7

LISTENING

A family therapist must listen carefully to the stories the family members tell.
The aim of this listening is not in the first place to gather information in
order to make hypotheses or to formulate a diagnosis. Rather, the central
aim of listening is to connect with the family members in such a way that
they feel heard and that they experience that they are acknowledged by the
therapist in what they are going through, and in their good intentions. Put
in this way, listening is a fundamentally ethical activity within the therapeu-
tic relationship as an I-Thou relationship (Buber, 1923, 1947).

Listening is not obvious

Listening is by no means obvious. It is active, as it implies being not-knowing

(Anderson & Goolishian, 1988) and curious (Cecchin, 1987) in order to
receive the story as the client tells it. It implies listening to the broad strokes
of the story, as well as to the details. It implies listening to what is said, as
well as to what is not said. In the family therapy context, it implies listening
to the speakers, as well as to the listeners.

LISTENING TO WHAT IS NOT SAID

Ed Murrow was a famous American radio journalist. During WWII he was corre-
spondent for CBS in Europe. On 12 April 1945, Murrow was one of the first report-
ers at the Buchenwald extermination camp. This is how he ended his radio report:
‘I pray you to believe what I have said about Buchenwald. I have reported what I
saw and heard, but only part of it. For most of it I have no words.’

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This evokes memories of what happens to  György Köves when he returns home
from Buchenwald, in Nobel prize winner Imre Kertész’s semi-­ autobiographical
novel Fatelessness (Kertész, 2005). After all the hardship György endured in
Buchenwald, he arrives in Budapest and on the streets of Budapest he meets a
journalist. The journalist asks György: ‘Would you care to give an account of your
experiences, young fellow?’ György is dumbfounded and asks: ‘But what about?’
‘The hell of the camps,’ the journalist replies. György says that he has nothing to
say about that. There is a whole discussion and finally the journalist says to György
to think about it, and he hands György a slip of paper with his name and address
on it. After the journalist has disappeared in the swarm of passers-by, György
tosses the slip of paper away and goes on his way.
As a survivor of Buchenwald himself, Kertész understands that it is hard for
victims of trauma, sometimes even impossible, to talk about what has happened
to them. What has happened has not only fundamentally shattered their feeling of
safety and of belonging, it has also cut them off from language. Words fail them
to express their experiences.

The therapist listens to the story of the client: the plot, the main characters,
the events, and so on. But while the therapist is listening to the story, he/
she also notices the small details in the story itself, as well as in the way it
is told. The small details often give some indications of what can’t be said
(yet) for whatever reason. It is often a small detail, something very easily
overlooked, but the therapist notices it and recognises it as important. Still,
it does not lead to hypotheses or to judgements; rather, it sparks reflections
about possibilities and potentialities. It awakens the curiosity and interest of
the therapist, and gives rise to respectful questions posed to the client such
as, ‘Can you tell me a bit more about it?’ or ‘Can you help me understand?’

LISTENING TO THE LITTLE DETAILS: THE INSPIRATION OF MORELLI

Giovanni Morelli (1816–1891) was an Italian art critic. He developed a method to

distinguish genuine works of art from counterfeit works. His method consisted of focus-
ing his attention on the small details of an artwork. The identity of the painter is above
all reflected in the seemingly insignificant details, Morelli said. Imitators of artworks
can easily copy major themes and mannerisms, and they will concentrate their energy
on doing so. However, painting all the small details (e.g. how the eyes of a secondary
figure are painted) accurately in the same manner as a master is not possible.
We can use this Morellian method as a metaphor for the listening of the thera-
pist. He/she should not only listen to the big story, but also pay attention to the
small details of the story. These little details may seem insignificant at first, but

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then the therapist notices them . . . They strike the therapist as remarkable or odd,
and arouse his/her curiosity. This can be the starting point for a joint exploration
with the family about the subtle meanings of these details.

When a client tells a story, the therapist listens carefully to what is said.
The therapist’s listening means a lot to the client, especially when the client
tells about experiences that are personal and vulnerable. In line with what
I discussed in Chapter 3, about the therapeutic process, this listening to the
story of the client could be called vertical listening. In a family therapy ses-
sion, vertical listening, while important, is not enough. The therapist also
has to pay attention to the responses of the other family members to what
is being said. This could be called horizontal listening. Both kinds of listening,
vertical and horizontal, are indispensable in a family therapist’s listening.
Both vertical and horizontal listening have to be done with all the thera-
pist’s senses: the therapist listens not only with the ears but also with the
eyes and the heart. Let’s look closer at what this means.

