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CHAPTER 8: Listening and Responding Introduction Listening well to others is therapeutic, a healing activity. For that reason, doing so effectively is very important. Although case managers do not practice therapy as we think of it in a counseling setting, they do have many opportunities to listen to others in a way that is therapeutic. At intake and during the course of the relationship as problems and issues arise, the case manager can offer listening as a first and important step in the resolution of people’s problems. Writing in the American Journal of Psychiatry, Dr. Stanley W. Jackson (1992, p. 1624) talked about the importance of listening: The effective healer in the realm of psychological healing tends to be someone who is interested in talking with and listening to the other person. And these inclinations are grounded in an interest in other people and a curiosity about them. Further such healers have a capacity for caring about and being concerned about others, particularly about those who are ill, troubled, or distressed. Describing those who seek our help, Jackson wrote, “He seeks to be listened to, to be taken seriously, and to be understood, as crucial aspects of this process.” Finally, he talked about the process itself: The attentive listening of a concerned and interested healer can, and often does, have a compelling effect on the sufferer. The sufferer often enough responds by telling more about himself, by revealing more …. The relationship is deepened—more is said, more is heard, more is understood, more of a sense of being understood is experienced. Listening to another person in a way that indicates our concern for that person is important in the healing process. Reflective listening is a method that allows you to demonstrate such concern and interest in other people. Defining Reflective Listening Reflective listening is a term used to describe therapeutic listening and responding—a way of listening that is most helpful to people. This method of listening to others has three purposes. 1. Reflective listening lets people know you have heard their concerns and feelings accurately. 2. Reflective listening creates an opportunity for you to correct any misperceptions. 3. Reflective listening illustrates your acceptance of where the person is at that moment. When someone talks to you, there are two aspects to which you can listen and respond: 1. The content of what the person has said 2. The feelings that underlie what the person has said Responding to feelings is empathic and is, therefore, the most useful kind of response. When you accurately respond to the feelings the person is experiencing, that person feels heard. Someone is really listening. When clients feel that you truly hear them and that you hear the feelings they are expressing, even when they do not explicitly describe those feelings, they begin to develop trust and rapport with you, making it easier for them to fully talk with you about their problems and issues. As you saw in the discussion of roadblocks to good communication in Chapter 7, there are many responses that are barriers to trust and rapport. You want to provide a safe, accepting environment where people feel free to express themselves. For this reason, it is important to learn how to provide empathic responses that will further a constructive relationship with your clients. Responding to Feelings When you let another person know that you have heard the feelings that person is expressing at that moment, you are being empathic. Empathy is the ability to hear and experience accurately the underlying feelings and emotions that clients are expressing when they speak. We have empathy when we are able to put ourselves emotionally in their situations and clearly sense what they must be feeling. People may tell you how they feel in actual words, but much of our understanding of other people’s emotions comes from their facial expressions, body language, tone of voice, mood, and choice of words. In listening to feelings, we are listening to all of that as well as the words clients speak. In this way, we gain an understanding of the underlying emotions and concerns. It is important to really listen. Instead, many of us are tempted to think while other people are talking. We think about how wrong they are. We think about what they could do instead. We think about what advice we should give them and how to solve their problem. What we really should be doing is listening for the feeling and determining the degree of that feeling. For instance, a person may be angry or furious or just annoyed. Another person may be a little wistful, sad, or openly depressed. Can you tell the difference when you listen? Of course you can, when you are really listening for the feelings. Responding to feelings involves the following three steps: 1. Listening carefully to the client 2. Identifying the most