Who am I to tell you?

I have worked in the mental health field across London for the last 15 years.  I predominately worked with teenagers and learned ‘on the job’ about how to be a therapeutic listener initially.  Reading about how to be therapeutic will only get you so far.  When faced with a patient with a horrendous story, you really don’t know how you will respond.  When challenged by a frightened parent unsure about how to manage their teenager to go for a coffee, you have to find ways to say the right things quickly.

Sometimes I learned the hard way, with a teen screaming in my face.  Sometimes, it was a thump (tough days).  However, the key that I learned working with highly distressed young people was that it was never about me.  Even if the young people asked questions about what would I do, how would I manage a situation, it was never really about them wanting to know about me.  Instead they were often asking for advice because maybe they valued my way of thinking? (hashtag proud).

I was hugely lucky to have avoided the scary undercover dispatches TV programmes that highlight the failings in the NHS/care system.  I instead, was exposed to psychotherapeutic environments with lots of thinking.  Therapeutic modelling with behavioural systems in place and boundaries to support the young people to understand their emotional landscape.  Over the years, I have taken for granted the lessons I have learned working therapeutically.  The skills I have learned, sitting at 03:00 with a young person having a flashback, or dissociating and being able to provide meaningful support has been incredibly powerful.  Sometimes support had no words at all and my learning has become like a tool box that I can dip in and out of depending on the situation.

As I go through my adult life and experience love, hate, fear, loss, anger, resentment, shame, anxiety, mood changes alongside life events, I have thought a lot about breaking things down for other people to more easily understand by using my knowledge.  So here is my attempt at sharing how to ‘listen’!

Am I the perfect listener?

No.  In so many ways, I really try to be a good listener to friends and offer useful advice.  However, work and life are very different. Although I am able to sit and talk with friends about a difficulty, there is a natural drive to ‘join’ the person with their experience.  I think most people can think of conversations they have had with friends where a ‘I’m here to listen’ conversation, ends up being a 2 way, ‘well that happened to me too’ type conversation.  This is not really listening.

Sometimes the ‘listener’ might want to give helpful advice in difficult conversations and this comes with difficult consequences.  When giving advice to someone that wants to be listened to, there can be a level of defence that can come when someone maybe gets too close a the truth.  This may not be seen as ‘helpful’ to the person who wants to be listened to.  I have definitely highlighted cracks that people may not have seen themselves in my personal relationships and conversation.  I have had to read the situation and quickly back up or stop talking and just listen.  This in itself is a complex skill to manage as every person is different and every subject matter brings different emotion.  Learning to listen to people’s responses (words and behaviour) is key to supporting someone who wants to feel listened to.

You can probably sit and talk with your friends e.g. boyfriend dramas, house mate problem, disagreement at work and think you are listening.  If you join their difficulty to show compassion and understanding, this might not be felt as supportive by the other person.  Turning the conversation to yourself to talk from your own situation, is completely natural and how conversation happens.  This may not be what the person needs in this moment.

Being a therapeutic listener in a psychiatric environment, with the intention of supporting someone through difficulty is very different.  Having a chat with your mate is often 2 way.  Therapeutic listening, is not always a 2 way road.  This type of listening, can be listening to words or ‘listening’ (looking) to behaviours to see what might be underlying or around the edges.  It could also sometimes not need words.  I forgot this is a skill I think I have mastered at work and I became acutely aware of when I was pregnant, that many people do not know how to listen!

What is listening?

Google dictionary ‘take notice of and act on what someone says; respond to advice or a request’, give one’s attention to a sound’, make an effort to hear something; be alert and ready to hear something’.

All, quite different understandings of the same word – how wonderful is language!

I aim here, to describe what I did NOT find helpful during pregnancy to highlight what might be more helpful.  I also hope that the main points are transferable to both men and women whether pregnant or not.

