Active Listener

Active Listening

Active Listening

We can all recall situations where we have utterly failed to listen to what someone else is saying. For various reasons, we are simply not taking in anything useful. How many times have you been introduced to a person by name only to not know what their name is thirty seconds later?

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Therapeutic Interventions

Use modeling, role-playing, and behavior rehearsal to teach the client healthy problem-solving and communication skills to use in recovery (e.g., active listening, using I messages, cooperation, compromise, and mutual respect). 14. Use modeling, role-playing, and behavior rehearsal to teach the client healthy problem-solving and communication skills to use in recovery (e.g., active listening, using I messages, cooperation, compromise, and mutual respect).

After the Evidence Motivational Interviewing

The most promising technique of active listening to help patients The most promising new technique of active listening for health care practitioners is motivational interviewing (MI). It is beyond the scope of this chapter to provide detailed instructions in the related skills, which must be experienced and practiced over at least a few months. This section discusses the underlying principles and simple ways to start implementing these skills in medical practice. The development of skills requires sufficient understanding of the basic theory of MI to try the related clinical style with patients. Patients will then provide enough direct and immediate feedback to help physicians quickly refine their skills. The relevant basics of theory and practice are readily accessible (Rollnick et al., 1999, 2008 see also Web Resources). Listen use empathic, active listening throughout the clinical interview.

Nursing interventions

Active listening is not a very safe occupation. The consequences may be emotionally painful to the nurse because of the difficult questions that may be asked. Many may feel inadequate or too inexperienced. Koshy (1989) describes active listening as 'the process of receiving and assimilating ideas and information from verbal and non-verbal messages and responding appropriately'. Tschudin (1991) emphasises the importance of not making assumptions it is too easy for nurses to assume that they not only know the problem, but also have the answers for dealing with it.

The Psychiatric Examination

Examiners should conduct a thoughtful psychiatric interview, using the principles of the clinical interview as a guide (Table 10-2) (MacKinnon et al. 2006). Open-ended questions, active listening, and minimal interruptions are basic tools in a psychiatrist's repertoire and should not be discarded in forensic settings. For numerous reasons, some examinees may be withholding, guarded, or mute. Perhaps a more difficult plaintiff to examine is the one who speaks volumes without content. These difficult-to-examine plaintiffs can be interviewed similarly to patients who exhibit the same behaviors. The examiner must be flexible, patient, and sometimes inventive in trying to complete the task at hand (see Chapter 7, The Forensic Psychiatric Examination and Report, this volume, for a comprehensive discussion of the psychiatric interview).

Speak to be understood

W e've advocated effective listening as the best way to increase trust, cooperation, and understanding and as a prerequisite for effective communication back to your difficult person. When you express yourself, it's important to do so in ways that produce positive effects. The signals, symbols, and suggestions that constitute our communication output provide a profound opportunity to influence relationships for the better. Here are six effective techniques.

Classification of Crisis Incidents

J is an example of a nonhostage situation the rejected husband holds his wife against her will. Emotionality is driving the situation. A different strategy is used to resolve such situations, because perpetrators already have what they want, the victim. Noesner (1999) suggests maintaining low-profile containment, using patience and understanding, and giving without requesting something in return. Noesner (1999) recommends using active listening skills to lower emotion, defuse anger, and create rapport. The Behavioral Change Stairway Model (BCSM) uses a five-stage approach that includes 1) active listening, 2) empathy, 3) rapport, 4) influence, and 5) behavioral change (Vecchi 2005). Data from the Hostage Barricade Database System (HOBAS) show that 92 of all law enforcement incidents are emotionally driven, with the subjects having no clear goal (Federal Bureau of Investigation 2001). The FBI is using the HOBAS data to further characterize incidents...

Preparing a Speech in Another Language

In making a presentation in a different language, not only are your speaking skills important, but so are your listening skills. Listening is important for understanding questions, which can arise from several different people, each with a significantly different accent. For that reason, just memorizing and practicing a speech in the other language is not enough, as Niels Bohr found out in his meeting with Churchill (discussed in Chapter 2). You have to be able to understand the questions and to respond on the spot.

Role of Psychiatrists

The guidelines of the National Council of Negotiation Associations advise that negotiation teams consider establishing a consultative relationship with a mental health professional. The mental health professional should serve as a team advisor and not as a negotiator, participate in negotiation team training, respond to team call outs as requested, focus on behavioral assessment of the subject and assist in team debriefing after a critical incident (National Council of Negotiation Associations 2001, p. 3). The FBI has recommended that because mental health professionals have well-developed active listening skills, they can provide feedback during training of officers engaged in role-playing exercises (Van Hasselt and Romano 2004).