prominent feeling you are hearing 3. Constructing a single statement that includes that feeling This single sentence that includes the other person’s feeling is called an empathic response. This is a specific way to practice empathy for clients, to acknowledge clients’ feelings and concerns. We use a single sentence because to add more often distracts the person or moves the conversation away from the central concern. A single sentence allows people to know that they have been heard and that they are welcome to continue on the same track; they are reassured. Reflective listening does not include advice or solutions. A reflective listener does not tell the other person to feel another way or to look at the problem from another perspective. A reflective listener does not judge the message or the feelings. See Figure 8.1 for some examples of correct and incorrect responses in different situations. FIGURE 8.1: Correct and incorrect responses when listening to feelings In the following dialogue, based on the situation in which a client has wrecked a new car, notice the way the worker stays with the client throughout the exchange: CLIENT (sighing as he sits down): I wrecked my car yesterday on my way to work. WORKER: It sounds like you feel pretty bad about it. CLIENT (sighing again): I do. I guess I should be happy no one was hurt, but I just got the car. WORKER: It was brand-new and perfect. CLIENT: I know. I picked it out and ordered it special. It had everything I wanted. I don’t know, in a way it was my fault. She ran the stop sign, but I wasn’t really paying attention. WORKER: You’re sort of blaming yourself for this. CLIENT: Oh, I did. I still do. The police said she was clearly in the wrong. But now I’m going through all this unnecessary stuff with insurance and using a loaner car and trying to get a new car. WORKER: You must feel so disrupted. CLIENT: Yeah, I do. Listen now as the same client speaks to a worker who is not trained in reflective listening. Notice how the worker pursues her own agenda and how the client begins to sound defensive and ultimately stops participating: CLIENT (sighing as he sits down): I wrecked my car yesterday on my way to work. WORKER: You wrecked your car? How did you do that? CLIENT (sighing again): I guess I should be happy no one was hurt, but I just got the car. WORKER: Well, what happened? CLIENT: The other driver ran the stop sign, but I wasn’t really paying attention. In a way, it was my fault. WORKER: Well, you can’t drive and think about 10 other things. When you are driving a car, you have to pay attention to what is going on around you. If you’re daydreaming, it doesn’t work. You can’t do that when you’re driving. CLIENT (sounding defensive): Well, I wasn’t really daydreaming or anything. I just didn’t notice her. You can’t always see everything the other drivers intend to do before they do it. WORKER: I guess you can’t, but sometimes I think there are just too many drivers out there anymore. CLIENT (nods): But now I’m going through all this unnecessary stuff with insurance and using a loaner car and trying to get a new car. WORKER: Well, that’s all part of it. When you wreck your car you’re tied up for months with all the bureaucratic paperwork. And they never give you what you need to buy another one just like it. CLIENT: Uh-huh. Let us look at another example of good listening. Notice how the worker in this next example identifies the strongest feeling present in what the client is saying and how the client almost always responds positively to that recognition: CLIENT (tears welling up in her eyes): I never went through this before. WORKER: It sounds like you are devastated. CLIENT (nodding and crying more openly): My dad died, last week. He … he … well, he had been in dialysis, but he seemed so good Sunday night. Then Monday the nurse called me at work—oh, I guess around 10:00—and suggested I come in, but she didn’t say it was an emergency or anything. WORKER: You must have felt you didn’t have to rush, that you had a little bit of time. CLIENT: Well, no, I went in as soon as I finished up what I was doing, and here he was already in intensive care. His breathing was so labored, so hard for him … (cries). WORKER: That must have been a shock! CLIENT: It was! I couldn’t believe it. That was my dad lying there. He just fixed my electrical outlet 2 weeks ago. We went out to eat for his birthday. I just couldn’t believe he would go now. WORKER: It was all so sudden. CLIENT: Oh yes, and then they are talking to my mom and I about how to make him comfortable. He knew me and all, but he couldn’t talk. And you know how they say people need permission to die? Well, I told him it was okay to go (cries). I told him he gave his life a good shot and he could go (whispering). And he did (cries). WORKER: That must have been so painful for you. Now observe what happens in this situation when the worker’s listening skills are