Intent to Understand with Nancy McWilliams
Episode 3
Intent to understand: Embracing human limits as our ultimate guide with Nancy McWilliams
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Nancy McWilliams is Visiting Professor Emerita of clinical psychology at Rutgers University’s Graduate School of Applied & Professional Psychology and practices in Lambertville, New Jersey. She is author of Psychoanalytic Diagnosis (1994, rev. ed. 2011), Psychoanalytic Case Formulation (1999), Psychoanalytic Psychotherapy (2004) and Psychoanalytic Supervision (2021) and is associate editor of both editions of the Psychodynamic Diagnostic Manual (2006, 2017). A former president of Division 39 (Psychoanalysis) of the American Psychological Association, she has been featured in three APA videos of master clinicians. She is on the Board of Trustees of the Austen Riggs Center in Stockbridge, MA. Her books are available in 20 languages, and she has taught in 30 countries.
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Nancy McWilliams is renowned for her immense contributions to the field of Psychotherapy and Psychoanalysis. Her career, which spans six decades, has included roles in teaching, private practice, writing, and speaking. Of the many, Dr. McWilliams’ awards and achievements include the Gradiva prize, the Erikson Scholar award, and leadership, scholarship, and international academic excellence awards from Division 39 of the American Psychological Association.
Clinicians of every theoretical persuasion appreciate her ability to translate complex theory, implications of research, and even the human dynamics between different subgroups within the profession defined most broadly into simply human and accessible language.
In this brief and personal moment we share with Nancy in this episode, she touches on a nuance of listening to understand and be understood that doesn’t receive much attention. We seek to understand as clinicians dedicated to healing. We all yearn to be understood in the most personal and authentic way. But what people need and appreciate more than perfect understanding is to experience the effort – the ‘intent’ – to be understood. That’s what makes the space between us as fellow humans work. That’s what makes it count. As Nancy said, reiterating the fruits of much research, the outcome of work in therapy is determined by the fit and the relationship between speaker and listener, therapist and patient.
In this episode of The Art of Listening, Nancy will tell us how the power of the therapeutic process hinges on listening with the intent to understand, listening beyond reacting, listening for the meaning, the wisdom there to be received – for speaker and listener, patient and therapist.
Chapters
1 - The scientific benefits of therapeutic practice (3:59)
2 - The difficulty of listening and processing (5:23)
3 - How Nancy’s mother taught her how to listen (7:52)
4 - The difference between knowledge and wisdom (12:23)
5 - Where psychotherapy and academia do and don’t intersect (16:19)
Links
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Nancy: [00:00:02] I think we can't ever fully understand other people and what patients appreciate. What anybody appreciates is not so much moments of feeling profoundly understood. That's certainly very touching and critically important to the therapy process. But patients in an ongoing way appreciate that. You're trying to understand them, that you have the intent to understand them.
Eileen: [00:00:32] I'm Eileen Dunn, and this is the Art of listening, a podcast that delves into the incomparable power of human connection and the magic of good depth. Talk therapy. In each episode, professional listeners, seasoned clinicians, share stories about their personal journeys, their professional experience, and how they bridge the gap between receiver and giver, patient and therapist. We discuss the challenge, the wisdom, and the transformative power of listening within ourselves and with each other. Today's guest is Nancy McWilliams. Nancy McWilliams. It's a name that needs no introduction. She's a rock star, psychologist and psychoanalyst renowned for her immense contributions to the field of clinical psychology and psychoanalysis. I would even venture to call her the mother of talk therapy wisdom. Beginning in the 1970s, her career has now spanned going on six decades. In that time, she has authored innumerable influential books and articles, becoming a leading authority in psychoanalytic theory and practice. As active as ever. Nancy's time is precious. Luckily, we were able to catch her for a virtual morning coffee. Therefore, this episode is going to be a bit more raw and short than others. But why wouldn't it be a special episode? It's Nancy McWilliams in this coffee chat. Nancy tells us how her mother taught her to listen despite losing her at such a young age. We'll hear her thoughts on the role of suffering in the development of strength, the bandwidth necessary for listening to the real range of human experiences, the need we all have as social animals to have a witness, and more. Before we jump into it, I feel compelled to share an endearing anecdote I discovered listening to a talk Nancy gave to a gathering of theologians and clinicians about ten years ago in Boston.