To listen with the ears

The therapist listens to the story as told by the family member and tries to
understand the story as well as possible. This sounds obvious, but it is not.
Understanding is not in the first place something in the head of the thera-
pist; rather, understanding primarily happens bodily, between therapist and
client. The body understands before the brain has processed the information.
To listen means that the therapist has to postpone judgement and diag-
nosis. This is not evident in these times in which psychotherapy is often
described as a medical practice in which the diagnosis is the starting point
of the treatment. In our dialogical view of family therapy, the diagnosis is
important only if it features in the story of the family member.

ASKING QUESTIONS IN ORDER TO LISTEN

It is often said that questions are means to gather information. In our dialogical
approach, questions have a different purpose: they connect us with the family
member and help them to share their story. Questions are posed in order to
explore and develop a story, and ultimately to invite family members to listen to
themselves and each other. The most important questions a family therapist can
ask are ‘Can you tell me a bit more about this?’ and ‘Can you help me to understand?’

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Rather than diagnosing family members, the therapist listens to their stories
and tries to hear their stories as human stories about something that he/she
also might have experienced, if the circumstances in his/her life were dif-
ferent. The therapist listens to what the family members tell him/her, and
this listening is connecting them as limited mortals with good intentions: a
bridge between them develops.
The therapist listens generously. Listening generously is the opposite of
listening critically. It refers to the listener assuming that the speaker intended
the most coherent and reasonable meaning imaginable (Hoffman, 2002;
Shawver, 2004, 2012). It means to listen to the other as if he/she is me, and
to refrain from judging or diagnosing.
Here lies one of the main reasons why family therapists have to be careful
with diagnostic labels. Such labels do not convey empathy, as they imply a
judgement; the judgement that the behaviour is not normal. A diagnostic
label used by the therapist also suggests that the therapist considers him/her-
self to be different from the client (more normal, more healthy, more sane,
etc.), and in fact it also suggests a distinction from the other family members
(who are also more normal, more healthy, more sane, etc.). Saying to some-
one (or even just thinking about someone) ‘You are autistic’ implies that one
considers the other as different: ‘You are autistic, and I am not.’

ABOUT THE COMFORT OF JUDGEMENTS AND DIAGNOSES

Judgements and diagnoses can sometimes be very comfortable for a therapist.

We as therapists are often faced with very painful things. It can be reassuring
if we determine that something that is painful is in fact pathological. In that way,
we put up a wall between the suffering and our own lives, and we deny that we
recognise something of ourselves in the client. We fend off the suffering from
ourselves, and retreat on to an island of normality and sanity.
That is comfortable for us, but there’s a price to pay: we abandon the client
who is standing there in his/her vulnerability, his/her shame and his/her insecurity.
He/she is the weird, crazy, strange one; and we are the professionals with our clini-
cal judgement. In that way we end up in an I-It relationship, and, as Buber (1923)
wrote, in fact, if we consider the client as a thing to be objectively diagnosed, we
also deny ourselves our subjectivity.

In listening, the therapist identifies with the client as a person, and allows
him/herself to see a reflection of his/her own suffering in the suffering of the
client. It’s that reflection that can help the therapist to create a bridge to the
other. ‘Although I am not autistic, sometimes I also need to close myself of
from the world . . .’ or ‘Although I am not autistic, sometimes the world is
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very strange to me . . .’, etc.. It is in the humble recognition of the human

in the strangeness of the other, and in the recognition of the strangeness in
him/herself, that the therapist recognises the client as a Thou, and him/her-
self as a subject (Buber, 1923).
Such listening is particularly powerful in family therapy. If the therapist
listens to the story of one of the family members without judgement, but
rather with the recognition of understanding and empathy, the other family
members present are humbled and at the same time reassured that when they
tell their story, they will be listened to as well, in the same generous way.

To listen with the eyes

Listening with the eyes refers to the nonverbal communication of the family
members (see also Chapter 6). The family members tell their stories not only
with words but also with their body: facial expression, body movements, breath-
ing, tears, etc. Often, words can only partly grasp what the body can express.
Furthermore, family members respond to the stories told in the session
with their body first. They sigh, or they look away, or they start to cry. That’s
why it is important that the therapist integrates his/her listening with the
ears with his/her listening with the eyes. For instance, it is important to note
that the client’s eyes become watery, and the therapist can try to understand
what that might mean: Who was speaking at that moment? What was said at
that moment? And so on.

