Most people know that a stethoscope is an instrument used by physicians to listen to inner organs, specifically the heart, lungs, and gastrointestinal system. It is a tool to monitor and help diagnose health or disease; it works by letting the doctor listen to what’s going on inside the body.
The medical term for this type of examination is auscultation. Auscultation is a skill that requires substantial clinical experience, a fine stethoscope, and good listening skills. The key is listening. To be effective, the doctor must know how to listen, where and what to listen for, and must have an adequate tool to perceive what’s happening in the body.
Psychologists are not medical doctors, but we do use tools and instruments. Some of these tools are highly sophisticated and sensitive engineering instruments that help us listen directly to the operations of the brain and nervous system. Other tools include observational skills and the measurement of performance. Traditionally, psychologists are thought of and sought for the capacity and willingness to carefully and compassionately listen to patients’ symptoms and woes.
But is our listening as reliable and productive as the information transmitted to a physician via a stethoscope?
There’s a story about a young protégé psychiatrist (a medical doctor) in practice with his mentor, a senior psychiatrist. The young doctor has become very stressed upon hearing the burdens of his patients, day after day. He observes his mentor consistently in calm and jovial spirits, smiling often, and seemingly unperturbed. Verging on burnout, the younger man approaches his senior and asks plaintively, “How do you do it—how do you listen, day after day, to these patients’ complaints and their misery, and manage to stay in such good spirits?”
The senior psychiatrist shrugs, smiles, and says, “Who listens?”
(I don’t mean to pick on psychiatrists, who are my colleagues—that’s just how the original story was told.)
It’s a satirical, but intriguing question—who does listen? Furthermore, what does this listening accomplish? And what makes patients feel and believe that their doctor is truly listening?
These are questions I’ve struggled with over my decades of professional practice. An experienced medical doctor knows what to listen for, what questions to ask, and how to use tests and exams to help identify and pinpoint the source of the problem. Similarly, a seasoned psychologist knows how to probe, obtain data, distill superfluous information, differentiate, and illuminate the problem in a way that facilitates a successful resolution.
If only the practice of psychology were that straightforward!
The needs to be heard, validated, and connect run deep in the human soul and psyche. We all want to know that someone cares and understands us. When patients visit a therapist, they expect the professional to listen and, ideally, provide answers and solutions.
How does this listening take place? What does the therapist listen for, and what are the responses?
People want to tell their stories. It’s a natural human inclination. Partly, we want to vent. We want sympathy and validation. We think the details are critical to establishing our predicament and sometimes to justify our “rightness,” and sense of being victimized or unfairly treated. We want to express frustration and, perhaps, just complain. Though this desire for expression and connection is inherent to human interactions in different situations and relationships, in the therapeutic milieu it is uniquely played out.
In the therapeutic context, the sharing of information between patients and professionals is not the equivalent of the exchanges that occur between friends. The therapist must scrupulously avoid assuming the role of a “paid friend.” Patients must be attended to, listened to carefully—not just their words, but the totality of their situations and conditions, and they must be provided with understanding, compassion, reassurance, and a concrete, appropriate, and systematic plan for relief.
This process is often made more difficult by the patients’ pressing needs to relate all the details, narrate the backstory, and gain assent and encouragement from the therapist for their positions of helplessness. This puts the therapist in a bind: if he listens to the continuing story (often embellished compulsively with accompanying tangents, opinions, self-justifications, and emotional forays), time will pass unproductively. More importantly, the repetitive venting tends to reinforce the patients’ frustration and painful emotions. Alternatively, the therapist can re-direct or abruptly short-circuit such anguished ramblings, but there is substantial risk that the patients will feel stifled, as if believe that the therapist is disinterested in their stories, and conclude that the therapist is not listening to them.
Much of how these interactions proceed depends upon the skill, tact, and experience of the therapist. But it also depends upon the willingness of patients to be confronted about the excesses and irrelevancies of continued narratives and upon the patients’ confidence and trust in the therapist to provide an effective course for correction and healing.
There is a wise saying: You can either have what you want, or you can have good reasons that you don’t have what you want. In leading patients to adaptive results and favorable outcomes, this saying serves as a maxim. The defense mechanisms that allow us to survive psychologically can also get in the way of relinquishing our reasons why we are stuck instead of our becoming flexible and liberated from the underlying issues that are impeding us.