inadequate. Notice in this example how the worker brings the conversation around to a more cheerful topic. In this case, the worker may very well be protecting himself from feeling the enormous pain of the client: CLIENT (tears welling up in her eyes): I never went through this before. WORKER: Like what? CLIENT (crying more openly): My dad died last week. He … he … well, he had been in dialysis, but he seemed so good Sunday night. Then Monday the nurse called me at work—oh, I guess around 10:00—and suggested I come in, but she didn’t say it was an emergency or anything. WORKER: So you went right in! CLIENT: Well, no, I went in as soon as I finished up what I was doing. I didn’t think she meant I had to hurry, and here he was already in intensive care. His breathing was so labored, so hard for him … (cries). WORKER: Did he have a living will? That would have helped you to know how to handle this. CLIENT: I don’t think he did. I don’t know. Mom and I made the decisions. We knew he couldn’t go on much longer, and we didn’t want him to suffer. I couldn’t believe it. That was my dad lying there. He just fixed my electrical outlet 2 weeks ago. We went out to eat for his birthday. I just couldn’t believe he would go now. WORKER: We never really know when death will strike, do we? We just have to look on the bright side, at all the good times we had with people while they were here. We know our parents won’t live forever. CLIENT: It isn’t that I thought he would live forever. It was just so sudden or something. We didn’t have much warning really. I guess in that respect I can say he didn’t suffer, you know, like in a long illness for years and years. WORKER: See. There’s something to be thankful for. There is a silver lining in everything. CLIENT: Sure. Did you notice that the client stopped crying? She took the cue from the worker that crying and continuing with the painful story about her father’s death was being discouraged. It must have been clear to you as well that a significant part of the story was left out. The first worker received more information about what really happened by saying less. The second worker said more, but cut off part of the story and, therefore, did not receive as much information. Good listeners stay with people until their emotions are drained off. If a client cries, we know we are helping that person to face and come to terms with intense emotion. People who are supported through this process by skilled listeners heal better than people who have been forced to shut down their feelings in front of the worker and deal with them alone. Responding to Content When you respond to the content of what clients say, you are usually doing it to check the accuracy of the information you believe you heard. Listening to content gives you clarity and helps you understand the facts. If the event the person is talking about was traumatic, listening to content helps that person to begin to hear and integrate this experience. We are helping that person to come to terms with what happened and heal. Generally, we listen to content less often than we listen to feelings. Figure 8.2 provides some examples of correct and incorrect responses in terms of listening to content. FIGURE 8.2: Correct and incorrect responses in listening to content Responding to content is a good way to help people who have just been through a traumatic event. As noted, when you repeat the facts of the traumatic event back to the person, the individual can begin to integrate her particular experiences into the whole of her experiences, and her healing is facilitated. In fact, the sooner people begin this process after a traumatic event, the more readily they may be able to heal in the future. Here is an example of a worker who listens to the content of a client’s discussion of a traumatic event: CLIENT (looks pale and shaken, and is silent) WORKER (responding first to feeling): It seems like you’ve been through something pretty terrifying. CLIENT (nods): I … Can I tell you? It was … in the parking garage at the hotel. Not late or anything. I heard this person get off the elevator as I … (is silent). WORKER: You had gone to the parking garage to get your car. CLIENT: Yes, and as I was walking toward the car, and it was at some distance, I thought I heard the elevator, and then someone started walking along behind me. WORKER: The person was walking behind you, but at that point you thought the person was just going to a car. CLIENT: Right. And just as I was ready to get in my car, … I mean, I almost made it, and he grabbed my coat and just pulled, just pulled as hard … just pulled me backward. WORKER: So, in other words, you were grabbed and pulled down from behind. Notice that the worker rephrases the facts the client gives so that the client hears them again. Through this listening process, it is not uncommon to find that unpleasant memories, which the client has blocked, begin to surface in the