Saying Goodbye to the Silence

The case report presented is about a boy with auditory difficulties', who grew up in a family with a hearingimpaired father and a deaf-mute mother. Throughout the support of a psychotherapist, as well as of a specialist of auditory and speech difficulties, the boy has completely change his way to communicate. The system of signs and images has been left in favor of the verbal language. The case demonstrates the causal relation between the choice of buying a hearing aid and the process of learning to talk and interact with others without fear. It demonstrates also that this passage is no painless because of psychological and social implications. The considerations argued in this article starts by the great value of communication, passing through the themes of language and images, the use of devices for deaf, to get to their use in clinical practice through case Robert. The subtle and intricate exchange and relationship between the language of silence and the one of sounds is gradually illuminated. Though the present research is not carried on with a statistic method, future development could be the investigation, on a large scale, on the sociopsychological and emotional difficulties involved in people with hearing difficulties who have to face such a


The Sound and Images of Persuasion
It is said that the first therapist convinced of this power, well known for his capacity of persuasion, was the sophist Antifonte, (500 BC). He rented a shop near the market of Corinth to offer his services to afflicted people. He stated that there could not exist a pain so great that it cannot be relieved from its special 'conferences'. Perhaps it is possible to compare the work of modern psychotherapists to that of the ancient sophists, although, unlike them, some of modern professionals still use expressions as 'patients', 'disease' and 'care', even if the aim is the same: take care of those who are in a dysfunctional emotional state ( Figure  1). Figure 1: The importance to buy an hearing aid since the childhood.
The power of words has been discussed since when the art of rhetoric, as a discipline of great importance in western intellectual tradition was affirmed, starting from ancient Greece and up to the nineteenth century. Just think of names of great importance, such as Aristotle, Cicerone, Erasmo, Agostino e Adam Smith [1,2].
With a different point of view, Socrates criticized the moral foundation of the discipline of rhetoric, considering it an argument not so intellectually serious. In particular, the worry was that it could become an instrument of strong persuasive impact: the power to convey messages in an irresistibly convincing way, no matter what was the message. Critics argued, in fact, that if it was true that the rhetoricians could have had such convincing power, to the point of being able to turn worst the best reason, they could even get to subvert the political order and morality. Similar fears have been expressed in modern times in relation to psychology, in particular the psychology of communication, of persuasive, strategic and hypnotic language, especially about the consequences of knowing and using the hidden secrets of the mind bypassing the will and the consent of the patient, or using that persuasive power through the media. Modern psychology has also proved that communication is extremely complex, and it is too reductive to say that you can find out the hidden trick to ensure the success of conviction ( Figure 2). Even the ancient orators like Cicerone agreed, in fact in his "De oratore" he tells how young fans of Crasso, an orator of great success, asked him to know the secrets of public speaking [3].
He replied that the real mystery was the common sense and the hard work. Modern psychologies have moved forward his position, they have shown how human thought processes are extremely complex. In particular, the interest of cognitive psychology has been to reveal the so-called rules of thought, which is to discover the rules that one must follow in order to have a successful thought, both in theory (the rules one should follow), than in practice, that is, those that men effectively follow.
Understanding the rules of thought is of particular importance in cases where verbal communication is not possible because of a lack of auditory or total deafness. The argument in fact, although has his highest road in the choice of words that can be heard, has made possible, in the mentioned cases, by the skillful use of mental images and sign language.
The theme of the argument goes along the ancient manual of rhetoric. These texts not only deepened the topic of how to impress an audience, but also of how to counter the arguments against. Protagora was the first to use the method of refutation, by organizing dialectical disputes, as well as he was the first to be defined 'sophist'. Although we do not have today any text written by him, we can read a very brilliant portrait sketched by Platone who refers some of his famous sentences, such as, for example, 'around each topic there are two statements, opposing each other ' [4].
In his experience in the cause of justice, Protagoras had certainly seen that in each case there is an accusation and a defense offering two theses absolutely opposed to each other. An experienced attorney, with his fancy argument, and persuasive words, always find something to say about each of the two.