Case story: the Smedts family

I had a conversation with parents who lost their child. The father sat in silence
as the mother told about the long nights sitting at the hospital bed with their
daughter.
Mother’s story sounded dull. Without much emotion.
Still, I knew there had to be a lot of emotion. Somewhere.
I asked: ‘What is the last thing your daughter said?’
Immediately Mother’s eyes were full of tears. My question catapulted her back
to a specific moment in the months-long process of her daughter’s illness. She
was back at the hospital with her sick child. She remembered that her daughter
had said to her: ‘Do not worry, Mom, it’ll be fine.’
However, in the session with me, the mother could not say this. She had no
words, but I saw her shoulders shake, and she leaned forward and grabbed her
arms around her stomach, as if she had severe abdominal pains. Tears were
dripping on the floor.
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The father moved closer and, without words, he took her in his arms and com-
forted her.
I got tears in my eyes and took a handkerchief to dry my eyes.

This is an example of the body that speaks; or, rather, of bodies that speak.
For it was not only the mother’s body, but also the body of the father, and
even the body of the therapist that spoke.

TEARS OF A THERAPIST

Often the question is asked whether the therapist is allowed to show emotions in
the session. In my experience it is obvious that the therapist feels emotions during
the session, and often these emotions are so strong that it would be impossible to
hide them. This does not have to be problematic. The emotions of the therapist
may be very important for the family members because they show that the thera-
pist cares and empathises.
But, of course, the emotions of the therapist should not be too important in
the session. No, the story of the family members and their emotions should be
central and the therapist’s emotions should not be a burden on the family. But it
is inevitable that a compassionate therapist is touched at emotional moments, and
that then his/her body speaks.

To listen with the heart

This is perhaps the most difficult kind of listening. This is about the feel-
ings and experiences evoked in therapists by the family. Sometimes strong
emotions are evoked in him/her (e.g. Frediani & Rober, 2016). Pope and
Tabachnick (1993) asked 600 randomly selected professional therapists in
a survey study about the feelings they had experienced in their work. Over
80 per cent of the respondents reported experiencing fear, anger and sexual
feelings in the context of their work. The most widespread feelings were fear
and anger, both experienced by 90 per cent of the respondents. This research
illustrates that experiencing negative emotions is an inescapable part of the
messy and unpredictable process of therapy and should not be considered as
a sign of being a bad or inexperienced therapist.
Some authors have emphasised that the personal experience of the thera-
pist is a source for creative interventions (e.g. Andolfi, Angelo & Nichilo,
1989; Whitaker & Keith, 1981; Wilson, 2007). Especially when working with
children, but also when working with adults, play, humour and drama are
important aspects of the therapeutic dialogue. Also, the sharing with the

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client of the therapist’s own associations, fantasies and bodily sensations is

not uncommon (e.g. Whitaker, 1989).
Furthermore, the therapist’s own experiences can be helpful in ensuring
that the therapeutic relationship is a warm, personal, working relationship
that is experienced by the client as authentic and empathic. If the therapist
actively wants to contribute to an effective therapeutic relationship, rather
than playing the ‘role’ of therapist, then he/she should really be present in
the session as a person.
Of course, the therapist has to avoid giving in to the temptations of hubris
and colonisation (Rober & Seltzer, 2010). This implies being not-knowing
(Anderson & Goolishian, 1988) and bracketing one’s prejudices and theoreti-
cal preconceptions in order to be open to the story the client wants to tell.
Furthermore, it implies that the therapist should be aware of his/her phanta-
sies of being a benevolent healer, in order to make space for a real dialogue
with the client in which there is room for the client’s discomfort with the
therapy and his/her criticism of the therapist (see also Chapter 5), without
the need to break the connection or to stop therapy prematurely.
According to some authors, what the therapist experiences during the ses-
sion is particularly meaningful as it sometimes tells part of the client’s story:
our clients make us feel what it is like to be them.

WHAT CANNOT BE SAID

In his book The Shadow of the Object, Bollas talks about the unthought known
(Bollas, 1987). Some of our experiences remain unthought and unspoken; while
they are remembered. Sometimes the body recalls things the brain was unable to
process (Griffith & Griffith, 1994; van der Kolk, 2015).
There are two reasons why important experiences remain unspoken and
unthought:

1. 
Developmental: the experiences refer to the period before we acquired
language. This refers especially to crucial attachment experiences in the first
year of the baby’s life (Wallin, 2007).
2. 
Protective: the experiences are not articulated because it would put the person
him/herself or loved ones in jeopardy. This refers, for instance, to traumatic
experiences that cannot be processed because brain centres that are respon-
sible for language go offline (e.g. Broca’s area) and other centres go into
overdrive (e.g. amygdala). This can help us to understand why it is difficult for
traumatised people to talk about their experiences (van der Kolk, 2015). But it
is not only for traumatised people that unthought knowing is protective; it also
applies for people struggling with chronic illness (e.g. Charmaz, 1999, 2002)

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Licensed to Loreto Paredes ([email protected])

 LISTENING

and for people in grief (e.g. Hooghe, Neimeyer & Rober, 2011, 2012). For
instance, it can be better not to talk, and even not to think about their experi-
ences. In that way they protect themselves and their loved ones against the
unspeakable pain of losing someone they love or of losing their health.

