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Features Practice Technique
An Issue of Ethics: Spring 2004

A few years ago, a commercial on CBC television stated, “Let’s talk, we need to communicate.” Although it is obviously true that communication involves talking or the verbal transmission of information, the true medium that promotes and fosters communication is listening.

September 24, 2009  By Cidalia Paiva

A few years ago, a commercial on CBC television stated, “Let’s talk, we need to communicate.” Although it is obviously true that communication involves talking or the verbal transmission of information, the true medium that promotes and fosters communication is listening.

The ability to listen to our patients is one of the greatest gifts and perhaps the most effective healing modality the therapist possesses. Most of us feel so seldom heard and validated, that those few rare instances when someone gives us their presence, attention and energy to be truly with us, and see us as we are, are rare and precious.

listening1.jpgBut it is most often in these special instances that true communication occurs and that healing is facilitated.

Listening, however, may be something that many of us may have little experience with.


We are so often caught up in the business of our lives, trying to get our own point of view across and be heard, that we are not in fact even reflecting on the question, do I listen, or am I a good listener, and if not, how can I become a better listener?

At other times, we may think we are good listeners, and we may discover when a spouse or friend stops trying to communicate with us that we simply took it for granted that we could communicate because we thought our relationships were working. When they stop working we may start asking ourselves what happened, and discover that we did not after all possess this often taken for granted ability and skill. 

While some of us are instinctively better listeners than others, the practice of good listening, especially in health care, requires the development of listening skills.

The skill of good listening involves the ability to respond reflectively, that is to say, to restate the feelings and/ or content of what the other person has said in a way that demonstrates understanding and acceptance.

As theologian John Powell writes, “Listening in dialogue is listening more to meanings than to words.

In true listening we reach behind the words, see through them, to find the person who is being revealed.

Listening is the search to find the treasure of a true person as revealed verbally and non-verbally. There is a semantic problem, of course. The words bear a different connotation for you than they have for me. Consequently, I can never tell you what you said; only what I heard. I will have to rephrase what you said and check it out with you to make sure that what left your mind and heart arrived in my mind and heart intact and without distortion.” 

listening2.jpgIf we do not listen to and for the feelings behind the words, we miss the person, his or her joy, sorrow, pain, anger and so on. Ultimately, we communicate best and achieve the greatest source of mutual recognition and understanding and a desire to stay in relationship when we listen to the other person’s feelings.

If we cannot or do not listen to his or her feelings, we miss out on him or her and the opportunity to connect on a deeper and more meaningful level in the future.

The ability to be emotionally sensitive to another is a gift for some, but for many others it is a skill which requires lifelong learning and practice. Many of us are more apt to focus our energy on the content rather than the feelings behind a speaker’s message. This can be especially true when we are busy, when we find ourselves triggered by a specific statement, or when we have had very little experience listening for feelings, rather than content.

A second and very important factor in facilitating the health care professional’s ability to communicate with patients is empathy.

What is empathy? Psychologist Carl Rogers, whose work has greatly facilitated our efforts to understand the concept of empathy, defines empathy as, “Entering the private perceptual world of the other and becoming fairly at home in it.” 

He further explains that empathy includes communicating your sensing of his world as you look with fresh and clear eyes at elements of which the individual is fearful. It means frequently checking with him as to the accuracy of your sensing, and being guided by the responses you received. To be with another in this way means that for the time being you lay aside the views and values you hold for yourself in order to enter another’s world without prejudice. (Rogers, 1975, p. 4)

It is important here to distinguish empathy from sympathy.

These two words are frequently used interchangeably, although their meanings are very different.

Sympathy is the concern, sorrow or pity shown by one individual for another individual. It is the expression of one’s own feelings about another person’s predicament and the urge to relieve their suffering.

Empathy is an attempt to feel with another person, to understand the other’s point of view.

Empathy involves taking the role of another and attempting to feel the way that person feels. In empathy, the focus is on the client with the problem, whereas with sympathy, the focus shifts away from the client to the listener.

listening3.jpgEmpathy essentially involves putting yourself in someone else’s shoes. Or as the famous Sioux adage enjoins us “never to judge another until we had walked for two weeks in his moccasins.” There is a wonderful story, a Brother Grimm’s fairy tale which captures this concept perfectly.

There was an elderly man who lived with his son and his son’s wife.  The father was almost deaf and blind, and had difficulty eating without spilling food. Occasionally he would drop a bowl and spill it.

The son and his wife thought it disgusting and made him eat in the corner behind the stove. They gave him a wooden bowl which couldn’t be broken. One day the grandson was working with some pieces of wood when his father asked what he was doing. “I am making a trough,” he said, “for you and mother to eat out of when I grow up.” They got the message, and the grandfather rejoined the family at the table.

Demonstrating empathy to clients or patients produces positive therapeutic outcomes. Showing empathy reduces clients’ feelings of alienation and being all alone with their predicament. When patients feel understood, they feel connected to others, and a part of life.

Empathy also helps clients feel that others care about them, which leads to greater self-acceptance. Empathy enhances clients’ feelings of being understood and facilitates their adjustment to sometimes stressful situations. Being understood in a non-judgmental way, assists clients in feeling positive about their worth.

Finally, empathy provides clients with a sense of control. If professionals have listened to them without making judgments, clients feel like they can express their own thoughts without opposition or evaluation.

The non-verbal expression of empathy is equally important and conducive to our efforts to communicate empathy to clients and colleagues. In fact, it is only when our verbal expression of empathy is delivered by a warm and caring presence that we are able to communicate our genuine care and concern for them.

However, we must be cautious and keep in mind that if we overdo it, that is, if we overwhelm the client with empathy, this effort will prove counter-productive.  

Empathy is not about the judgment of “you poor thing,” it is a clear, value-free message you send to the client that tells him or her that you understand where he or she is coming from. The warmth we extend to our clients must convey genuine caring for him or her, not feigned sincerity aimed at achieving a result that our presence cannot confirm and in fact, betrays.

Remember, the client is listening for our sincerity in order to ascertain whether to move forward or back away with her trust. Only true sincerity and caring will facilitate the client’s moving forward in trust.

If you do not genuinely care about how your client is feeling, using an empathetic response will not work. The client will feel and experience the incongruence between your words and your intentions.

Even if you become expert at the verbal expression of empathy, your intentionality and non-verbal behaviour will convey the truth to your client and he or she will not likely respond to your efforts.

The mixed message you send your client will likely be experienced as confusing at best and/or lacking in integrity and sincerity at worst, both of these responses will assuredly thwart your efforts to build a positive and effectual therapeutic relationship with the client.

Patients have a need to see health care professionals as competent practitioners who care about them and whom they can trust. In order for a patient to perceive a health professional as trustworthy, he or she must experience him or her as a good listener, who can sincerely empathize with them in order to serve their best interests and well being.

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