This fantasy of argument remains a crucial element in any communication context, because it allows you to select the right words or the thought, or the mental image, the more effective, to achieve a fixed goal. It seems evident, besides the great importance of this choice, the psychological implication linked to the fact that around each topic there are two statements opposing each other: man is basically equipped with a capacity of inventing arguments to oppose counterarguments, the other statement mentioned by Pythagoras. These critical skills are able to outline, and at the same time limit, the power of persuasive communicator, and ensure that it is not inevitable to get an unconditional surrender in the face of such power. This is even more true in the context of treatment of a patient who needs to overcome a hardship, or a mental or emotional dysfunctional condition. So, if on one hand it is true that the therapist should have in his words a 'power' which is able achieve an healing result, it is also true that, in the patient that he will appeal, this' power 'does not ignore its will, whichever is the situation he leave.
He, in fact, must always 'choose' the words (and of course the concepts associated with them) that are proposed to him politely, and not given as a medicine [5]. When the therapist has to face hearing difficulties or deafness, the challenge is to choose concepts which powerful mental images associated, well-defined and functional to the resolution of a particular issue, just as through words ( Figure 3). Manuals as 'Education oratory' of Quintilian and the anonymous 'Rhetoric to Hennium' showed how the ability of denial was part of the practical skills of an orator. We can add that, although not trained after a period of exercise, everyone is able to use this ability of negation.
One argument is potentially infinite because there is always something to add, this can make it difficult to translate the inner topic into a specific action [6]. What seems to be the last word on the issue, maybe it is not really so. It is exactly the same at the level of thought. Intuition of the Elea's stranger, according to which the thought is the inner conversation of the soul, has a psychological implication: the way of thinking is modeled on the dialogue, interaction, communication, whatever form it occurs.
It is often said that the process of thinking is something unobservable, that remains shrouded in a mysterious silence. However, if the internal deliberations resemble to public ones, the structure of a spoken debate may resemble to the structure of thought. Therefore, knowledge of the dynamic of thought assumes an intrinsic value even greater when it is translated into a language of a different type, such as that for the deaf, which makes greater use of images and not of sounds.
Hence the choice of the right arguments proves an instrument of effective impact that comes to fit into the flow of thoughts and that determine the attitudes of a person, as well as his actions [7].
It seems very easy to find out the mechanism of the effectiveness of communication: is it enough just to follow the simple rules of rhetoric and argument against argument? No, because this process could continue forever, up to block, paradoctically the decision-making process, rather than encourage it. The same thing can be said about the healing process. Thought cannot be reduced to the simple act of following a rule. We can, however, extract a moral from what written above. If there is a close connection between matter and thought, when teaching, or helping to think, one must first teach to argue. And the argument goes through choosing the right words, the right sequence of images, with respect to a context, a situation, a person. One should keep the right amount of critical spirit, which is not afraid to challenge or to place themselves above the authority or what is conventionally called 'correct'.
One should therefore ask what are the essential sounds that should be heard in a place where we learn, where we communicate. This is the roar of the ideas, the essential sound of place of thought, audible to all. Essential for the simple reason that the sound of thought is also the sound of the argument.

How Deaf Children Learn to Talk
Although in the dynamics of communication the language is generally considered the interactive medium par excellence, what happens through words, could also happen through signs. There is no doubt, however, that the acquisition of language occurs with greater difficulty for people with hearing disabilities. For centuries researchers have investigated the secret of how we learn to speak. Remarkably, children who are barely able to walk and eat alone, learn to talk without even knowing the rules of grammar and without specific training! The linguist Ronald Langacker [8] writes: "[The child] is master of a linguistic system. And this happens on the basis of indirect evidence and fragmentary, and at an age when it is not yet able to formulate logical and analytical thoughts." But how does a deaf child learn the language? There are several factors to consider: • Severity of deafness: transmission or perceptual • Age of beginning: prelinguistic or after language acquisition • Parents are deaf or hearing impaired • Communication with the deaf, with hearing impaired or both • Prosthesis: there is always a residual, there is hardly ever a complete silence.
