In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.

1. Just Listening
James Tobin, Ph.D.
April 14, 2016
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2. Listening: Short-Changed as a Concept in
Clinical Psychology and Psychotherapy
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3. The Graduate Student in Clinical
Psychology
• Enters training to become a “helping”
professional with an early developmental
history of emotional deprivation/trauma.
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4. “The Drama of the Gifted Child”
(1979)
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5. Ross Rosenberg’s “Human Magnet
Syndrome”
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6. The Narcissistic/Codependent
Continuum
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7. The Narcissistic Position
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8. The Codependent Position
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9. Characterological Tendencies of the
Mental Health Professional
• Early emotional deprivation/trauma is
organized in the formation of
characterological tendencies:
(1) the professional maintains his/her early
coping style (schema);
(2) the professional counter-identifies with
his/her early coping style and incorporates
that of the primary caregiver;
(3) the professional maintains a combination
of (1) and (2) above.
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10. Clinical Theory and Technique
• Trainees in the mental health professions
learn a considerable amount about clinical
theory and technique, yet do so through their
own particular characterological lens.
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11. When the Trainee Begins to See
Patients
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12. Example #1: The Processing of
Transference
• The narcissistic trainee (to his/her patient):
“I don’t know why you’re getting so angry
with me …. It’s not about me, it’s about your
unresolved feelings toward your father.”
• The codependent trainee (to his/her patient):
“You’re so angry with me. I’m sorry I
offended you. I’m not really good at this yet.
I will try harder.”
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13. Example #2: Silences
• The narcissistic trainee: [stares at the patient,
observes the patient’s discomfort, and
continues to stare and say nothing]
• The codependent trainee: [as soon as a brief
pause in the session occurs] “So, tell me how
your week has been going.”
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14. Example #3: Conceptualizing the
Patient
• The narcissistic trainee: the conceptualization
is largely self-referential, i.e., reflecting the
therapist’s identity, biases and/or personal
values (e.g., the patient needs to be more
assertive/the patient should learn that guys
are jerks and should not be
trusted/depression is biologically-based, not
contextual)
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15. Example #3: Conceptualizing the
Patient
• The co-dependent trainee: the
conceptualization is largely non-self-
referential, i.e., not linked at all to the
therapist’s personal identity and merely
reflects the identity of anybody else besides
the therapist (e.g., the patient, the supervisor,
the professor, an author, a theoretical
approach, etc.).
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16. Everything I’ve said so far
applies to the trainee
therapist …… what about
the patient?
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17. The Patient’s Early Developmental
History
• The character of the patient’s primary
caregiver also falls somewhere along the
narcissistic/co-dependent continuum.
• Therefore, it can be assumed that during
childhood the patient’s “going on being”
(Winnicott) was interrupted.
• This interruption determined how the
patient’s characterological tendencies and
defenses were organized.
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18. The Clinical Situation
• Features a (trainee)
therapist who is
characterologically narcissistic or
codependent.
• Features a patient who has never been free
“to be”/“to be me” (he/she has always been
acted on by a narcissistic/codependent
caregiver and had to adapt to this intrusion).
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19. Enactment and Role-Reversal
Configurations in Therapy
• Enactment: the patient had a narcissistic
primary caregiver (impinging/enmeshed), and
finds a therapist who is similarly narcissistic.
• Role-reversal: as a child, the patient coped
with his narcissistic father by being co-
dependent. In therapy as an adult, the patient
seeks to be the narcissist in relation to a co-
dependent therapist.
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20. Enactments and Role-Reversal
Configurations in Supervision
• The supervisor who needs to be idealized
• The trainee who disagrees with the supervisor
• The supervisor and/or trainee who seeks to be
liked by the other over all other agendas
• The trainee who conceals information from
the supervisor
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21. “Just Listening”
• Unfortunately, to most people “Just Listening”
implies doing nothing, sitting there, passivity,
not knowing what to do; depicted merely as a
foundational skill on which other more
important skills are
developed.
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22. “Don't Just Do Something, Sit There”
• Alonso, A., & Rutan, J.S. (1996). Group, 20 (1), pp. 43-
55.
• The abstinent stance of psychoanalytically-oriented
clinicians is often confused with passivity or coldness
toward the patient or the group. Given the current
move toward more active, shorter-term treatment, this
paper offers a reaffirmation of the value of the
abstinent analytic stance. The theoretical rationale for
the technique is reviewed, and some specific
arguments are made to illustrate the continuing
importance of the method in the treatment of patients
in psychodynamic group psychotherapy.
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23. “Just Listening”
• “Just listening” is a meta-skill (attitude and
technique) that all clinicians should aspire to:
it is the capacity of the therapist to restrain
his/her characterological tendencies in the
therapeutic situation.
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24. “Just Listening”
• The therapist’s capacity to restrain has a vital
impact on the patient: in the context of a non-
interfering parental surrogate, the patient is
encouraged to resume “going on being.”
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25. Resistance
• Resistance can be understood from this
perspective: the patient, never allowed “to be,”
has learned to habitually cope to the demands of
the other and seeks to continue this arrangement
in all relationships, including the psychotherapy
relationship.
• If the therapist manages to approach the patient
without characterologicallyt-based demands
(non-narcissistically and non-co-dependently),
the patient will feel the excitement of being but
also the anxiety of this liberation.
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26. Therapy as Transactional Space and
Self-Space
• I view the clinical situation as organized into
relational modes centering around this notion
of resistance (i.e., wanting to stay in
transactional space and fearing the
development of self-space).
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27. Mode I: Transactional Space
• Either or both the therapist and patient recruit
the other to transact (or achieve an enactment):
A trainee therapist, largely co-dependent
based on her own upbringing with a demanding
and depressed single parent, aims to please a
narcissistic patient (enactment); the trainee
therapist avoids confrontations, does not say
what she thinks, etc.; the trainee therapist is
also driven to affirm her narcissistic and
insecure supervisor.
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28. Mode II: Self-Space
• If Mode I can be bypassed or overcome, the patient is
newly challenged to grow by entering “self-space”:
A co-dependent trainee therapist gives up her
need to be liked by her patient, and is encouraged “to
be” with her patient by her healthy, encouraging
supervisor; the trainee therapist is then able to say to
her patient, “Whenever I make a comment you don’t
seem to like, I’ve noticed that you usually then say
something insulting to me.”
******Here: “Just Listening” is not only restraint on the
part of the therapist but also the capacity “to be”
with the patient; one depends on the other ********
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29. The Underlying Assumption of this
View of Psychotherapy
• What psychotherapy offers over and above all
other social situations and relational experiences
is a context in which the patient can recognize
and self-reflect on his/her characterological
tendencies …. Not merely TRANSACT THEM.
• This requires, of course, that the therapist
restrains his/her transactional tendencies with
the patient which then promotes the therapist’s
capacity "to be” with the patient: this is the
essence of “Just Listening.”
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30. An Exercise Suggestion
• Take a recent transcript of a therapy session and
evaluate the amount of material that could be
“coded” as transactional (Relational Mode I) vs.
self-space (Relational Mode II): determine the
percentage differences.
• You may then want to look at the transactional
material and distinguish what amount was
initiated by the patient vs. by you.
• Identify places in the transcript where you were
able to reside in Relational Mode II in order “to
be” with your patient.
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32. James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
949-338-4388
Email: jt@jamestobinphd.com
Web: www.jamestobinphd.com