This is where the therapist’s resonances (Elkaïm, 1997) come in. Through our
resonances we can connect with experiences of the client that have remained
unarticulated. By becoming aware of what the client evokes in us, we may have a
window that allows a glimpse of the client’s unthought known (Bollas, 1987).

What the therapist experiences reflects some of the things the client cannot
express in a verbal or a nonverbal way. Psychoanalytic inspired family thera-
pists argue that this form of communication functions through the mecha-
nism of projective identification (e.g. Flaskas, 2002) and is expressed in what
they call the countertransference. Elkaïm (1997) situated this form of preverbal
communication in a systemic frame. He stated that the personal experiences
of the therapist in the session can be seen as a therapeutic tool that provides
information about the system. According to him, what the therapist experi-
ences in the session is not only the result of the therapist’s own personal
history, but is also evoked and reinforced by the dialogical context in which
the therapist is invited to play a part (Elkaïm, 1997).
So, it seems that we have to listen to our own experiencing process in
order to better understand the stories of the family members (Rober, 2011).
However, being sensitive to one’s own experiencing is no simple matter.
The therapist has to be aware of his/her own experiences, to bear them and
to tolerate them; instead of acting impulsively on his/her emotions (Rober,
2011).

THE THERAPIST’S INTEROCEPTION

In order to listen with the heart, the therapist’s self-awareness is of crucial impor-
tance. Such self-awareness can be called interoception, as it refers to a sensitivity
towards our inner life (Ceunen, Vlaeyen & Van Diest, 2016). The term comes from
the Latin words ‘internus’ meaning ‘inward’, and ‘capere’, ‘to take’. It refers to
the perception of our inner life; our bodily state (e.g. tension, pain) as well as our
psychological state (e.g. memories, emotions, anxiety).

Being aware of one’s experiences in the heat of a family therapy session

is usually tough. According to Frosh (2004), dealing with the unsaid and
the unsayable may be frightening for therapists as clients appear as others

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(Larner, 2004) or as strangers (Kristeva, 1991), while at the same time

they demand something from the therapist: ‘When clients say, “Help me,
cure me, reach me,” what on earth do they want? And why, especially,
do they want it from me?’ (Frosh, 2004, p. 60). The client’s suffering and
his/her expectations can evoke feelings of impotence and helplessness in
the therapist. They may also stir up the issue of feeling like an impostor
(Clance & Imes, 1978; Sightler & Wilson, 2001), as they can give rise to
the therapist’s secret fear that he/she is not worthy of his/her position as
a therapist.
Impulsively acting can be our way of protecting ourselves: triggered by the
client’s suffering we intervene and in that way we keep strangeness at bay
and avoid being really aware of some of the confusing and painful things
that are evoked in us. That’s why carefully reflecting on one’s own experienc-
ing and positioning in the session is important. It is, however, not always
possible to find the time and space to really reflect on these things in the
session. Taking time after the session to think over what happened, or, even
better, talking with colleagues or with a supervisor about the session, is no
luxury, but rather a necessity. It is important for the therapist to find ways in
which his/her experiencing can open space for new and enriching dialogues
with the family members, between the family members, and between family
members and their social context.

The complexity of listening

In this chapter I emphasised the importance of both vertical and horizontal

listening if the therapist wants to use the full potential of the family therapy
setting. Furthermore, I stressed that listening is not obvious. I referred to
three ways of listening; with the ears, the eyes and the heart. Figure 7.1 sum-
marises this view.
With our ears, we listen to the story told by the client. With our eyes,
we can see what it emotionally means for them and we can observe the
responses of the other family members (e.g. their hesitations). Our listening
with the ears and with the eyes will lead to questions like ‘Can you tell me
more?’ and ‘Can you help me to understand?’ Then there is the listening
with the heart. When we are aware of our own experiences in the session,
sometimes it can give a hint of what the client experiences that has remained
unthought and unsaid. This kind of listening should be done with the
utmost respect for the client’s silence, but it can help us to empathise more
with what he/she has been through.

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 LISTENING

STORY
ears
HESITATION eyes
UNSAID

heart

UNSAYABLE

Figure 7.1  The therapist’s listening

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 In the attic, in the dark 6

I asked Dad yesterday,

Why does the house creak?

Does the house creak? he asked.

Yes, I said,
every night when it gets dark.
Is that so? he said.
Yes, I said.
And I added,
Yesterday I heard someone groan.

Dad said,
Oh, that’s nothing.
That’s normal in old houses.
That’s nothing, 
he repeated.
And then he added,
Don’t mention any of this to Mom.

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