We’re always happy to receive submissions from therapists who might be thinking a bit differently about what they do. Here are some thoughts from a noijam reader on listening to clients in a different way:
Normally as a client speaks, we make sense of his words through an active interpretation of meaning. We might apply some judgments and filtering, but in the end we create an understanding. This type of listening has it’s place but doesn’t appear to be therapeutic. Since we spend such a short time with clients, I like to try to incorporate a different kind of listening which will make a difference. This approach has been described by a number of different authors, and involves attention without interpretation or understanding.
As the client speaks, listen for the underlying emotion. Or if there’s not much emotion happening, listen to his/her ‘inner self’. Attend to their ‘essence’. If you do this with full attention, you won’t be able to simultaneously interpret or understand the words since the mind can’t do both at once. I tend to switch back and forth between the two modes of listening, so that I can still get a rough idea of the meaning of the words and not get caught out when asked a question! It sounds disrespectful, but actually it’s a very valuable thing to do for the client.
What I discovered by using this approach is the following: All the words a client uses and the symptoms they present with, are possibly just a way of trying to make their inner self known; make their emotions known. People want to be known at a much more fundamental level than words can convey. So it’s possible to go direct and just attend to the inner processes and there’s much less need for words. It has enormous therapeutic power.
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Yeh that’s a good question db, so long as we don’t get caught up in interpretation and analysis. I always think of analytical thinking as very useful to me, but not directly helpful to the client. I try to not indulge in it until I am outside the treatment room.
“Paying attention to a client’s essence” might seem a bit vague to some students. I can picture a student saying “Huh???”. ‘Essence’ is that which makes a person alive as opposed to dead. ‘Aliveness’ is another word that could be used. There’s an inner ‘aliveness’ which causes the heart to beat and the lungs to breathe and the body to move. Of course a scientist would say the heart beats because the SA node fires an electrical impulse… and in doing so would completely miss the depth of it. My interest is in what works and I have no alliance with either mainstream or alternative medicine dogma.
When you apply it, the client will very suddenly become more animated and engaged. The rapport which follows is very deep particularly if you work it a bit. Any students want to know the clinical signs of deep rapport? I don’t imagine they teach such stuff at university nowadays – it’s too real, too useful.
Thanks for this very interesting perspective and post. I was wondering, what does it feel like, sound like, look like etc to listen to a person in this way? Put another way, how do you know when you are achieving this way of listening, and any additional hints to getting there?
You know when you see a new baby there’s a feeling of amazement and curiosity which drives a deep attention? That’s all it is. Just carrying that feeling/attitude of “this is an actual living person!” to the interaction. Of course one needs to be congruent with such techniques, so I don’t do it when I don’t feel like doing it.
Various people have mentioned this mode of attention; one of them an old boss of mine. I often used to quiz him because he is one of the few practising physios I’ve met whom I’d consider successful. [By successful I mean he wasn’t a “Come back Jack”, never advertised, and yet his book was always full of new clients. How many physios do you know who regularly see 30-40 people a day and are not churning the hell out of the same clients over and over?]. He used to say “I just find people very interesting”. He also used to say “I work at my best when I’m in a sort of trance”. He has scaled back quite a bit nowadays with advancing age.
The other person who has mentioned this style of attention, albeit in a slightly different way, was your buddy Mark Jensen whom I’ve had some email contact with recently. I don’t think he will mind me quoting him from a private email: “Focus, focus, focus on them. Pay attention to every detail. Be curious … what is this like for them, this experience? What might they want? What do they need? Make them the center of your universe, so that *you* disappear. If you find yourself drifting, get curious about them again”.
Then there’s Erickson – “Patients will tell you any story that seems reasonable, that seems to be well founded. And they’ll tell it to you with great intensity. They will make you believe it. But they are using that particular thing”. He was quite disinterested in the surface stuff the conscious mind was doing, preferring to observe the various ways the subconscious was expressing itself. And emotions stem from subconscious thoughts.
Then Rogers – “Instead we offer another type of understanding which is very different”. Much more detail on this is his book ‘On Becoming a Person’.
I think one of the best signs of doing it properly is that the client will initially look like a rabbit in a spotlight – stunned. She will lose track of thoughts, stumble over words and simultaneously allow emotions to come up unhindered.
At a lesser level, we’re just talking about rapport. And one of the most reliable sign of rapport is when the client unconsciously starts to mirror you (in body language mainly). Some people will also address you in a much more front-on stance [shoulders squared with yours] when there’s good rapport, and also stand a bit closer than they would otherwise. Men also offer their hand to shake at the end of the treatment.
Breath synchronization can also happen with rapport. It’s easy to observe when the client is lying prone. I’ve tried forcing my breath to synchronize with a client’s during a treatment and some very odd stuff has happened.
Thanks EG – some really nice, juicy stuff to think on here.
Excellent post and concepts! I think it’s high time we teach our students principles and constructs of basic psychology, counseling, listening, motivational interviewing, etc.
I wrote recently about sympathy & empathy & caring at the PT Think Tank in a piece “Do you need to care to be caring? Sympathy, empathy, compassion, and caring in health care”
Kudos for continuing to make us analyze and think how and why we approach patient care, including what we listen for, and how we interpret those words…
It’s all about “Feeling” your patient in the true sense of the word…….just like ” Flying a plane from the seat of your pants” instinctively and intuitively …….This requires a deep sense of connection to oneself ….. I have experienced young children with this quality and high ranking professors with a total lack of it, so it’s not an age thing, and equally therefore not a learning thing……….and therefore maybe can’t be learnt…………I say again ” Learning Medicine is a science, Applying is an Art……
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