“I Don’t Mean To Be Mean But…”

How is it possible that when we are not our best “therapeutic” self can lead to a good outcome?

In the last post, Develop Good Taste, I talked about the benefits of listening to how others work. More specifically, employing the principles of deliberate practice and learning sciences, I argue for a need to listen in a certain way to other therapist work, in a way that actually causes dis-fluency i.e., disrupting your usual pattern of listening.

Here’s a summary of the 6-Steps I’ve highlighted:

1. PLAY –> 2. PAUSE –> 3. ACT

4. PLAY–> 5. REFLECT –> 6. SYNTHESISE

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A few days ago, I was pleasantly surprised to read couples therapist and author Esther Perel’s newsletter. Here’s snippets of what she said:

It was a bad therapy day. We were recording a one-time anonymous session for my podcast “Where Should We Begin,” but by the end of it, I was convinced the material was unusable. The recently married, early 30s, white American couple (and new parents) sitting across from me were bickering to no end. 

Familiar to her work and specifically to her Podcast Where Shall We Begin (big fan), I was intrigued. I mean, how bad could it be? Besides, she embodied a style that carried the spirit of Salvador Minuchin, who was someone I greatly respect. And more than 15 years ago, I recall a discussion with my clinical supervisor that one of the things I wanted to work on is to be more direct. Perel and Minuchin’s voice helped me to find my own voice…

…So how bad could Perel’s session be?

Perel goes on in her newsletter:

I snapped. They had given me license to be direct—but had I been too direct? Had my reaction been inappropriate or unhelpful? I cringed at the reality that I would have to hear this failure played back as a podcast episode. I won’t tell you what I said (the tone is perhaps more important), but you can hear it for yourself because, after all that, we decided to release it as an episode anyway

Before you go on to list to this particular podcast episode below, I want you to take this opportunity to invite you to listen in a different way. By employing the 6-step sequence I’ve outlined (more details here), practice listening to yourself AND listen to how Esther Perel engages this couple in consultation. If it helps, use my own inputs and reflects as stimulus to think clearer of your own ideas.

I Don’t Mean to Be Mean, But…

Listen to this episode from Where Should We Begin? with Esther Perel on Spotify. She has no boundaries, he’s walled off. And their opposing communication styles cause immediate tension in this explosive session. So much so, that Esther finds herself adding to the chorus of angry voices.

Play-Pause Exercise

There are 4 specific timepoints that I would like you to PAUSE at and engage in this exercise. Listen intently to the interaction, and when you’ve come to the specific timepoints, pause the recording, and write down your response, as if you were the therapist. In addition, list down your intent for saying what you’ve said.

In turn, I will also provide you how I would have responded. (I can feel my nerves about this, because it isn’t the best. But that’s not the point. The point is to go through this exercise with you).

Here are the 4 Time-Points for you to PAUSE and respond:

1. 4:15 min
2. 7:28 min
3. 38:45 min
4. 43:10 min

(Note: You might be tempted to just listen through the entire podcast episode because it’s so engaging. But for the purposes of this exercise, I encourage you to put on the brakes at the stipulated time-stamps.)

Segment #1: 0:00 min to 4:15min

Let’s Begin.

Step 1. Play: Play the session from start and stop at 4:15min

Step 2. Pause: Once you’ve paused the recording, respond to the couple.

This is right off the bat of the session, where the therapists asked the couple

Therapist (T): “If this was a helpful conversation… what needs to happen?”
And the couple responded with the following:
Husband (Hs): Some sort of a plan…
Wife (W): ” I wanna know if this is broken… I go to my mom… I go to my bro… my grandma and they tell me one thing…”

Step 3. ACT:

OK. YOUR TURN. Respond as if you are the therapist.

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Here’s my response:

Therapist: “You have a lot of support from family that you turn to… Who does he turn to?”