supportive atmosphere created by the worker. At this point, some people might say the client is lying or making up things because the story has changed somewhat. More often, however, the client is beginning to remember more of what actually happened because the worker is encouraging and has created a safe environment. Positive Reasons for Reflective Listening Some specific therapeutic reasons have been given for employing reflective listening. These are described in the following two sections. Self-Acceptance Arnold Beisser (1970), writing about Fritz Perls’ ideas, talks about Perls’ paradoxical theory of change. The theory asserts that people change only when they are able to accept themselves exactly where they are right now. Judgments about where clients should be only engages them in defending how they came to the place they are now. This wastes clients’ energy and the valuable time you have to work on healing. When you accept where the person is at the moment, the individual can accept herself and move forward. The most healing, and therefore the most therapeutic, practice is reflective listening. By saying “You must be angry,” you accept the fact that the client is angry. If you say “You should try to curb your anger and think more positively,” the client then has to explain why she has not done so or cannot do so. In this situation, some people say nothing and decide you do not really understand. By accepting, without judging, where the person is now, he can then move on toward something better. People cannot move in a positive direction until they have accepted where they are now. Drain Off Feeling In the human service profession, you will meet people in all sorts of life crises and difficulties. Some of the circumstances are very traumatic, and considerable reflective listening will be required on your part if the people are to begin the healing process. A woman who has been raped will start coming to terms with it sooner and heal more readily if she encounters a good reflective listener soon afterward. An older person can prepare for the end of life and feel comfortable about his past life if he can talk about it with a good reflective listener. Human service workers have been criticized for not listening long enough. Some take only a few stabs at it, and then move into problem solving: Where will this person stay tonight? Who should I call? What facts do I need to open this case? The importance of your role in trauma, in healing, and in helping clients to grow cannot be overestimated. You play that role in large part by practicing good reflective listening. Points to Remember Listen Reflectively Long Enough Do not cut short this important piece of the client’s healing process because you feel pressed for time. Be sure you go over the situation thoroughly once and, if you can, review it several times. In cases of violence, reviewing the content several times, along with listening to feelings, helps the victim begin to hear the story and come to terms with it. Reflective listening, in this case as in others, promotes healing. Introducing Solutions Do not rush to the solution phase of the interview unless the person seems extremely anxious about what will happen. Even if you have ideas, wait until the emotion has been drained off. You cannot confront the issues you feel are important if you have not done your reflective listening first. If you do, the client may go along with you, but not as well or with as much involvement as she would if she felt heard and understood. For instance, if you immediately explore your concerns about where the client will stay tonight instead of acknowledging the loss of her home in a fire just hours ago, she will not be as ready to work with you on solutions. Her mind is on her many losses, and her emotions may be ranging from guilt to anger. Listen first. Likewise, if you try to help a young couple with the details of their baby’s funeral without listening to their story about the baby and the baby’s death, you will be taking care of the details that matter most to you, but the clients are likely to experience you as unfeeling and impersonal. By starting where they are, you can help them to move toward the matters that must be addressed. Most important, you help them to integrate this experience into the whole of their life experiences, making it easier for them to ultimately accept the reality. If the client would obviously feel comforted to know there are solutions or resources, tell him about these first, but then demonstrate reflective listening at another point in the interview. If the interview is pressed for time, after you give the information that is needed, give at least one reflective listening response. “I know losing your home has been devastating for you” or “This evening must have been heart breaking.” The person will leave feeling as if he is understood. Reflective Listening Does Not Mean You Agree Just because you