by Margaret Parish, PhD
In a 2012 TED talk Ernesto Sirolli  tells a story about Italian aid workers trying to help people in Zambia to grow food. Italian tomatoes and zucchini flourish in the fertile African soil, and at first the workers feel proud they can save the local people from starvation. But then, just as the vegetables are ready to harvest, 200 hippos emerge from the river and eat them. The Italians had not thought to ask the Zambians’ very good reasons for not having already developed agriculture.
Helpers often waste time and energy because they fail to listen to the experience or the desires of those they wish to help, instead imposing their own ideas in situations where they may not apply. That any successful effort to help must begin with listening is as true in mental health as it is in international aid. There so are many interventions (techniques, drugs, skills) available to the modern therapist. Many have been tested in sophisticated studies and shown to be effective for many people. But deciding what to do in any one situation involves knowing specifics about that person – not just knowing from the outside (this treatment works a lot of the time for most people with this diagnosis or that attribute) but knowing from the inside (who is this person, what has he experienced, where is she trying to go, why haven’t the usual methods worked ?).
Just as with the Zambian villagers, it is people seeking help who can best identify what they want help with – their troubles as well as their aspirations, passions, and dreams. They also know the most about the dangers experienced and expected, the metaphorical hippos lurking in the psychological environment ready to devour the fruits of their labors. In fact these dangers may account for what at first appears to be “resistance” to treatment. The Zambian villagers appeared resistant to the Italian efforts to help, but that resistance turned out to be a kind of intelligence, anticipation of an outcome the Italians didn’t foresee.
The first task of a psychotherapist is to listen. This is not as easy as it might seem. Another person’s suffering can be hard to witness without turning away. Formal education in mental health teaches us to categorize and formulate according to patterns and principles. These are necessary guides but they cannot fully capture the sources of an individual’s trouble nor pinpoint guaranteed cures. Our categories can offer some refuge, but they are not where we do our best work. And if staying present in the face of emotional disturbance is not hard enough, people who are not used to being heard also often elicit a kind of deafness in others. They are unwittingly adept at deflecting attention – their own and other people’s – from what matters most. Being able and willing to listen can make an enormous difference to people in distress, diminishing their isolation and encouraging them to listen to themselves. In an unfolding psychotherapy , close attention to trains of thought and feeling loosens the constraints of the past and opens possibilities for claiming a more desirable future.
Other interventions are equally dependent on listening to a person’s experiences, wishes and fears. In order to prescribe a medication effectively , or to understand the response to a medication , a physician must listen carefully to the patient’s experience. Compassionate listening is the bedrock of nursing support , the first step in teaching arts and skills , and essential for fostering involvement in meaningful work or community action . We can only offer help that is actually helpful if we first take the time to understand what a person has suffered and what he or she is trying to accomplish.