Eileen: [00:02:54] She told the story of committing to the work of curing herself, of the sin of pride. This goal came on the heels of late night discussions at stay away camp with fellow young teenagers of different faith traditions, envious of the Catholics who got to go to confession. Envious of the Jewish campers who were the chosen people. Envious of the agnostics who just didn't care. Here she was, stuck being Protestant, which meant being stuck, being sinful with no recourse. And so she committed herself to curing herself of the sin of pride. Then the trouble compounded. She said she found herself feeling proud of her humility. Nancy's rock stardom begins and ends with her humanity. Throughout this episode, I challenge you to reflect on your personal knowledge of suffering, the loss and limits that make you feel your humanity. And the role of understanding and being a human in a world full of other humans. I'll share my thoughts at the end. So, you know, the other phrase you used in that talk was life is capricious as a big little statement about a lot that happened in your early life, which is really, really loaded. But I also know your shtick to call it whatever you call it. And just to say it in bullet point fashion, you know, it's hard to generalize about people. You know, we're not traits. There's themes and personality, and individual differences are what make us fascinating and always will and unique. And that's what makes our work so challenging on the one hand and vital on the other. And thirdly, that it's the human to human therapeutic relationship that is the real instrument we're using. Yeah.
Nancy: [00:04:47] And there's data to that effect. This is not just an article of faith that there is very solid data, that 85% of the variance in psychotherapy outcome is a result of factors of personality in both the therapist and the patient and factors of relationship. It's not in what brand name treatment you apply to what brand name. Dsm disorder.
Eileen: [00:05:14] Amen. And that, you know, people in general. And this podcast is aiming for the world beyond our inner circles. People need and want to be understood. They do, you know, PsiAN. That was one of PsiAN conclusions, in addition to how many other studies, I'm sure. But I'm thinking to myself with this title, the Art of listening, that it all hinges on listening. And you and I know as human beings committed to this life work, that money could never be enough of a reason to do what we do. It's got to come from somewhere more meaningful and deep inside because it's too hard.
Nancy: [00:05:53] It's very hard. I think one of the things that people often don't understand about being a therapist is how much you have to absorb other people's suffering. You have to listen to excruciating things. And furthermore, often people have very strong feelings that come toward you. They are enraged that you're not helping them faster, or they're envious of you, or they find ways of making you feel ways that they feel which are pretty difficult to tolerate, or they evoke in you ways that other people typically feel toward them. So there is a lot of research that's been done in Germany about affect transmission in psychotherapy and how in psychotherapies that are effective, the therapist takes in the patient's emotion but gives back something else. And that is a hugely difficult discipline. That's why we're exhausted at the end of the day, because we are taking in a whole lot of toxic feelings, and instead of just reacting, we're trying to understand them. We're listening to them, we're absorbing them, and then we see whether we can give back something else. And some of it's intuitive, like the patient who comes in enraged and instead of being enraged back, which is normal, our face will show curiosity about why the person is so enraged. So we're we're giving back something else. Or the person who comes in shamed. We don't take a contemptuous position of, yeah, you're shameful. Instead, we might show anger on our face that someone has shamed the patient. So the patient gets the message. There's a different way to feel about this. So listening is complicated and difficult.
Eileen: [00:07:53] So, Nancy, how did you learn? How did you learn to listen?
Nancy: [00:07:59] I think my mother taught me to listen, basically, she would always try to help me understand what was coming at me. You know, for example, if a kid mistreated me, she would first comfort me and then she would say, well, let's figure out why they might have been mean to you. They've been having some troubles. Their parents just recently divorced. Maybe there's some envy in it. So she taught me to mentalize, and she taught me how comforting it was not to take things personally and to feel what was coming at me, but not internalize it. She also told me that you can get away with saying anything if you can figure out a way to say it, which is a very fine lesson for me. I didn't have my mother for too long, but she was very psychological and what I got from her was very good.
Eileen: [00:08:52] That is so sweet to hear and amazing. And what kid wouldn't want a mom like that? So to know that. You were seven when she was diagnosed and you were nine when she.
