This is contingent upon a particular set of cultural beliefs, of course, but the implication in general is that it might be more helpful and useful to our patients for us to listen to what they are telling us, rather than simply to suppress the symptoms of psychosis.

But for someone to feel heard, three things have to happen. First, they have to feel like the other person paid attention to what they said. Second, they have to feel like the other person understood what they said. And third, the other person has to demonstrate that they listened.

I would offer them a checklist:

1. Listen closely.

1. Give advice cautiously.

1. Feed back what you hear at a deeper level.

1. Affirm the person.

1. Help deepen the story.

But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things

beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.

To coordinate successfully, your requests must be precise and detailed. You’re not insulting the listener if you make detailed requests. You’re setting up the possibility for mutual satisfaction.