say to a client “You must feel very angry” does not mean you think the client should feel angry or should not feel angry. You are simply acknowledging where the person is right now. You have accepted that. This makes it easier for him to accept that. Now he can more easily move from being angry to something better. You Could Be Wrong Suppose you say to a client, “It must have made you sad to see your parents go through that.” The client responds, “Well, not really. I think I felt more anger than sadness.” This is a good exchange. Here you get important, corrected information that allows you to follow the client’s concerns more accurately. Reflective listening allows us to clarify and correct things so that we are following where the client is at the moment. Mind Your Body Language To facilitate the interview, lean toward the client, look the person in the eye, nod, and look interested and enthused. While the client is talking, do not fiddle with things on your desk, lower your head to write, stare out the window, or glance at your watch. Give body language signals that indicate you are being attentive to what the person is saying. Do not stand over people talking down at them. If the client is in a wheelchair or is a small child, get down to a level where you can make eye contact. Pull up a chair so that you can look at the person directly. Summary Good listening is one of the most supportive and healing techniques you will practice in your work with other people. The opportunities to provide solace through good listening skills are numerous and occur in many diverse settings where people come for help. What you give to people in uncertain circumstances and difficult times is the gift of truly being heard and understood. You bring with you the warmth and interest in people that makes them feel valued. Their story is an important story to you. Their anxiety or sad feelings are noted and responded to. Whether or not you are able to effect a positive resolution to people’s problems, your listening skills will always provide the support people need to take up the tasks of their lives and go on. Video Examples To view the videos that accompany this book, go to CengageBrain.com. • You can see Keyanna responding to the underlying feelings Michelle has about her situation by watching “The First Interview” online. Two other vignettes demonstrate how this is done: “Developing a Service Plan” and “Helping Tom Solve a Personal Problem.” Exercises These exercises can also be filled out online at CengageBrain.com. Exercises I: How Many Feelings Can You Name? Instructions: In a group of no more than four people, see how many feelings you can name in 10 minutes. Remember that there are many different degrees of the same feeling. After you do the exercise check your list against the list in the appendix. Exercises II: Finding the Right Feeling Instructions: When responding to feelings, it is important to know the intensity of the feeling. It is very important to reflect to clients an accurate reading of what they must be feeling. All feelings have varying degrees of intensity. For each word listed here, list other words that mean the same thing but indicate varying degrees of the feeling identified by the original word. The first one is done for you as an example. Check the list of feelings in the appendix to see if there are other words you missed. HAPPY: overjoyed, exhilarated, glad, delighted, cheerful, ecstatic, merry, radiant, content, elated, euphoric, ebullient, chipper, bouncy, bright, joyful, pleased SAD: ___________________________ CONFUSED: _________________________ TENSE: __________________________ LONELY: __________________________ STUPID: ___________________________ ANGRY: ___________________________ ___________________________ Exercises III: Reflective Listening Reflective Listening I Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “When I was in court, the defense attorney really pounded me. You know, like he thought I was lying or didn’t believe me or thought I was exaggerating.” FEELING: EMPATHIC RESPONSE: 2. “Those dirty, lousy creeps! Everything was fine in my life, and they really, really ruined everything! I don’t care if I go on or not. Why live if someone can just take everything away from you in one night?” FEELING: EMPATHIC RESPONSE: 3. “I know you said this is temporary housing and all, but I never had a place like this place. I can’t stand to think I have to move again sometime, and God knows where I’ll go.” FEELING: EMPATHIC RESPONSE: 4. “This whole setup is the pits. He gets to stay in the house after beating me half to death, and I have to go to this cramped little room. Does that make sense?” FEELING: EMPATHIC RESPONSE: Instructions Part II: Now go back and respond to the content in each of these vignettes. Reflective Listening II Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “Sometimes it kind of makes me sick to think of all the stuff I