Nancy: [00:09:06] When she died. Right. And she handled her death very straightforwardly. I have cancer, I am going to die. You are going to have to be more self-reliant than you would otherwise. At this age. I trust that you can do that. Your father's going to have a hard time. You'll have to be patient with him. It was very valuable to have a parent who spoke the truth. So I did feel understood by her. But I beyond that, you talked about the importance of feeling understood. I think we can't ever fully understand other people and what patients appreciate. What anybody appreciates is not so much moments of feeling profoundly understood. That's certainly very touching and critically important to the therapy process. But patients in an ongoing way appreciate that you're trying to understand them, that you have the intent to understand them. My husband, who works with psychotic patients, finds that the most important thing to making a therapeutic connection with them is that they feel that you have the intent to understand what's behind what everybody else is telling them is totally crazy.
Eileen: [00:10:25] It's just so it's so impactful, just brilliant. Because how much do we struggle learning to do what we do with feeling responsible for making change or taking away suffering. And yet your emphasis that it's just it's the effort and it's the honesty of the effort. Yes, that makes the difference. And it moves me to this other thought. There's so many conversations to hopefully have again some time and continue. But at the moment, in the name of witness and your life story, I was also very moved when you mentioned Anna. Oh yeah, the woman that was there for you in your youth when you lost your mom. And it's amazing to meet your mom and the way you described her and how substantial she was and how full a relationship, however brief you had with her, the fact that that woman, Anna, that your father paid $40 a week. Yeah. Was there that when you said that you saw the movie The Help and. Yes, you is kind, you is intelligent and you, as important, you know, made you cry as much as it did me. I really appreciated that. I guess she was a witness for you.
Nancy: [00:11:41] She listened to me and she gave me help. I knew her only three months. Unfortunately, I wasn't able to track her down. The internet wasn't available until a few years after she died and she was at her funeral. People remembered her kindness. My sisters remember her kindness, too. She was particularly kind to me at an absolutely critical point in life. I wanted to name my daughter after her, but my older sister had already taken the name. And for her daughter.
Eileen: [00:12:17] Listen, only only three months. But the moral of the story is that even where there's a brief moment, it means the world. That relationship between suffering and wisdom. Yes. You know, it dovetails with what you're saying, that we can't take away someone's suffering. We can't even perfectly understand someone. And understanding ourselves is a lifelong process. But the business of using the suffering that's inevitable to receive wisdom. That's the other thing that's so struck me. Wisdom is received, not earned. Yes. Could you say more?
Nancy: [00:12:51] Yes. I've been interested in the topic of wisdom because these days there's so much effort put into being sure that our techniques are based in evidence. And it's true that it's important to have evidence. And evidence can come from randomized controlled trials of particular techniques. But there's also evidence that comes from clinical experience, from life experience, from research that's done on more profound issues like personality differences, defenses, neuroscience, developmental issues and wisdom is different from knowledge. People tend to seek out therapists and supervisors that they think of as wise. And one of the things that's interested me is that therapists tend to have a different orientation toward growth than most academics do, and academics tend to be dominating the conversation. Because they're together in universities and they speak to the media and so forth. But academics tend to value brilliance. I mean, I was on an academic faculty for 40 years, so I'm I'm not putting down academics. It's just seems a realistic way to talk about what they value, to talk about how they they value a brilliant reframing of something. They value finding out what's wrong with accumulated wisdom. Therapists value wisdom. We are very aware that any particular patient is going to challenge us in ways that are not in any of the textbooks, so we have to learn to grow.
Nancy: [00:14:44] And, you know, it's true that whatever doesn't kill you makes you stronger if you're able to mourn it. And we need to mourn that in the presence of another person. We can't mourn alone. We're social animals, and we need to mourn with a witness and to give up, you know, fruitless efforts to change reality and to then come to a position of acceptance, forgiveness, gratitude for what we do have and pleasure in what's available to us. And that is more the psychotherapy process than the application of skills, training or techniques to particular symptoms. Not that we don't want to help people with symptoms, and not that those techniques aren't often very useful, but the relationship is the most important thing. When patients in therapy are interviewed about what was helpful to them, they never talk about a technique. They never say, wow, that free association was wonderful, or wow, this interpretation was wonderful, or the skills training I got was helpful. Sometimes. Sometimes they'll say that that it helped. But what they talk about spontaneously are qualities in the therapist. There's recent research on that by William Miller and his colleagues about how attitudes of the therapist of empathy, acceptance, curiosity, respect all make much more difference to outcome than technique.