My Intent: Attempts at a systemic balance due to the nature of the imbalance of community of others in each of them

Once again. I’m not saying my response–nor Esther Perel’s–are the model responses. Here, the aim is to deliberately engage in a different kind of listening, listening to other’s voice and our own, and in turn, sharpen our craft in the healing endeavor.

Step 4. Play On

Now, play from 4:15min.

Here’s Esther Perel’s response:

T: …It is as if I need another 3 chairs… cos’ you show up with… when he talks to you, he hears a cacophony of others (a cast of other family members).

Step 5. Reflect

Now that you have heard your response, Esther Perel’s response and mine, take a few minutes to reflect on what you’ve just heard and what you are now thinking.

Here’s my reflection:
– I love this. Not what I would have done.
– I appreciate the principle of pointing out the 2 implicit points
1. How does she hear her husband unfiltered and unbiased and directly
and
2. How does she hear herself?

– This is something I notice of some couples I work with; one partner who turns to their parent like a best friend.
– I would likely incorporate this principle and application
– Gels with Karl Tomm’s idea of community of internalised others.

Segment #2: 4:15 min to 7:28 min

Step 1. Play

We repeat Step 1 again and play the recording from 4:15min and pause and 7:28min

Step 2. Pause: Once you’ve paused the recording, respond to the couple.

Here’s the gist of what transpired in Segment #2:

Hs: You mind I speak up abit?
W: Yes.
T: You are BEING VERY POLITE!

T: Do you have a picture?
Hs: of her mom? (Ha).
T: No, your 1 yr old baby.

W: But the problem is… I never had to sit w my own thinking
(Hs interjects with his analysis of wife)

Step 3. Act

OK. YOUR TURN. Respond as if you are the therapist.

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Here’s my take on this:

1. “Wow… you’ve just psychoanalysed your wife to me… IN FRONT OF HER!
2. (To both): Slow down for a second…
3. (To hs): What do you think is going on inside your wife when she hears you describe her to me this way?”
4. Then I would check with wife and get her to voice her unspokens.
   My intent: to punctuate what just happened, and then slow down the process to process what’s happening within each of them

Step 4. Play On

Here’s what Esther Perel said

T: Every time you talk… “Let me describe you… I can describe you better than yourself… why don’t you wait and see first?”
Hs: You are right…
…
T: Let’s make an agreement here… each of you are going to talk for yourself.

Step 5. Reflect

Now that you have heard your response, Esther Perel’s response and mine, take a few minutes to reflect on what you’ve just heard and what you are now thinking.

Here’s my reflection:
– interesting. She direct… and sharp!

Segment #3: 7:28 min to 38:45 min

Step 1 Play

Now things are heating up. Play the recording from 7:28min to 38:45min and hit pause.

There was a lot of ground covered here. Here’s a gist of what transpired in segment #3:

W: I think there’s a lack of respect over the years… I wish…
T: (interrupts) Not I wish…
W: If things change…
T: (interrupts) Not things…

Wife worries about instability of income. Issue of hidden trust funds?

Around 15mins:
T: You are not listening to a word he’s saying
W: That’s not true… (Note: potential alliance rupture moment)

Around 18mins:
T: Money, Sex, Family… the topics doesn’t matter… it’s the ways you talk.
W: The problem is that he talks soo slowly… I’m so high energy…

Around 23mins:
W: When you were talking about your father… how cold and scary that is…
T: Can I stop you on that? How did that feel?
Hs: that was a good point.
T: That was really Nice.
W: Nice? I thought that was mean… (but) I thought I was being more respectful to him

(Hs tearing. T says, “take her hand.”)
Wife jumps in “He had to feed himself (as a child)…”
T: NO… let him tell his story…
T: And it’s a story that tells what about you?
Hs: I had to support myself
(W: It’s so sad.)
T: you were so alone…
Theme of Hs’ Loss … T: and then you learn not to ask for much Hs: That’s right… But I did have my mom.

T reflection: She is a constant pursuerer and he is a redrawer.

