LISTENING

«  There is more to listening than waiting to speak.

«  Listening is the most important (and most difficult) of all the skills needed to help patients and families. It is the foundation of good care.

True listening is a form of hospitality. It is making space in our schedule for the concerns of others. It demands energy and commitment. It does not need to be unduly time-consuming.

A doctor with advanced cancer said to a group of medical students, “Give me just 10 minutes of interested, uninterrupted listening, and I’ll tell you all you need to know to help me.”

Energetic listening is ideally preceded by a period of solitude and reflection, however brief, so we can be entirely present for the other person. We listen best to others if we have already listened to ourselves. (see Burn Out)

Sit down. We listen with our whole body. Our non-verbal communication (eye contact, facial expression, posture, hand movements) will signal our true depth of listening. (see Non-verbal Communication)

Set aside time for listening. It is possible to spend a lot of time with a person and never listen properly.

Set clear boundaries. (“We can talk together for 20 minutes now and if necessary we can meet again tomorrow afternoon.”) Be realistic about your own time limitations, but always keep a promise to return.

Basic listening skills include:

1. Reflecting

2. Tracking

3. Repeating

4. Exploring

5. Clarifying

6. Linking

7. Silence

8. Noticing

1. Reflecting is an important technique early in a conversation. (“Why do you ask that?”) It encourages a person to keep talking, and helps the listener to tune in to a person’s belief system and focus of concern. It avoids assumptions about what is being asked.

2. Tracking is listening for key words or phrases, then turning the word or phrase into a question. This is more likely to lead to relevant discussion than asking random questions.

3. Repeating a phrase or sentence shows you are listening, and draws the speaker’s attention back to what he said. Getting the person to repeat or to summarize can help him to analyze his own feelings.

4. Exploring is gently seeking more information. (“Could you say a bit more about ... ?”) By listening carefully, you may notice a word or phrase used but quickly dropped. This sometimes points to a sensitive subject that requires gentle probing.

A great deal of constructive discussion can take place when a subject like this is “incised”.

5. Clarifying may be for your benefit as a listener. (“Could you explain that again, please?”) It is very important that you understand what is being said. Clarifying is also a useful technique to help the speaker take another look at something.

6. Linking demonstrates careful listening. (“You said your wife had been more irritable, and earlier you said your daughter had not been coming home so much. Do you think those things are connected?”) Linking can draw things together and can sometimes bring new insights.

7. Silence allows a person to analyze his feelings. Silence must be friendly and relaxed, and the listener should signal that the silence is comfortable to him. Sometimes after a period of silence the question “What are you thinking about?” brings up a relevant topic for discussion.

8. Noticing when a person’s behavior conflicts with what he is saying, and kindly pointing out the discrepancy, can result in real emotions being expressed. (This works only when the person trusts you and feels you like him.)

Changes of subject, illogical or seemingly irrelevant comments are motivated by something. Sometimes it is evasion due to fear or embarrassment. It can be helpful to say “It seems difficult for you to talk about this.” Sometimes it is an important clue that should be picked up. For example, during a conversation about symptoms a person may say “No never, well not since I was in the army.” It is easy to pass quickly over additional information when it doesn’t fit the scheme we are using, but a response like “Oh, you were in the army, tell me about that” may well reveal vital information.

You are not listening when:

• You are in a hurry

• You think about yourself

• You interrupt

• You ask the same question twice

• You don’t ask any questions

• You change the subject

• You assume you know what I’m going to say

• You over-react to certain words

• You feel critical of me

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.