Therapeutic listening is a cornerstone skill of health professionals.

Empathy, understanding and recognition of the patient’s emotions and feelings are crucial to building a therapeutic rapport with the people we care for. However, there are several myths when it comes to listening, such as: ‘it’s the same as hearing’, ‘it’s passive’, and ‘good listening skills can’t be learned or easily improved’.

These are all myths. Let’s look at rebuffing these:

The Five Stages of Listening

There are five stages of listening that we need to pass through and apply to each conversation:

Attention and Concentration (receiving, hearing and attending);
Learning (understanding, learning, deciphering meaning);
Memory (remembering, recalling and retaining);
Critical Thinking (evaluating, judging and criticising); and
Responding (answering, giving feedback).

So how do we do this?

There are strategies that can be practised to improve your ability to master each stage, and ultimately, become an effective listener:

Receiving

This strategy focuses on what’s being said during the conversation. Receiving involves verbal and non-verbal communication.

What’s not said can be equally as important as what is. Really focus on what the speaker is saying, not saying, and what they haven’t said.

Maintain your role as a listener – do not interrupt, and avoid assuming you understand what the speaker is going to say before they’ve said it. Lessen the physical distance between you and speaker (but still keep them comfortable), reduce background noise and try to ensure lighting is adequate so that you can see their lips.

Finally, avoid overlapping speech – one person speaks at a time.

Understanding

A crucial part of therapeutic listening is to truly understand and learn what the speaker means. Relate new information to what you already know but try to see the speaker’s message from their point of view. It is important to be able to link new information to existing ideas and concepts in order to understand the message, but remember that the person speaking may interpret information completely differently to you.

Don’t judge their message until they’ve finished speaking. You could try paraphrasing the speaker’s ideas that appear especially important to ensure you have understood them correctly.

Remembering

The art of remembering lies in being able to reconstruct a meaning in their message that makes sense to you. This relates to linking new information with your existing knowledge.

Try to focus your attention on central ideas. Repeat these in your mind and avoid focusing on minor ideas. Organise, summarise and categorise what you’ve heard, uniting old ideas with new ideas as they come in.

You will be able to remember key information if you link it to something that you already remember, and by repeating key names and concepts (either internally or back to the speaker).

Evaluating

This listening strategy focuses on making a judgement over the message or information – NOT the speaker. However, it is vitally important to resist evaluating the final message until the speaker has finished communicating. Distinguish facts from fiction, and focus on the argument/problem/issue/message, rather than the speaker. The conversation should never be personal.

Responding

Finally, listening involves dual communication – after the initial speaker has finished, you must be able to effectively communicate a response that says, 'I heard you and I understand you'.

There are two types of responses – one occurs during the conversation, and one occurs after.

Responses during should be supportive and acknowledge that you’re listening. These are called ‘back-channeling’ cues, and include affirming sounds and words such as 'yes', 'mmhmm', and head nodding (or other appropriate non-verbal cues relevant to the emotion).

Responses delivered after the speaker has finished should be more elaborate and may show empathy (the acknowledgment you understand the content and feelings associated with the message). After responses may include:

'I understand how you feel…'
'Do you mean…'
'I disagree…'
'I agree…'

Problems and Barriers to Therapeutic Listening

There are some common mistakes that people make during a conversation that indicate the receiver is not listening adequately to the speaker:

Not expressing appropriate support for the speaker during the conversation using varied ‘back-channeling’ cues;
Not ‘owning’ your responses – i.e. simply agreeing with the speaker for the sake of agreeing or because you didn’t hear what they said;
Being overly expressive or using inappropriate supportive techniques or language;
Appearing preoccupied – i.e. allowing physical and mental distractions to enter into the conversation. This includes thinking of other things while the speaker is communicating and diverting your gaze to something else happening in the distance or to the side of the speaker;
Becoming biased or having prejudices about the speaker, the topic or the people/institutions involved. This can also arise when you allow your own values and beliefs to influence the conversation and the speaker’s point of view;
Not being focused on the conversation and the speaker and making a conscious effort to hear them and understand their message;
Judging the outcome, intent or message prematurely;
Giving monotonous feedback that is not to the point; and
Avoiding eye contact.

The next time you find yourself in a conversation with a patient, family member, or colleague, try applying some of these strategies to improve your listening. You never know what you might hear…

References

AlfredHealthTV 2017, Patients Come First – Caring With Compassion and Respect, Alfred Health, Melbourne, viewed 27 April 2017,https://www.youtube.com/watch?v=YEFW28wzwig&feature=youtu.be
Birks, M, Chapman, Y & Davis, J 2015, Professional and Therapeutic Communication, Oxford University Press, Melbourne, Australia.
Chapman, YB & Robertson-Malt, S 2015, ‘Frameworks for communication’, in M Birks, YB Chapman & J Davis (eds), Professional and Therapeutic Communication, Oxford University Press, Melbourne, Australia.
DeVito, JA 2016, ‘Listening in Human Communication’, in JA DeVito, Essentials of Human Communication, 9th edn, Pearson, New York, NY.
Kelley, JM, Kraft-Todd, G, Schapira, L, Kossowsky, J & Riess, H 2014, ‘The Influence of the Patient-clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials’, PLOS ONE, vol. 9, no. 4, viewed 27 April 2017,https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094207
Riess, H 2013, The Power of Empathy, TEDx video, viewed 27 April 2017, https://www.youtube.com/watch?v=baHrcC8B4WM

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