Example of clinical reasoning process

In the following illustration some examples of the clinical reasoning process are given in italics. In this clinical example not all possibilities are explored the main emphasis is on trying to establish a mechanical diagnosis and appropriate management. The data gathered was relevant to this end and another clinician with an alternative perspective could have focussed on other aspects of the case. It should also be noted that the patient initially displayed a number of poor coping responses to her problem, typically labelled 'yellow flags' or 'barriers to recovery'. However, following a thorough assessment process, good listening skills by the clinician, good rapport between clinician and patient, and a convincing management strategy. the patient responded to the intervention and the 'yellow flags' disappeared. This highlights the fact that overly focussing on poor coping strategies, rather than performing a thorough mechanical evaluation, may actually undermine patients'...

Auscultation The Technique

There are several other pitfalls in auscultation. Make sure that the stethoscope is in good shape Cracked tubing certainly interferes with good listening. Both the examiner and the patient must be comfortable for the best hearing. An examiner who is straining over the patient and is uncomfortable will want to finish the examination quickly without a proper assessment. Always inspect and palpate before auscultation. Accumulate as much information as possible before listening

A diagnosis of cancer

The NHS Cancer Plan (DoH, 2000a) stresses the importance of good communication between health professionals and patients. But, however good communication is, it alone is inadequate. The individual patient, together with carer(s) and family members, needs the offer of ongoing support from the time of diagnosis and throughout the entire patient journey. If the 'offer' is initially refused, health professionals need to ensure that it is repeated at appropriate times. Support can take the form of 'active listening', providing written information, or onward referral to other professionals, such as specialist nurses, social workers, palliative care specialists, counselling services, voluntary organizations, etc. Whatever support is offered, it must be appropriate for that individual (Young, 2001).

The Listening Environment

The following LISTEN paradigm is only a suggestion, and health care clinicians should modify it for their own practice situation and environment. The purpose of the paradigm is to provide a structural mnemonic that moves the conversation logically and holistically throughout the interview. As determined by the clinician, any particular part of the interview may be expanded as the situation warrants, and any part may be minimized. By covering each part at least minimally, the clinician can achieve a general overview of the functioning and strengths of the patient or client, as follows L Listening is active and empathie, as the clinician maintains a friendly countenance and good eye contact, while responding in a respectful and affirming way to the person. Active listening includes verbal and nonverbal listening. It means to look and listen, to listen with the eyes and the ears, assessing the person's behavior and facial responses. It includes an assessment of dress, grooming, and...

Motivational Enhancement Therapy

Motivational enhancement therapy (MET) engages patients in increasing their internal motivations for making healthy changes in their drug use, building on a patient's strengths and resources in making prior behavioral changes. Goals are set by the patient, although the counselor may advise specific goals when appropriate. This approach is noncon-frontational. The counselor seeks to have the patient talk about the pros and cons of the substance use, reflecting and summarizing as an active listener in a way that highlights discrepancies between the patient's life goals or beliefs and current drug use behaviors. These discrepancies are then used to increase the patient's internal desire for change or discomfort with the status quo. A patient's stage of readiness to change, whether precontemplative, contemplative, preparation, action, maintenance, or relapse, is also determined at each session. In addition, a patient's self-efficacy for change is assessed, and the patient is guided to...

Listening Well

A good family physician must be a good listener. Of all the communication skills essential to rapport, the ability to listen well is probably the most important. All the information in the world about body language, vocal messages, and nonverbal cues is of limited value unless it helps the family physician be a better listener. As Lown (1996) states, In the brief time available to take a history, the aim is to obtain, in addition to essential facts, insight into the human being. This seems easy, but listening is the most complex and difficult of all the tools in a doctor's repertory. One must be an active listener to hear an unspoken problem (p. 10). The appearance of readiness to listen is aided by bending forward and maintaining eye contact. The physician can discourage a patient from talking by looking away or writing in the medical record. Well-chosen questions can be rendered useless by inappropriate nonverbal behavior. Even great questions are of no value if you do not know how...

Listen to understand

Vhen people express themselves verbally, they generally want evidence of at least two things they've been heard and they've been understood. A good communicator tries first to be a good listener. We advocate five steps toward good listening. The first step toward good listening introduced in the last lesson is blending. How does someone know that you're listening and understanding In essence, it's through the way you look and sound while they're talking. Rather than distracting a difficult person with puzzled looks, interruptions, or statements of disagreements, help him or her to fully express his or her thoughts and feelings. You do this by nodding your head in agreement, making occasional sounds of understanding. Everything about you, from body posture to voice volume, must give the impression that you hear and understand. Learn and practice the five steps to good listening


The sections on patient advocacy, communicating, truthfulness and consent will be considered together. Patients have the right to choose whether to accept or refuse care. In order to make an informed decision a patient needs to know all the relevant facts. Communication is extremely important and involves active listening as well as speaking. Good record keeping is also essential. Seeking consent from a patient may mean making compromises if a patient is not willing to accept all the aspects of a particular treatment. For example, if a patient is not prepared to


Be flooded with a large amount of irrelevant information by some patients. Data-gathering requires empathy and active listening by the clinician and the knowledge base to ask the appropriate questions when the initial response is unclear. Unless the situation is relaxed, friendly, respectful and non-judgemental, the patient is unlikely to tell his or her whole story.