The skilled and tactful therapist imbues in patients the sense that they are being heard and are connecting effectively, but also that there is work to be done that requires that they set aside “their embedded story.”
A healer must be comforting and consoling; otherwise, he will not have receptive and responsive patients. But the healer must not become entangled in the self-justifying loops and narratives presented by sufferers. The flailing of the drowning person must not be permitted to unwittingly derail the rescue effort.
The expectations of patients are important. Sometimes, they facilitate treatment, and sometimes they require exploration and adjustment. Typically, when visiting a physician, patients expect to be touched, palpated, and examined with instruments. There is the scale, the blood pressure cuff, the thermometer, perhaps the dreaded needle, and, yes, the stethoscope. We expect and tolerate these sterile intrusions in the interest of letting the physician obtain the needed information to provide diagnosis, treatment, and relief. These exams are not particularly pleasant, but we assume they are necessary and we generally don’t object.
However, patients are often vexed by the short amount of time their doctors usually spend with them. Their appreciation of the efficiency of modern medicine is hampered by a sense that doctors are too busy, and have little time for patients’ stories. Exams are geared to gathering vital data: the bottom line on the patients’ physiology and the status of organs and blood workups rather than patients’ day-to-day experiences and feelings. Patients with physical ailments or awaiting physical exams are accustomed to waiting for up to an hour (or more) in the reception area, and then they are resigned to waiting for up to a half-hour (or more) in little examination rooms. Typically, they see their doctor scuttle in and, ten minutes later, scuttle out. It all seems to be efficiently choreographed. Before leaving, the doctor writes a prescription for meds, and the nurse comes into the room to draw blood.
In psychiatry these days, most everything is ultimately funneled into a prescription. Patient reports and complaints, if noted, are converted into dispensing different pharmaceuticals or dosages. The formerly attuned psychiatric stethoscope has, for the most part, been set aside, and the patients’ ailments and symptoms are relegated to the biochemistry of the pharmaceutical industry’s associated pills and propaganda. The side effects are frequently noxious—not only the physical ones, but also the distance and hopelessness that pervades the doctor-patient relationship and the lack of accurate and gratifying auscultation of the patients’ true situations.
The tradition in psychotherapy is the method of talking. Patients reveal their woes and conflicts, and the astute therapist interprets, reframes, and gives advice. This mysterious process is viewed with skepticism by many professionals and by the public—with good reason. It is expensive, time consuming, somewhat embarrassing, and the results are usually disappointing when held to the standards of symptom elimination and enduring well-being.
Perhaps the main and sustaining virtue or psychotherapy is that it provides a context for patients to connect and be heard. The refrain that echoes in the hearts of all sufferers is: Will someone please understand and soothe me? I need compassion and relief! Therapists attempt to serve this need. Unfortunately, words and conversation are insufficient vehicles to transport most people from suffering to relief and sanguinity. Compassion and connection notwithstanding (and they are vital), the healing of angst and pain requires more explicit and effective tools and methods.
Ironically, effective psychological relief and healing can be found in the physiological approaches that leave many patients disillusioned by medicine’s mainstream. However, such physiologically-based treatments must be better than what medicine offers as standard.
Patients grow tired of drugs and become disheartened by the cold plow of medicine’s impersonal pace and procedures. So they seek warm and empathic therapists, professionals who understand and validate them. They expect to be heard and validated, and yet that is not in itself sufficient.
But, how do we make patients better? What are the tools and methods besides compassion and understanding?
Over decades in practice, I’ve gravitated toward a physiological approach where implementation and theory are mutually confirming and congruent. People improve when their physiology is better regulated and controlled, enabling their brain and nervous system to function more effectively. I previously had spent years trying to talk people into improve their behaviors and feelings—to little avail. The predominant assumption in psychology, even today, is that when people think differently and more correctly, they will feel better. However, the evidence for that is startlingly lacking. In truth, when people feel better, they become capable of thinking better and acting better! This has been proven repeatedly and reliably.
So, we are back to a physiological approach to healing—not with drugs and inattention to patients’ perceptions, but instead with technological tools for listening and healing that enhance both patients’ well-being and their sense of connection and satisfaction with their healers.
What are these instruments of detection and healing?
Like other health sciences, psychology has developed tools for assessment, diagnosis, and treatment. Surprisingly, these well-researched, effective, and reliable tools are utilized by only a small subset of psychologists and other mental health professionals. Nonetheless, they are critical for sound practice.
