Uh oh, it’s happening again. Another session where my patient, a man in his 30’s, has taken over the session. I sensed this might be an issue from our first intake visit, which extended into a second session because of our mutual tendency to allow him to speak in long-winded answers. And here we go again – 20 minutes into our session and I’ve barely gotten a word in edgewise. I take an audible in-breath and lean forward in my chair, signaling that I’d like to speak. He responds with a small nod, but at the same time speeds up his words and raises his voice, effectively saying “no” to my bid for a turn. We’ve been through this cycle enough times that I’m feeling rather trapped – my choices seem to be either to shout him down or fall silent. On the one hand, this isn’t a good thing. He’s not going to get any help if he doesn't let me participate in the conversation. On the other hand, falling into this pattern is exactly what needs to happen. He’s come to see me for help with his relationship with his wife, who complains that he interrupts her all the time. I can almost see the thought bubble above his head shouting, “Help! Stop me!”

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Healthy relationships offer opportunities for the joy of conversational “flow.” An excellent conversation can have the charge of two soccer players passing a ball back and forth down the field or the grace of a figure skating pair. The two parties read each other’s non-verbal communications, sensing when to move forward and when to shift to support their partner’s motion. In conversation, the “silent” partner is active in the role of listener, sending feedback signals in the form of nods, reactive facial expressions and all of those wonderful listening noises: “uh-huh,” “mmm,” “oh?” “I see,” “yes,” “go on.”

People can fall out of conversational cooperation by either talking too little or too much. Some people offer excessively terse “closed down” answers when discussing emotional content, obliging the listener to work hard to draw them out. Others tend to speak with excessive length or over-complexity, in ways that can be hard to follow and difficult to interrupt¹.

Traditionally, the culture of therapy has been to let patients talk. Psychoanalysts famously say almost nothing. But failing to address conversational imbalance is a huge missed opportunity. Helping patients recognize and shift a problematic default tendency is an important part of therapy – both because conversational collaboration is a key part of the working relationship, and because the therapeutic dialogue serves as an in-vivo training opportunity in collaborative behavior. What is tricky is to do this in a way that is encouraging rather than shaming².

“Allan, can I stop us for a moment?”

He looks at me somewhat surprised, for I’ve raised my voice a bit louder than usual in order to get his attention.

“Sure?” he says a bit dubiously.

“I’ve noticed something happening between us, and I was wondering if we could take a look at that together because I’m thinking it’s an opportunity for us to communicate better.”

“What do you mean?” He’s flinching as if anticipating a harsh blow.

“There have been a number of times I’ve had something I’ve wanted to offer you, but I haven’t been able to find a way to break into the conversation. I’ve noticed feeling a bit frustrated, and also sad because I don't feel as connected to you as I’d like to be. I’m wondering if you’ve noticed this, too, and if you’ve felt anxious or frustrated with how we’ve been connecting.”

I can see him physically expand, as though about to let out a flood of thoughts, but he stops himself. He speaks slowly for the first time.

“I was afraid you were going to criticize me for interrupting you, just the way my wife does. I think I’ve been worried all along that you have been silently judging me, and ironically I think that makes me talk even more so you won’t have a chance to hurt me.”

“It sounds like I was on the mark about your feeling anxious in our relationship – and that you’ve been feeling that anxiety for good reason, because you were picking up on my unspoken frustration. It’s really cool that you noticed that. It feels awkward to talk about this, but at the same time, I’m excited by the opportunity we have to shift things, so we can have a better connection.”

“But I don’t know how to stop interrupting or even to talk less. I don’t feel like you really get me, so I have to give you all the details. Like, I mean…”

I raise my hand and smile. “Is this an example where you wanted to add in more details so I’d understand?”

He nods.

“Could we try something?” I ask, “I wonder if this might be a ‘less-is-more’ situation. Would you be willing to let me guide you a bit? I’m thinking that if you give me a little more space to talk, we might actually communicate better and ironically, you might feel more understood.”

“I already feel more understood since you stopped me to talk about this.”

Together we agree on a plan for me to raise my hand when I’d like to talk so we can practice a more back and forth dialogue. He recognizes that this shift away from telling every story in completeness is going to be uncomfortable for him, but he sees what he stands to gain.
Two sessions later, things are already starting to look different – he’s still a talker, but we’ve gotten ourselves in rhythm, and we’ve gotten down to work tackling his communication difficulties with his wife.

“Wow!” he tells me at the end of a particularly good session. “We had a real back and forth going there. That was actually a lot of fun! I’m so glad you stopped me!”

Gratitude to Dan Brown’s work on fostering collaborative behavior (see his book Attachment Disturbances in Adults, Norton, 2016)

Gratitude to Dr. David Burns for his method “Changing the Focus” demonstrated here (see his book Feeling Good Together, Crown Publishing Group, 2008.)

File under: Musings and Reflections