Around 30 mins:
W: I just want to be independent etc..
T: You think he doesn’t!?
W: Well, if i dont have a job, I would go out and get one in 2 weeks…
T: You explode, he implodes…

Hs feeling guilty (not having a job)
T: Say more…
Hs: I try to help her to be a better mother…
(W: that’s not fair).
T: What you are doing is “kitchen sinking.”
(Therapist goes on to explain kitchen sinking ie piling up pass issues)

Around 35 mins:
T: The question is not whether you should be together, but to change this dynamic.

Around 37 mins:
Hs: I feel for you as you are anxious…
W: I’m NOT an anxious person; it’s a product of my environment
Hs: But you are…(gave examples).
W: (Change of tone; sarcasm). Must I see the numbers on how we can pay the rent? You know everything about my income…I’ve given you everything…

Step 2: Pause

Ok. That was a huge segment to go through. Feel free to take a 5 min break and come back later.

I must admit, there were a few points I should have stopped the process and work through, but I slipped and was so caught up with the interactions.

Step 3. Act

Pausing at 38:45min after hearing what wife has just said to her husband about her being an anxious person, jump in with your response as a therapist. YOUR TURN.

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Here’s my imperfect take in point form:

1. I would say to wife… you are really really worried that you will not have a roof over your head
2. and you keep coming back about some hidden trust fund that you don’t know about.

(Reflect: Ok… Now that I’ve said that, I feel that the two points convolute the water.)

3. Instead of diluting w the 2 points, I need to change 1. Maybe I would say #2 first and suggest that we should circle back to that. And then say #1. And then say to her, “Can you say this now… i know you’ve said before in various ways— but in here, can you speak to your hs about your deep worries and fears…”

4. And then check w how the hs took what she say and reflect back.

5. And then use this to synthesise a collaborative plan on how both of them are going to work together to manage money, but more importantly, the fears….

(I’m eager to hear what Esther said…)

Step 4: Play On

(T interjects)
T: You try and you start and you see if he can cross that bridge… it’s like saying there’s something wrong with you…
W: I have to be honest… I’m so angry that it has clouded the whole way I treated him. (T affirms her)
W: I went home and cried to my grandparents… they asked me to get a divorce…I’ve tried to stop talking to my family too much… T: He is so kind…

Step 5: Reflect

Now that you have heard your response, Esther Perel’s response and mine, take a few minutes to reflect on what you’ve just heard and what you are now thinking.

As mentioned in the previous Step 4, I found myself reflecting as I tried to respond to the best of my ability. I really like how Esther pointed out key patterns of him trying but her inadvertently putting him down. I’m thinking about the underlying principles that can help me translate this in my own clinical practice.

Segment #4: 38:45 mins to 43:10mins

Step 1. Play

Play the recording from 38:45min and 43:10mins and hit pause.

Here’s the gist of what happened in this segment:

W: High sch… I was a model and actress… I feel that messed me up… He has never kissed me or hugged me, or touched me or be intimate…
T: When you say never, he’s going to dig up the one time he tried.

T: (to W) ASK FOR WHAT YOU WANT.
W: I want a husband that…
T: No no no… not a husband that… no no no… You are not in a magical fairy land… you have to be precise… if not he will defend himself to his core.

Hs: I’m trying to build a list of what’s she’s saying that isn’t true… I can’t keep track of it.

Step 2. Pause

OK. Again, pause at 43:10. ONE FINAL TIME. YOUR TURN.

Step 3. Act

Respond to the couple.

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Here’s my attempt:

Ok this is a tough one.
I would say,
1. “Hang on… let’s go back. Lets de-list all the wrongs. and start again.
2. (to wife) One more time: Slow down, speak from underneath all of those hurts… ask your husband what you really want.
3. Hs, listen. No need to reply. Just listen deeply. I will come back to you.
And I’d coach wife through this part…

My intent:
Counteract his “list” by “de-listing” and do a do-over. Again, to slow them down and allow space for wife to voice to her husband what she really wants and needs. Also, counteract the need for husband to reply so that he can listen without worrying on his reply, so that he can receive more deeply.

