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The Art of Listening as Affirmation

The Art of Listening as Affirmation
Photo: The Art of Listening as Affirmation
As a public health researcher I worked for a time in an acute inpatient ward of a large mental health facility. In this ward some of the staff had worked with particular consumers over many years, knowing their capacities and difficulties well. A keen observer of human interaction, I was particularly struck by two nurses: one a young man in his late thirties, and the other a woman in her sixties, who listened intently to their patients’ stories, the kind of “active listening” you observe in people wholly engaged in the language of the person they are relating to. The nurses’ body language was calm and empathic. There was no visible attempt to formulate responses, something Freud promoted (Purdy, 2011). Nor was there condescension or a sense of the innate difference of speaker and listener. There was no way, or indeed need, to quantify the outcomes of these interactions.It was clear that this attentive listening was nurturing and deeply appreciated.

Some years later I had the privilege of coordinating a research project exploring the experience of people with mental illness who had been admitted involuntarily to hospital, a predominantly qualitative project. The project team created a number of “safety net strategies,” in case my interviews re-traumatised people whose memoriesof their admission were very painful. One of these strategies was a telephone call perhaps two days post interview, simply asking participants how they were travelling. I was struck by how frequently people would say that on the contrary, rather than feeling anxious or traumatised, they deeply appreciated being able to tell their stories to someone who really listened, as if this was a rare occurrence. I interpreted these comments in the context of the   relative luxury I had as a researcher speaking to people individually or in focus groups, in contrast to nurses, who juggle a myriad of clinical tasks and obligations. How hard must it be for nurses to really attend to consumers on wards, when their minds are rolling through a list of tasks to be achieved prior to their change of shift?

The fundamental tenet of therapeutic listening is nothing new in clinical spheres. There is a wealth of academic literature promoting the therapeutic benefits of listening well in any clinical setting (Hirdes A, 2003; Stickley and Freshwater, 2006). Attending closely to other people, patients or friends, is a skill that some people are innately better at than others, with ongoing debate about whether or not listening skills can be learned. Active listening is a core component of clinicians’ communications skills training in undergraduate modules.

Deep attentive listening is also a skill we need in life generally, but one we tend to take for granted rather than consider closely. It seems common sense that when we perceive the listener as wholly focussed on us, we are acknowledged and respected by them. Equally all of us have had the experience of recognising the distraction of a listener, and how this seems to negate us. Philosophers like Martin Buber emphasised the deep need of all of us to be affirmed by the people we speak to, to be acknowledged irrespective of the kind of social encounter (Gordon, 2011).

How then to translate this very basic life and clinical skill into core practice? The enduring debate about the gap between policy and practice is relevant here. Nurses are often simply too busy, understaffed, and inundated with paperwork to be as attentive to patients as they would wish. Psychiatrists bemoan the current medication focus at the expense of more reflective therapeutic modalities of twenty or thirty years ago.Clinical settings are often noisy and hyper-stimulating, offering little in the way of calm, reflective space. 

There are additional cultural factors posing challenges. This is very obvious when reading anything written in the nineteenth century or before, when writers such as Charles Dickens went to what seems to our current sensibilities extraordinary lengths to describe a person’s physical self, their face, voice, gait and general manner.

People today are far more inclined to be intently focussed on small rectangular screens than on peoples’ faces and voices.Medical students on rotation in a mental health facility in which I worked would attend the staff tea room, a place where psychotherapists and nurses would frequently discuss various theoretical approaches, their challenges, utility and acceptability to consumers. This seemed a perfect milieu for students to listen, to ask questions and to learn from people with lengthy experience in a range of psychological treatments. Instead they sat heads down, thumbs frenetically tapping a phone, wholly engaged in their digital devices.Will the skill of attentive face-to-face communication simply atrophy as people fixate more on screens and less on other human beings?

Nurses have a multitude of tasks, in a culture that no longer seems to value interpersonal focus. How then to ensure in clinical settings that listening well to patients is assured?It may seem potentially insulting to suggest to highly skilled and experienced nurses that they practise active listening to patients wherever they have even a brief opportunity; engaging staff and stimulating discussion about the issue will reveal barriers and solutions

References:
Australian Health Ministers Advisory Council (1997) National Standards for Mental Health
Services, Canberra. Department of Health and Aging, p. 29.

Gordon M (2011). Listening as Embracing the Other: Martin Buber’s Philosophy of Dialogue.Educational Theory, Vol 61, Issue 2, pages 207-219, April 2011.

Hirdes A (2003), Therapeutic Listening: a work instrument at the service of mental health? International Journal of Psychosocial Rehabilitation. 8. 37-46.
Purdy M (2011), Freud and Jung on Listening and Projection: Presence in the field.Cited 5th September 2014.
http://www.academia.edu/1226927/Freud_and_Jung_on_Listening_and_Projection_Presence_with_the_field
Stickley T, Freshwater D (2006), The Art of Listening in the Therapeutic Relationship.Mental Health Practice. February 2006, Vol. 9, Issue 5, p. 12.

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Ellen Rosenfeld

Ellie Rosenfeld has been a public health researcher for 25 years, beginning in the field of injury surveillance and prevention. She has conducted studies in a broad range of public health areas such as diabetes, smoking cessation and mental health.  She holds a Bachelor of Arts degree, a Graduate Diploma of Special Education and a Master’s of Public Health.  Ellie has lectured and tutored in public health, research ethics and medical ethics.  She has a particular interest in mental health research at levels of both practice and policy. Her research life began with quantitative studies, however her preference is for the depth and meaning afforded by qualitative research.  Ellie is currently engaged in ethnographic research considering the way in which hospital staff in paediatric settings discuss medication with other staff members, with patients and their families. Ellie has a life-long passion for literature and writing.