The Psychiatry Blog by John Deri, M.D.

“The psychoanalyst listens, the shaman speaks.”

Thus wrote Claude Levi-Strauss, the French anthropologist.  Levi-Strauss, like Carl Jung, was intrigued by pairs of opposites.

I have been reflecting on this particular pair of opposites, listening and speaking, in the context of psychotherapy.  I have come to think of listening and speaking as representing the yin and the yang of the healing process.

The Yin and the Yang of Healing

From a Taoist perspective, yin energy is associated symbolically with the feminine, yang with the masculine.  These energies are not, however, linked with gender.  We all embody the potential for both yin and yang poles of energy.

Yin energy in therapy is manifested through phenomena including listening, empathy and nurturance, as well as through a metaphoric “holding space” for the other.

Yang energy may be expressed through speaking, interpretation, emphatic engagement or confrontation.

Both patient and therapist must develop a full range of these capacities.  The process of healing is catalyzed by a creative dance between these polar energies.  Both therapist and patient need to cultivate their respective abilities to speak freely and to listen fully.  Each must be able to listen to herself as well as to the other.

The Role of Early Life Trauma

The reason why listening and speaking are healing can be understood against the backdrop of early life trauma.  The traumatized child goes unheard.  Neither parent has the wherewithal or the willingness to listen to the child.  As a consequence, the child comes to feel alone, uncared for, disconnected and afraid.  Moreover, such a child is liable to grow up as an adult who is wary of closeness to others.  Such an individual is prone to seek social isolation.

Wilfred Bion, a British psychoanalyst, in his paper “Attacks on Linking,” put forth the premise that such a child is deprived of a primary experience of emotional bonding or “linkage,” with either parent.  This absence breeds in the child an experience of sadness, a sense of futility and ultimately of rage.  The child’s rage has the potential to generalize into an unconscious hatred of all “linkages”: between the child and another human being, between thought and feeling, between the child and himself, and ultimately between the child and reality.  Such broken or unconsummated linkages are the substrate for unspeakable suffering.

The Alchemy of Healing

Through reciprocal speaking and listening within the therapeutic relationship, emotionally meaningful linkages are formed.  The patient’s capacity to achieve emotional connection with the self and with the other is enhanced.  Dissociation between thoughts and feelings, between feelings and images, is transformed into integration.

Through integration of split off parts of the self, healing occurs.  Through relatedness with self and others, the full potential of the patient blossoms and flourishes.

These transformational processes are always reciprocal, between patient and therapist.  Witnessing and participating in this alchemy of healing is deeply moving.  Such participation is the central calling of my life.