It is therefore important to implant the prosthesis early so that the child consider the part of himself. Instead, in the family where no one knows sign language, the child will have difficulties to learn it because for him it's like a second language. As for the written language, if children are educated early with audio-oral programs, around 16 years they will be able to read and write in a similar manner of the deaf [9]. For a certain period of time, from birth to vocalizations, language development in deaf children and hearing impaired improves in the same way. Later, in the child with disabilities, the vocalizations end, but the period of babbling doesn't start because there is a feedback system: the child speaks, but he hears a different sound, so he is not able to self-correct. The use of gestures is greater, since it replaces the use of the first words.
The first five years of life, and particularly the first two, are the most critical ones for learning. In this period, in the cerebral cortex billion nerve cells grow and branch out, forming a tissue, closely interconnected [10]. Between 15 and 24 months, the nerve cells of the brain grow enormously. Now the brain is ready to learn the language. So it is essential that the child is put in touch with the language, even that of signs, during the first years of life.
Some researchers studied the effect of regular talking with children of nine months. The sample of population was of 140 children. Parents of half of these had been explained the importance of talking to children, and the best way to do it, while the parents of the other half was not suggested of anything. After seven years, "the average quotient of intelligence of the group whose parents spoke was one year and three months more than the other group", and their language skills were "significantly higher". The researcher Sally Ward [11] believes that today parents speak less than in the past to children because of the major changes that have been in the society. For example, a greater number of mother work, and in many homes the television has taken the place of conversation. Dennis Child, [10] a professor of education, said: "Language is the most beautiful gift that a human being can have." The awareness of the preciousness of this gift is essential to help parents to allow their children to develop this effective means of expression.
The transmission of information and ideas from one person to another take place when there is a message to convey, an idea to understand, or the therapist has taken the responsibility to help a person to face a difficult moment. In these cases, the effort to improve the communication skills should not stop ever. Be heard or not depends largely on the effectiveness of this effort. The words are effective, even if in a different manner, whether pronounced verbally, with sign language, or written ( Figure 5).

Figure 5:
The mechanism of the brain.
For example the great literary works are read many times by the public in exactly the same way that the great musical works have repeatedly heard and that the information is imprinted on the mind therefore through repetition. Most people have heard of Shakespeare, for example, even if English is not their native language. Moreover, the majority has a tendency to remember what he read with pleasure. The great literary critics, as the Roman Horace, the greek Aristotle or English Samuel Johnson, studied the works of others to find out what did their readings unforgettable. Everyone admits that it is not easy to write effectively and persuasively. Samuel Johnson said that what is written without effort and 'in general read without pleasure. So if the goal is to understand a point, or convince someone, one need to make the language effectively no matter if he speaks or he writes.

Therapy with People with Hearing Difficulties-Case of Robert
The case proposed below is about a case I followed. It is an extract of a lived experience, the case of Robert. It demonstrates how winning has been the choice of buying a hearing aid in order to help Robert to come out from his sound of silence, despite his parents resistance.
In July of 2014, when he appeared in my study of Rome, Robert was a young musician of 25 years old, whose great dream had always been represented by the desire to live off his music. His father had left the family when he was 5 years old, his mother was deaf and dumb. Robert wasn't completely deaf, he just had hearing difficulties, so, in the first years of his life, with his father, he had learned to talk, even if not perfectly. Since his father left, he had been living alone with his mother, so, day after day, he had started to fall into a world of silence.
The mother had chosen for him a school for people with hearing difficulties, also because, as she has completely deaf, she wasn't able to understand the real abilty of his child. She even had not ask for help to a specialist, because she was, as sometimes happens in these cases, very cautios towards others; she also was still hurted by the abandonment of her husband, thinking it was due to her handicap, so she was scared his son would have passed the same experience if immersed in a world of hearing people.