Eileen: [00:16:20] The fact that you've straddled these worlds as academic and scholar, as clinician as well, puts you in that uniquely powerful position to speak from your experience of all sides of the coin. And so it's pretty powerful to say that the academia favors the intellect, if you will. And how often in clinical work are we faced with sitting at a kind of a conscious, intellectual, defended level with someone and trying to find creative ways to break through, to connect and really touch them?
Nancy: [00:16:54] I yeah, I don't think academics understand our work very well these days. Back 30 years ago, if you wanted to study abnormal psychology in the university, you probably would also have a small practice. But academia has gotten so difficult, and you have to spend so much energy, you know, chasing grants and working on tenure and generating short term publications, that it would be professional suicide to be listening to patients at the same time. So there has grown a greater gulf between therapists and academics. And there's more, I would say, even contempt among many academic psychologists. For psychotherapists, it's not entirely undeserved, because as therapists, especially those of us who are psychoanalytic, we often talk to academics with a kind of contempt back in the heyday of psychoanalysis. And they remember that. And we set up psychoanalytic institutes that were separate from the universities and stopped talking to our academic colleagues. So I'm not critical of them for this. It's just a fact.
Eileen: [00:18:09] Time, the what we all wish we could have more of. I could sit and listen to Nancy forever. Yet even in a short amount of time, there is so much to be learned from Nancy and her wisdom beyond symptoms. The evidence of suffering beyond theories and techniques. The purpose of therapy boils down to the challenge of life, and that challenge is to give up fruitless efforts to change reality. As Nancy said it in her warm and matter of fact way. Giving up fruitless efforts means learning to see and bear reality. Getting to the acceptance. The forgiveness and gratitude for what we do have. As she said it, this is the point at the heart of every one of our journeys deepest down. Who knew that at the very beginning of Nancy's life, not long after she left home for first grade, and well before she could reason abstractly, she learned that her mom was dying. She learned that from her mom. The death of a parent, not unlike the death of a child, leaves a defining imprint at any age. All our lives. But when I asked Nancy who her best teacher was in the art of listening, I expected a different answer. And what struck me most was how quickly she moved to the forthright statement.
Eileen: [00:19:28] I did feel understood, but we can't ever be fully understood. No wonder Nancy McWilliams exudes sacred regard for the wisdom that comes with clinical experience, our patients and our own. The use of the intellect alone, no matter how brilliant, can't touch the human heart. I asked you to reflect on your experience of suffering and the role of understanding as a person in a world of others. At the opening of the episode, let me share my thoughts. Care of this virtual morning coffee with Nancy now. Nancy spoke about something so many of us could use to reflect on more. That is the truth, that there is no singular right path in therapy as in life. It's about embracing the real, the genuine between us as human beings. The act of daring to try to share, to listen, to actually register and really think about the truth of our experience without simply reacting in kind. This is what forms the core of transformative human to human connections. Understanding truth comes from a place of bridging the gap between academia, research, and clinical practice. Yes, but we develop strength and we receive wisdom when we learn from suffering in the space between us. When we learn to see and appreciate things as they are, rather than as we think or feel they should be, for whatever reason.
Eileen: [00:21:07] And this requires learning to absorb pain without over personalizing it. To remember that fear wears many costumes, and to hold on to the belief that there is always a way to find meaning together. Nancy has an unwavering dedication to communicating complex ideas in the simplest, most human terms for herself and for us as a profession dedicated to healing suffering. Her ability to connect her knowledge, her wisdom, and lived experiences on a continuous and honest journey toward truth is intrinsically inspiring. Her insights into the imperfection of understanding, the importance of trying, and the necessity of mourning in the presence of a supportive witness, are invaluable lessons that redefine what the art of listening really means. Friend, scholar and clinicians. Clinician Nancy McWilliams is a beacon in the realm of human connection and healing. This has been the art of listening. My name is Eileen Dunn. Please join us for our next episode as we continue to dive into the space between speaker and listener. You can follow on Apple, Spotify, or wherever you listen to podcasts. And if you enjoyed the show, please leave a review and a five star rating. It helps us to grow so that we can keep bringing you new conversations. We'll see you next time.
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