Despite the rosy picture that is painted in society of how wonderful pregnancy is and how blooming you should look and feel.  I had an awful pregnancy and had no idea it could be that crap.  As a personal trainer and a nurse, with a psychology degree and psychoanalytic training, I like to think that I am knowledgeable about mental health and physical health.  I was passionate about wanting to remain physically fit to be able to look after my tiny human and was listening to my body throughout pregnancy.  At times, going to the gym was the only thing that stopped my morning sickness.

I am a believer in evidence based research and try to learn from research that has a scientific backing.  Despite this, I was challenged and looked at a LOT in the gym or in a class.  ‘Should you be working out?!’  I was shocked at the archaic views people had.  I started to doubt myself, thinking that other people knew ‘more’ than me about the impact of physical exercise on pregnancy.  Even though, I had done my research!

Right from the beginning, I didn’t feel listened to when I talked about morning sickness (hypermesis gravidarium) that lasted for 5 months.  Pregnancy hormones (I hate that this is something women have to ‘excuse’) made me not know where my own thresholds/barriers/limits were emotionally.  Normally I know when to walk away (sometimes I don’t at the right time).  I was very intolerant to certain situations and had a very low threshold for bullshit (even more so than normal) while pregnant.  My reactions were quicker and faster changing.

However, with all of the rubbish I felt during pregnancy which felt never ending, I also felt like I was in a constant battle with other people’s pregnancies.  I felt a constant spiralling, unpredictable at times emotional landscape where people’s words and ‘listening’ skills were particularly poor.

Unhelpful things people would say:

‘Oh I had morning sickness – but you’re not being sick, so do you really have it?’

‘Mmmm I only had morning sickness for 3 months, it was awful, I’m sure it will go.’

‘What? you’re still working out – is that allowed?’

‘But you are 6 months pregnant, are you sure? You don’t look it?’

‘Are you sure you’re pregnant’

‘Oh, you’re not sleeping – this will just prepare you for parenthood.’

‘Say goodbye to sleep’

‘Pelvic girdle pain – what is that?’ – oh yea this was the last 3 months of pregnancy.

These comments may seem quite non-confrontational, not problematic, or may even be things that you have heard and you didn’t think twice about?

So, why did these comments get my back up?

From my perspective, at that time, I was in a lot of discomfort.  It is well researched that sleep (or lack of) affects productivity, mood, ability to multi task.  I not only was not sleeping (like most pregnant ladies), but had a lot more going on.  At the same time I was expected to be getting on with life in my normal, lots of plates spinning, always on the go way.  For 9 months I felt I was basically being told, ‘fuck off your old life, it is no more’.  It seemed that I was constantly justifying my pain, sickness, discomfort, lack of this or lack of that.  Yet, no one ever said ‘oh goodness, not sleeping sucks, I’m so sorry you’re having a rubbish time.’

Is my experience completely unique?  I think absolutely not.  At the time, I was unable to separate all of ailments and feelings out for myself.  Comments about sleep and physical exercise got to me the most.  This, I think was because all I wanted to do, was look after myself the best I could and my body wouldn’t let me.  At the same time, it felt like everyone was telling me that I had to change my entire way of life and this did not sit well.

I wanted to feel heard.  The words I was saying seemed to be interpreted as ‘this is just pregnancy’ and ‘just get on with it’.  The colloquial – on well morning sickness is only the first 3 months isn’t it?!  NO IT’S NOT FOR SOME PEOPLE!   All of my difficulties were jumbled up into one word ‘pregnant’.  That was not fair in my mind, because I was still me and I was different to the next pregnant person.

Somehow I think we have come to a point in the world where everything has to be so tick box driven and everyone needs to fit into these boxes.  People have stopped talking about their unique experiences (although I think there is a drive for this to come back).  I find people talk much more broadly about things, maybe because everyone is time poor these days.

Sadly, this also translates to anyone who may be having a crap time with their mental health.  Not everyone’s depression, anxiety, psychosis, OCD is the same.  However there seems to be a drive to make a one size fits all model to make a quick buck.  :(.  The key problem, I think here is that no matter what the problem, pregnant or not, is that listening takes time and patience.  Understanding what someone is really trying to tell you is complicated.

