient’s internal longings. My colleague was tempted to interpret the patient’s seeming incapacity to be in dialogue with another and to let the patient know how left out from a dialogue she, the therapist, felt. Instead, my colleague decided to speak to the possible longings this behavior of the patient’s might be communicating. Perhaps the patient, like a loud patient, might have a great longing to get her story out, that is, to be heard, and had, in addition, the fear and expectation (learned from childhood experience) that a listener’s attention could not really be held for long and so the speaker better get in as much as possible before the listener 'disappeared.’ 

Childhood may teach us (and become a relational paradigm) that listeners disappear: A mother who is starting to give us attention, but then is distracted away by her other children, her own worries, or by her dissociated unresolved trauma. Caregivers may tell us to go away, that they don’t have time for us. They may teach us we are not really deserving of being listened to, or that we are boring, by pretending to listen while not really giving their full attention (e.g. while on the phone). Perhaps worse is to have had our parents dismiss our feelings and points of view such that we feel misrecognized and misunderstood, never heard.

An analytic attitude listens with heartfelt attention, allowing the patient the experience of being ‘a child of the universe [with] ... a right to be here.’ Another colleague told me how a particular patient would not stop talking at the end of a session, as if to “grab” the therapist, sometimes running over twenty minutes! I was reminded of children I have seen in play therapy who, when the parent calls for them at the end of a session, throw their arms around my legs and not want to leave. I notice aloud their attachment, let them know I will hold them in my mind, and that I will be here next time. Sometimes, because of our experience together, they know that to be true.