Using words to describe our negative emotions, tames the experience. For example, knowing that the terror we are experiencing is called a panic attack may not get rid of the experience, but it may make it feel less of the nightmare than the experience of not being able to name it.

However, sometimes words are not enough. Edvard Munch’s painting The Scream focuses on a figure, silently screaming – its power is silence. There are no words for the experience. People suffering from mental health problems experience their version of The Scream. For friends, family, and therapists, it is essential to validate their experience. However, validation is problematic.

Creating a balance between being heard and change

Marsha Linehan’s Dialectical Behavioural Therapy recognised the contradiction at the heart of many therapies. People want to be heard; however, they also want to change. If there is too much focus on being heard, then the only goal of therapy is the ventilation of feelings and validation. However, if the only focus is on change, then the person may not feel heard. Validation and its opposite invalidation are hard-wired into our personal histories.

Invalidating environments neglect people’s needs. A child who grows up in an invalidating environment will learn to cope; they may grow up believing that they have no needs at all. And in adulthood, this may be seen in lives devoted purely to serving the needs of others. Alternatively, they may try to control the misery produced by the invalidating environment through drugs. They may sometimes cope by expressing their feelings in extreme ways, overwhelming others.

When Jane talked about how desperate she felt, she would often talk about suicide. She hoped that her partner would then understand how she felt. However, the result was that her partner then felt powerless to help.

Jane’s example is a vicious circle. The powerlessness that other people feel can be followed by withdrawal, thus confirming that the person doesn’t deserve to have their needs met. How we begin to resolve the problem was explored by Robert Leahy using the idea of ‘black and white thinking’.

How to listen to what has been heard

This is a familiar concept in CBT. It describes seeing the world in extremes. For example, if other people, family, friends or therapists were not 100% in their attempts at validation, then they would be seen as 100% uncaring. The solution to black and white thinking is grey thinking.

The question that Leahy posed was what would someone who was 50% in their attempts at validation be doing, saying or thinking? Although it is hard to quantify behaviour in this way, it is a valid question to ask as most of us are near or around this halfway mark. In our relationships with others, we can at times be kind and at other times we can be thoughtless. But we are rarely 100% kind or 100% thoughtless.

Also, for the speaker, Leahy advocated using assertiveness skills such as knowing when to ask for help and how to disclose feelings. And for the listener, whether they are family members, friends or therapists, Linehan emphasises the importance of using skills such as paraphrasing or reflecting as a way of proving that the other person has been heard.

Ultimately, it is vital to recognise that keeping the balance between validation and change. Leahy summed this up, quoting the words of the Spanish novelist Miguel Unamuno.

"We must learn to weep for the plague, not just cure it.” Before there is change, a person needs to be heard.