What would I REALLY like, is a more uniform way of supporting someone when they want to feel listened to.  If I chose to have a second child and am fortunate enough to be able to conceive a child again –

Helpful responses or comments I would like

‘Oh gosh, morning sickness, what’s happening for you?  It might be totally different to what I experienced’.

‘Still working out – Good fucking job!’

‘You are 6 months pregnant – you look great, is it as you expected?’

‘You’re not sleeping, that must be utterly shit, I’m so sorry, you feel crap, you’re pregnant AND you’re not sleeping.’

‘You’re not sleeping? Oh god, that must just be so hard! How do you think that impacts on you day to day? Must be hard coming to work with not much sleep?’

‘Pelvic Girdle Pain?  Why haven’t I heard about that?  Why don’t you tell me about it?  It doesn’t sound very nice.’

What I think is the difference between responses?

You are not just telling the other person in a one-dimensional way whether you understand.  You are actually trying to say that you want to hear what they have to say!

I found that often when someone would ‘join’ my ailment, it would become some kind of competition (although not really the intention).   I felt like the only person who was experiencing such a shit pregnancy at the time.  This absence of feeling heard reminded me of my experience of being in 3 times a week psychoanalytic psychotherapy where, there’s no ‘need’ for a response.  What you say can stay in the room or be directed in a supportive way, but feels heard and understood.  Sometimes, a pause is hugely effective.  Not, just filling the space with words.  This was the most therapeutic thing I could do with a distressed teenager at times, just be there with them.

Most people do not have intensive psychotherapy or experience psychiatric care.  The absence of my own therapy, reminded me that listening is not taking in words and responding.  Hearing what is being said and feeling understood is different.  Making sense of what the person talking is really asking you for.  If a pregnant, unhappy person tells you they are not sleeping – telling them that this is their future life, really is not going to make them feel better in that moment.

Validating someone’s emotions is key – not squashing their emotional experience and replacing it with your own.  The challenge then, is whether the person talking is able to articulate how they are really feeling (such an easy thing to do hey?!) Listening can help someone find ways to articulate how they feel.

This principle applies across all areas of life, not just pregnancy. This even resonates across my experience of a horrible bereavement (loss of a parent) when people think they are listening.

What would be my top tips for ‘listening’:

  1. Stop and make time – If someone tells you they are struggling/having a tough time. Stop and look at them when they talk.
  2. Diarise a time – Immediate time may not be available.  Find/allocate a time later in the day to have space to talk.
  3. Appropriate space to talk – Find an appropriate space to talk.  Not in an open office with people around, not on the bus with people overhearing.
  4. Don’t just say anything – If you become aware that someone is struggling and tells you that they are having a tough time.  Don’t have to just ‘respond’ for the sake of it. You can take a pause and let the person know you need to think about what they may have said. Or even tell them you need them to explain more what they mean.  ‘Gosh, I need to process what you’ve just told me, that sounds really hard’ for example.
  5. Check what they are saying – If you are listening, you may have to ask the person to repeat themselves to make sure you understand what they are really saying.  Paraphrasing in your own words may highlight to the person that wants to feel listened to that they have not been clear about what they are trying to communicate.
  6. Share with more people – Ask if they have spoken to anyone else about it and whether they know where to get help/advice/support – if not, maybe help them do this.
  7. Comeback again – Let the person know that you are available to talk again if they need to.
  8. Check in with them – you can ask them if they feel understood, heard, listened to.  This is probably the best feedback you will get. From the person themselves.

Although the list doesn’t come with an acronym, although Im sure I could make one.  I think these are the starting blocks to showing someone you really are listening.  The person could be talking to you about their hamster dying and it would still apply.  You don’t necessarily have to care about the hamster.  You, as a good friend, should try and show meaningful listening.  When someone knows that you are listening, they are more likely to be able to fully process what they think and feel.  You, may also feel like the supportive friend that you want to be.

I hope this is useful and if you think there is anything key to add to the list, do get in touch.