Despite his difficulty, Robert had graduated, and he had emerged as a boy of great capacity, full of dreams and aspirations. He also had demonstrated a real talent for music, he had learned to play drums and the music teacher had encouraged him to continue even to try to became a music teacher. Sadly, the hard contact with reality had disappointed his expectations. In fact, as he came out from the school, at the age of 18, he didn't find a job. He passed his days at home with his mother, in their world of silence, even if he had always has been fond of music. In fact, as he was not completely deaf, he was able to hear some sounds, especially those of the drums. He also had bought one, and during the period he stayed at home, he spent many hour to play the drums. He was very good in his music. However, this situation had resulted a state of deep sadness and despair. So when one of his friends, one of former patients, had spoken well of me and of the type of strategic psychotherapeutic approach I adopt, he decided to meet me.
Robert began to talk, in its own way, about his difficulties; the problems he wanted to solve were: feelings of inadequacy, crushing anxiety, unhappiness and as feeling of being trapped in himself and his circumstances. He suffered insomnia and panic attacks, and he was also victim of a series of hypochondrias, including a persistent fear of losing the view. Despite his feelings, Robert had a lot of care of his image. So, we began in setting some goals for the first few months of therapy: better identify the possible causes and contributing factors of his disease, raise the level of well-being, and simultaneously lower the anxiety, in part responsible of dysfunctional attitudes and actions that contributed to the feeling of inadequacy boy, as well as to the deterioration of a situation not particularly simple. In addition to this, we decided to start some excersises with his voice. I invited him to use a detection system of sounds, in order to help him to understand that he was able to produce sounds, and, maybe, that he was able to hear something as well. So, he explained to me that he wasn't deaf, he had learned the sign language because many of his friends were deaf, but that maybe he could hear more with the support of a hearing aid even if he had never done it because he didn't need it. Neither his mother could have never hear his voice! So, we decided to work on a personal relational style in order to improve his selfesteem and social relationships, and, therefore, tracking the strategy route to put into action the levers of change. The main objective was the behaviour modification in order to leave the approach he had learned of helplessness. The techniques used to reach these objectives were: conversation, drive, relaxation techniques and regressive analysis of the dream material, shifting the point of view, use of metaphors, improving in perception by the use of different senses but the view.
It was also important to understand his current family situation. The picture that came out, the 'here and now' of his circumstances was a little bit disheartening. In fact there was a friend of his mother that usually came to visit them, who was aggressive and violent. He had always been living in fear of him. The young musician was therefore in a situation even more complicated, since he wanted to help and defend his mother but, without a real economic independence, remained in some way subject to the dominant presence of this man who, sometime, helped them materially. To help him better visualize his reality and create a genuine opportunity to produce positive change, I chose to use a metaphor: a dark and silent room. I began by asking him to describe the emotions he felt when he thought to himself and to his situation; Robert said that the prevailing emotion was fear, mixed with bewilderment and confusion.
When I asked him if he could at least in part identify a cause of his discomfort, he said he could not get a clear view of the situation and felt afraid and was lost in the dark, and silence. I suggested him to imagine to hear a little sound, a dump one, with rhythm, growing in intensity and beauty. He said he could see very well himself in that situation, and added that actually the reason for those feeling of fear and bewilderment was the difficulty to hear. We agreed that the first thing to do in his case was to try to solve the deaf problem asking to a specialist if there could be a device for his hearing difficulty. He decided to try one. It wasn't simple for him, because he had always refused this solution, with the idea that his mother would have suffered if he could come out from their world of silence. But the happiness he felt as he tried the device was so great that he immediately took the decision of not to live without it anymore. He finally could hear the sound of his dumps! Of course this new world of sounds was also full of new anxiety.
The next objective was, in fact, to control his anxiety. This would enable them to avoid wasting unnecessary energy in doing always the same things, as walking in a no -end street, finding out reference points to not lose orientation, and finally find his way out. We discussed long time on the meaning of leaving the world of silence, even through repetition of some words, that he had heard for the first time. We decided that the right thing to do was also to go to a specialist in order of being helped in learning a 'new' language. So he continued the therapy with me at the same time he went to a specialist of language.