Tests and measurements of mental and neurological status and performance have long been a bailiwick of educational psychologists and neuropsychologists. Those with training in these specialties use them to garner data and obtain information about patients’ functioning. Reliable tests and measures rarely lie: they reveal information that patients cannot articulate verbally, often portraying outlines of functioning that elude patients’ conscious awareness and/or ability to describe. Formal standardized tests are useful, as are skilled interviews and observational techniques.
Along with tests and measures, there are technological tools that help to heal. Among the best of these are methods of training brain state regulation, known as EEG neurofeedback, and methods of eliminating negative emotions rapidly. Chief among the latter are the tapping techniques, which have gained prevalence and increasing use in the relief of symptoms.
The original foundation for these tapping techniques was discovered and established by Dr. Roger Callahan in the 1970’s. Callahan developed and refined his methods, which he named Thought Field Therapy. I was privileged to study with Dr. Callahan over two decades. I attained and have practiced the most advanced level of this healing, known as Voice Technology. Though there are many variations and “knock-offs” of Callahan’s pioneering discoveries, none work as reliably or thoroughly as his system of diagnosis and intervention, implemented through step-wise levels of training and practice. The most effective, rapid, and consistent application is that using Voice Technology.
Voice Technology (VT) is a system of diagnosis and treatment of any negative emotion. It is highly effective at eliminating all symptoms of emotional distress, and it often relieves or eliminates a variety of physical symptoms as well. Voice Technology allows the practitioner to test a person’s voice and determine where the person is encoding information internally that causes and sustains negative symptoms.
Upon identifying and diagnosing the precise locations and perturbations (disruptions in the thought field—the information that connects thoughts and feelings), the practitioner can guide the patient to tap upon precise meridian points sequentially to get rid of the problem in its entirety. Though this may sound simple and incredible, this is a scientific and reliable procedure that does indeed eliminate all symptoms of the distressing problem within minutes. My success rate using this technique is at least 95 percent.
There is no question that this treatment works effectively and reliably. It works because it eliminates the underlying cause of the problem by essentially “deprogramming” the codes within the brain and body that trigger and maintain the disturbance. You might think of it as turning off the alarm within the nervous system: you have to know the code. Though simple meridian tapping can often partially work as a shotgun approach, the meridian points can be stimulated through several billion permutations. Therefore, a system of targeted sequencing is needed to be efficient and practical. Voice Technology uses the science that provides this system.
Thus, Voice Technology serves as a kind of psychological stethoscope that facilitates listening to and discovering the real source of patients’ distress. The key is to get the patient to cooperate with this process; by that I mean it’s necessary to bypass the patient’s pressing urge to “narrate” and reiterate the details and pain of the problem—in order to solve and get rid of it!
However, patients desperately want to tell their stories. They need to have someone listen. Unless the doctor attentively absorbs (and is often solicited to validate) the patients’ woes and justifications, they tend to become alienated and conclude that the doctor isn’t listening, doesn’t relate, and may not be able to help.
Ironically, it is necessary to curtail the “story” details and truly listen with the right tools—the psychological stethoscope that Voice Technology provides—in order to quickly and effectively resolve the problem.
Thus, the sensitive healer must maintain the delicate balance between calming and warmly connecting with patients verbally and implementing a clinical procedure that many patients must accept on faith, but which may not resonate with their sense of logic.
When advocating Voice Technology, I often tell my patients that I will listen to them talk about their problem for as long as they want after we do the procedure. I know from experience that once the problem is eliminated (virtually all of the time), patients have no need to belabor and expound upon symptoms that are no longer there.
This may sound too good to be true: but indeed it is routine with this procedure. Voice Technology lets me listen to what’s going on inside, where the source of the disturbance resides, and to determine systematically and scientifically how to eliminate it.
The process of listening involves structured interviewing and questioning that allows patients to focus on their feelings. This involves a set of skills that has taken me years to master. For example, when I ask patients to tell me what’s bothering them, they typically subsume the distressing feeling in opinions, thoughts, and rationalizations.
It goes like this:
Dr.: “Tell me what’s bothering you, specifically, and what the feelings are about it that are negative, distressing, or uncomfortable.”
Patient: “Well, when I think about not being able to fall asleep, just tossing and turning in bed with my mind racing, it bothers me.”
Dr.: “What feelings does this elicit; how do you feel when you think about it right now?”