did when I was drinking. I’d like to go and take it all back, but how do you ever do that?” FEELING: EMPATHIC RESPONSE: 2. “I just can’t go out in the car. All I hear is the screech of tires and the awful thud and scrape of metal. I thought I was dying. I can see it all before me as if it was yesterday.” FEELING: EMPATHIC RESPONSE: 3. “We have a neighborhood problem here! Yes we do! A real big idiot lives in that house. A real nut! He trimmed my own yard with a string trimmer and threw stones all over my car. Ruined the paint!” FEELING: EMPATHIC RESPONSE: 4. “I never meant to get pregnant. I know everyone says that, but I didn’t! I can’t think straight. What about my job and school and all my plans? I feel sick. I feel all the time like I’m going to faint.” FEELING: EMPATHIC RESPONSE: Instructions Part II: Now go back and respond to the content in each of these vignettes. Reflective Listening III Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “I can tell you now, I just can’t go back there. I just feel as if my husband will kill me one of these times.” FEELING: EMPATHIC RESPONSE: 2. “I can’t stand those people! They made fun of that retarded kid night and day. I hope they get theirs!” FEELING: EMPATHIC RESPONSE: 3. “I’ve been clean for 8 months! If you had told me this would happen a year ago, I’d have laughed in your face.” FEELING: EMPATHIC RESPONSE: 4. “When I was a little kid, my mom and dad got along okay, but now they fight all the time, and my mother says my dad is on drugs and has a girlfriend. Home is like hell.” FEELING: EMPATHIC RESPONSE: Instructions Part II: Now go back and respond to the content in each of these vignettes. Reflective Listening IV Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “When I took that test, it was really hard. And I guess I was nervous. I mean, I couldn’t think of any of the answers.” FEELING: EMPATHIC RESPONSE: 2. “Those guys are lousy! They’re always snickering and making fun of other people, especially people who have a disability. They make me sick!” FEELING: EMPATHIC RESPONSE: 3. “I know Jim said we could be buddies at swim practice, but I’m probably not as good a swimmer as he is. I feel sort of silly trying to swim with him. Maybe he would like to have a better buddy.” FEELING: EMPATHIC RESPONSE: 4. “This whole setup sucks. This other guy gets the tutor, and the teacher tells me to go home and see if my mother can tutor me. She never had this math. Math isn’t even her thing. Does that make sense?” FEELING: EMPATHIC RESPONSE: Instructions Part II: Now go back and respond to the content in each of these vignettes. Reflective Listening V Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “Well, every time I go off my meds, I get kind of crazy. My minister is really putting the pressure on me to quit and let God take over my illness.” FEELING: EMPATHIC RESPONSE: 2. “The people at the halfway house are so nice to me, compared to the way things were with my family.” FEELING: EMPATHIC RESPONSE: 3. “You have some nerve, having the therapist see my son every week for 6 months, and then you refuse to tell me more than ‘he’s doing better.’ How do I know he’s doing better?” FEELING: EMPATHIC RESPONSE: 4. “I’ve been on the streets since 1972, and I never slept inside a night until now. I don’t know, I just can’t seem to stay out like I used to without getting this cough.” FEELING: EMPATHIC RESPONSE: Instructions Part II: Now go back and respond to the content in each of these vignettes. Reflective Listening VI Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said. Behind the words, however, lie the feelings. Often it is most helpful to respond to the feelings. Following are statements made by people with problems. For each statement, first identify the feeling; write down the word you think best describes how the person might be feeling. Next, write a brief empathic response—a short sentence that includes the feeling. Refer to the sample openers provided in Chapter 7 under the heading “Useful Responses.” 1. “I can’t believe I was that intoxicated! I just don’t believe it. Their gizmo must have been broken or something. I just didn’t drink that much and I wouldn’t be driving if I had!” FEELING: EMPATHIC RESPONSE: 2. “You don’t expect us to take Alfred into our home, do you? He is very mentally ill—tore up the house several times. I really—well, I know he’s my son, but I just can’t deal with the way he’s been in the past.” FEELING: EMPATHIC RESPONSE: 3. “I can tell you what scares me most. It’s being by myself at the house one night and having him come back. I don’t know if I can go on living there.” FEELING: EMPATHIC RESPONSE: 4. “I just can’t go to class. Not after making a fool of myself the last time. I got every answer wrong when the teacher called on me, and people were making fun …. It was terrible!” FEELING: EMPATHIC RESPONSE: Instructions Part VI: Now go back and respond to the content in each of these vignettes.