The anxiety of feeling weak and inadequate to get out of his previous situation, had generated the consequence of the 'feel trapped' and unable to get out of it. This, in turn, reinforced a state of anguish and frustration. In contrast, a family atmosphere less oppressive would make possible to focus the thoughts and efforts of Liam on therapeutic prescriptions and his psychological well-being. So, in the following sessions, the situation slowly began to take a different direction. Robert informed me he spent days almost exclusively looking for a job. He became also able to change his way of expression. His words were already became more clear. After my suggestion the young man had prepared an updated curriculum. The curriculum was meticulously sent using the internet or delivered by hand to a variety of helping centres for deaf people, in particular those specialized in taking care of people with the same problems and experiences as him.
We established to consider the same search of a job from a different point of view: that it could be seen as job in itself, no matter what the results. A job to carry through day after day, planned and organized just like a real occupation. Robert in fact had planned things in order to spend less time as possible at home.
During our meetings I asked Robert to tell me the results of his research work, the conversations, the difficulties encountered; in this way we were going to gradually put in place a relational approach increasingly open and optimistic, as close as possible to the style of personality of the boy, whose attitude became, at the same time, more pleasant and appealing. Finally, a day, Robert burst into my office with news: he had finally found a job! After few months, he became able to help his mother, and the violent friend didn't come anymore.
So, we were ready to fix a new objective: play his music. Robert began to write music for drums and he was so good in playing it that he became part of a small group of musicians that meet during weekends to play in music bars.
This renewed state of infinite things, would allow him to regain strength and energy to trigger the dynamics of change, fundamental to find the much desired "way out".
He has begun to live simply, speak better, be able to do his music.
Once the emotional and financial situation, as well as the and family of Robert began to take on a relative stability, we agreed together that the first objective that we had set six months before, could be considered achieved: the level of welfare and quality 'of the boy's life was greatly improved. In later meetings we went by focusing more precisely the framework of emotions and family and friend relationships. After about one year from the first time Robert had turned up in my office, the therapy could begin to take effectiveness. In saying goodbye, he left me a gift: he had composed a sing, with the aid of his music group, entitled 'I say good bye to the silence' Robert has become able also to play his new experience of sounds.

Conclusion
The considerations argued in this article started by the great value of communication passing through the themes of language and images, the use of devices for deaf, to get to their use in clinical practice through case Robert. We have gradually illuminated the subtle and intricate exchanges and relationships between the language of silence and the one of sounds. The case of Robert has revealed an experience made of wellchosen decisions, with the essential support of the psychotherapist, whose first suggestion was that of buying a hearing aid. Thanks to the sound of the world the patient has understood his discomfort, and chosen, a new way to go through. He has chosen his new music, his personal "sound of healing" [12,13]. A personal sound, because everyone is a unique universe, the alchemy produced by the combination of genetic heritage and circumstances of life, such as social and working opportunities, creates a myriad of possible outcomes and different possibilities of the development of potential. It is therefore up to the preparation of the therapist, being able to capture and interpret languages and messages, even if they are silent and unconscious, but always full of meaning. This is a complex and precious personal universe that it is not possible to live aside when one want to pursue the objective of therapeutic improvement [14]. The psychotherapist must therefore be an excellent professional who uses the right strategy carefully, because a very effective process of activation of brain areas can start.
The tracing consists in reflecting the behavior of the patient in order to communicate: "you exist for me!" "I understand you," and then "I am able to help you" [15]. It is with ethical attitude that the therapist assumes responsibility as a part of the reality that he belongs to. Understanding weaknesses or deficiencies is the way to see and understand those of others. The prejudices, lack of self-criticism, arrogance, and di s respec t are the causes and consequences of many misunderstandings. It is increasingly necessary to move towards social, personal and organizational objectives that have higher goals than profit, and the first step in this direction is to learn to respect others through projects like a self-efficacy window and the improvement of people innovatively. To deeply respect himself and others means to live with dignity and with the responsibility of human relationships.
For this reason it this must be re-evaluated the value of making a psychological and ethical commitment towards the other, as individuals that are part of the society in the broadest sense of the term.