Patient: “It’s just a problem that I can’t sleep, and this has been going on for years; I’ve tried so many things....”
Dr.: “I understand. Instead of telling me the history and the problems it creates, just focus on the feelings when you think about the problem right now.
Patient: “I feel anxious and irritated thinking about it.”
Dr.: “Thank you. On a scale of 1 to 10, with 10 being the worst you can feel about it and 1 indicating it doesn’t bother you when you think about it, what number would you give it?”
Patient: (Pauses) “It’s about an 8.”
Dr.: “Okay, now you’ve tuned the thought field and rated it with a SUD (Subjective Unit of Distress). Now we can use Voice Technology to get rid of this problem.”
Another example:
Dr.: “You’ve described how inappropriately this person treated you, how you don’t deserve it, and so on. As you think about it now, what are the bad feelings and how disturbing is it—on a scale of 1 to 10, with 10 being the worst you can feel about it and 1 signifying it doesn’t bother you when you think about it, what number would you give it?”
Patient: “It’s really awful that he would treat me this way after all the things I’ve done for him; I just can’t get over how someone could be that…”
Dr.: “I get it. Of course, you are justified. But rather than tell me your opinion, how does it make you feel right now, as you talk about it?”
Patient: “I’m angry! It’s a 10.”
Dr.: “I can imagine. Any other feelings?”
P1atient: “If I think about it, I’m also sad.”
Dr.: “How sad?”
Patient: (Pauses) “About 7.”
Dr.: “Good. I mean, not good that you’re feeling that way, but good that you’ve tuned the thought field and communicated your negative feelings; so now we can eliminate them.”
And, another example:
Dr.: “We’ve talked about what happened, and you’ve shared how bad the situation is. It is hard to believe how that person could leave you stranded and be so inconsiderate. What negative feelings do you have about the situation and the person?”
Patient: “I don’t know. I just think I’m not worth much and no one really cares about me. Otherwise, why would people treat me like that? I’ll probably never get over this and have a good relationship.”
Dr.: “You have my sympathy—I really care, and I want to help you. In order to do so, I need you to tell me what the bad feelings are.”
Patient: “I just don’t know. It’s no use!”
Dr.: “I can’t speak for you—but if someone did that to me, I’d feel hurt and rejected. That’s just me. What about you?”
Patient: “Sure. I’m hurt.”
Dr.: “How hurt—from 1 to 10, with 10 being the worst?”
Patient: “I’d say a 9.”
Dr.: “Okay, thanks for clarifying that. You also mentioned that you think you won’t be able to get over this. I don’t know about you… but when that sort of thing occurs to me—and it has—I tend to feel hopeless.”
Patient: “Yeah, no kidding.”
Dr.: “Meaning…what, exactly?”
Patient: “I do feel hopeless.”
Dr.: “How hopeless, from 1 to 10?”
Patient: “It’s gotta be a 10.”
Dr.: “Okay, just to make sure I’m clear on this: when you think about the problem right now, you feel hurt at a 9 and hopeless at a 10?”
Patient: “That’s right.”
Dr.: “Thanks for clarifying it for me. I need to understand just how you’re feeling. Now, let’s make the bad feelings go away. I’m going to run some tests on your voice.”
Thus, the treatment with Voice Technology can commence and quickly eliminate all the negative emotions.
When patients can tolerate this gentle and persistent prodding to focus on their negative feelings, it sets the stage for Voice technology to eliminate them, as the thought field is tuned. In addition to the pronounced tendency of most people to obsess about the wrongness of what they are suffering, it’s a natural defense mechanism to try to submerge or repress the bad feelings, to distract oneself in order to not suffer from them. Indeed, most conventional therapeutic methods encourage such distraction with instructions on reframing the problem and substituting “good’ thoughts.
In stark contrast, I direct patients to think about, to dwell upon these painful emotions—not because I want them to stew in their suffering, but instead to tune the thought field so I can listen with the stethoscope that will help me diagnose and eliminate the problem.
In formal differential diagnosis, the medical model (including traditional psychology) uses history, observation, presentation, symptoms, examination, and comparison with known patterns to make diagnoses. These diagnoses fall under nosological categories: those listed in textbooks categorizing diseases and disorders. As previously briefly discussed (see Therapeutic Methods), these categories—however useful in recognizing patterns and communicating with other professionals—are not very useful in healing people psychologically. This may sound radical, but after more than 40 years of practice, I can tell you that labeling people and talking with them about their problems (e.g., using logic, persuasion, reassurance, reframing) seldom achieves any viable and lasting improvement.