Step 4. Play On

Listen on to what Esther said to the couple.

T: You’ve done this a zillion times… no need to do this in front of me. How can I help you take any piece of this and surprise her at the same time?
Hs: I don’t want the chorus of people to think this is true (of me)
T: OH, you are keeping scores of THEM!?

T: WHY DON”T WE MOVE THEM OUT OF THE ROOM? … So that you can actually have a conversation bettwen the 2 of you?”

Wife jumps in “he wants to set the record straight…”
T: “Can you stop?”

Step 4. Reflect

Now that you have heard your response, Esther Perel’s response and mine, take a few minutes to reflect on what you’ve just heard and what you are now thinking.

As you have heard Esther’s commentary in the podcast, she is activated and perhaps dsyregulated as she found herself sucked into the couple’s loop of interaction, both in terms of content and tone. However, I don’t necessarily see this as a bad thing. Based on the effect it has on the couple, things seemed to be moving… there seemed to be a vitality in the session (See the Impact of Session Grid graph below).

The session when a step first when the husband said
Hs: I desire you…
W: I’m embarrassed.
(T continues to interjects when W kept saying I’m just so angry…)

The therapy goes on and Esther sharpens the final part of the session by delineating one point that the couple must structurally work through, which is to create boundaries (in this case, between the couple and the chorus of voices from her family).

Step 5. Synthesise

We have come to the last step of pulling it together what we’ve learned. Contrary Esther’s reflection about this, it seemed that her approach, bringing forward her style and voice to help this couple disrupt old patterns, has a therapeutic effect on them, even though she wasn’t “therapeutic” in her approach.

Esther said,

After decades of practice, I have learned that I can be critical about my work without falling into a slump of self-criticism, but it helps to be reminded. After I shared the episode with my supervision group, I tried to do the very thing I had advised the couple to do: listen openly to feedback. “We have to remember,” my peer told me, “that when people aren’t listening, it’s because they don’t feel heard.”‍

My reflection on this as a whole:

1. Note to Self: to be critical without criticising.
2. I’ve spent several years giving myself permission to be more “direct,” and because if I put myself out there a bit more, I have a higher chance of missing the mark. And that’s ok. If I open myself up to counterfactuals, I may be able to learn a thing or two.
3. Go through this Play-Pause exercise with a session featuring Esther Perel made me revisit a principle I’ve noted for myself: Soften the Ground. This was something I picked up from my supervisor.. Softening the Ground means that I need to hear the tender and often less-spoken sides buried in the heat of the chaos on the surface, and allow myself to listen to that into speech.

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Impact of Session Grid (ISG)

The graph above is a visual representation of how I use The Impact of Session Grid (ISG) to deconstruct a therapy hour. Whenever I listen to a therapy recording, be it for the purposes of developing good taste, reviewing my own sessions, or supervising a clinician, I use this grid.

If you like to see this particular example of how I use the ISG with Esther Perel’s session discussed above, here’s the access to the spreadsheet:

I’ve talked about the ISG in Section III of The First Kiss. In future posts, I hope to elaborate more about this.
For now, it is noteworthy to mention that an unfolding like this pattern on the ISG appears to be linked with a good outcome of a session.

Couple’s Feedback

Finally, at the end the podcast episode, you get to hear the couple’s feedback about the session.

“Instead of staying neutral or diplomatic like most people would have…you told us what we really needed to hear...you told us we’re not broken and that we can work through this. I’ve listened to it completely.” 

Footnote:
1. I do not want to mislead anyone to think that I have copyrights to the Esther Perel’s work and her podcast, How Should We Begin. Fair use. All of the links to the podcast are directly from Spotify.
2. Photo by Filipe Almeida