Instead, it is much more productive to use technological tools to reform and improve people’s self-regulation and to rid them of counterproductive emotions and debilitating traumas by deprogramming the perturbations in the thought fields that cause and sustain the symptoms.
We can listen to patients without having to label them with deficits; and we can heal them by stethoscopically determining where the perturbations and inefficiencies are impeding the flow of energy and proper self-regulation. These are natural and lasting ways of harnessing biology to the rhythms of nature, as we are designed to function in its realms.
We can invite the person to send signals through the nervous system that recalibrate the natural flow of energy and facilitate normal functioning. To do this, we must listen proactively to the wisdom of the body and collaborate with its codes.
It may seem simplistic or peculiar to accomplish this through tapping on the body’s pathways. However, we obtain results through tapping in conventional life routinely: we press garage door openers that send radio signals to transduce energy and operate equipment. We press codes into phones to directly communicate with specific individuals. We tap passwords onto the keypads of bank machines to access funds, and we tap on digital devices to activate locations and obtain and transmit information. Should it be surprising, then, that the healing mechanisms of biology follow similar paradigms?
One sometimes sees fake surveillance cameras—props meant to convince people that they are being recorded, or signs warning that a burglar alarm system or company is monitoring the premises. These may be intentional decoys, masquerading as the real thing. Perhaps a scientific equivalent is the so-called placebo effect: a change caused by belief and expectation, rather than some actual bona fide agent of intervention. Many people have been fooled often enough to retain a justifiable aversive skepticism and mistrust of others. For them, Internet spam has become synonymous with Internet scam. More and more people have steeled themselves against systems, programs, methods, and manipulative schemes that promise riches, instant weight loss, relationship bliss, and spiritual contentment, yet have subsequently failed to deliver the goods. Strange as it seems, determining what is real and substantive can be confusing, even for otherwise sensible and rational human beings. Unfortunately, we live in a society where “snake oil” salesmen have always targeted and preyed on those who are gullible and easily persuaded.
Modern life takes its toll on us with its concomitant depersonalization. Sometimes, the impact of the stressors can be softened by resorting to jokes about the lack of human connection:
— “For address and directions, press 1; for directions, press 2; for billing, press 3; for all other questions, visit our website; to hear these options again, press 4.”
The technologies and methods for healing emotional distress have evolved into greater efficiency and sophistication. Healing still, more than ever, requires compassionate human interaction and skilled sensitivity. However, thank goodness we have not yet arrived at the threshold of:
— “For depression, press 1; for anxiety, press 2; for constant worry, press 3, or open your prayer book; for panic, trauma, or overriding despair, dial 911 or visit your local hospital Emergency Room.”
It takes a present and caring human to listen—really listen—and to know what to do. This is what a real doctor does.
There is, of course, a hierarchy and pecking order among professionals in the healing arts and sciences, a hallmark of status and achievements that runs in tandem with compassion and efficacy. As I was coming up in the ranks, this was revealed to me in a poignant and true story told to me by a senior psychologist with whom I worked at a facility in New York in the 1970’s. His name was Morris Cohen; he was a Ph.D. psychologist.
“Morrie” told the story of his wife having their first baby. In those days, women commonly spent several days in the hospital upon giving birth, even when things went well. Such stays were considered ordinary. He called the hospital where his wife had given birth to speak to her. When he identified himself as Dr. Cohen, the nurse stammered and apologized that Mrs. Cohen was in a semi-private room with no phone (land lines at the time, remember?). When he arrived at the hospital several hours later to visit his wife, he found that she had been moved into a private single room with a bedside telephone. After profusely apologizing for the “mishap,” the nurse asked him about his medical specialty and his affiliated hospital privileges.
“I’m a psychologist,” Dr. Cohen explained. The nurse quietly nodded. When Morrie called later that night, he was told that his wife had been moved back into a semi-private room with no phone. Apparently, psychologists are not considered by some to be real doctors!
The story stuck with me for decades because it is true, funny, humbling, and full of potential ramifications in the way we hold people in certain esteem and expectations.
Regardless of the alphabet surrounding the name or the diplomas and certificates in the office, a real doctor knows how to really listen. And if our patients think that we hear them, then they are more likely to reveal themselves and to listen to us.
— Mark Steinberg, Ph.D.
