Listening skills in therapy

Clinicians, such as counselors, psychologists, and clinical social workers, work in therapy settings with a number of patients. During this time, it is essential to showcase to the patient that they are well-understood and listened to. This is to ensure that the patient feels that the clinician truly cares about their well-being and is attending well to their feelings and problems. After all, if the patient doesn’t think the clinician even knows what the issue is, they cannot have confidence that the patient and clinician are on the same page and working to get to the right solution.

Listening skills are basic counselling techniques that every clinician has in their back pocket. That’s because being a good listener and understanding the patient’s concerns is something that all clinicians strive to do regardless of their therapeutic orientation or field of expertise.

Listening skills are important in a few different ways. First, they help to indicate to the patient that the clinician understands their problem. Second, it creates a feeling of trust and develops positive therapeutic alliance. And third, it can be helpful in formulation – which is just a fancy term for beginning to understand what the patient’s problems are and what could be factors that are maintaining the problem. The last point is particularly helpful for determining which therapy technique to use.

Overall, listening skills can lead to a better therapist-patient relationship, increased well-being and feelings of social support from the patient, and assist with developing insights and formulation.

Below, I list 3 common listening skills clinicians can use with patients to support a strong working relationship.

Listening Skill #1: Reflections

Reflections are – as the name suggests – statements that reflect upon the deeper meaning of what a patient said. That is, what is underlying a patient’s thoughts or feelings when they are provide more surface-level information.

To give an example, let’s say a patient (Troy) is talking about his relationship with his father. Over the next couple minutes, he discusses many instances where his father would often spend more time with his brother and give his brother a lot more opportunities. A reflective statement in response to this could be “he prioritized your brother over you” or “it was important for you to also feel like you mattered to your dad”.

As you can see, these statements succinctly reflect the underlying feelings of unfairness and desire to be treated similarly to his brother.  

Another example might be a person discussing the many changes that are happening in her life: she recently got out of a romantic relationship, is living in a new city, and starting a new job. A simple reflective statement might be “this must be a huge transition for you”.

Listening Skill #2: Summarizing

Summarizing (or summary statements) are a way to paraphrase what the person has told you about something.

At first glance, some people might consider summary statements to be rather trite or lazy – all you’re doing is providing a shortened version of what the person just said. However, I personally disagree.

Summarizing can be a great skill because it helps get to the pit of what the person is saying without the details that are of less importance. In some cases, it clearly lays out the dilemma or issue that a person is having.

For example, let’s say Abby is having difficulties with her decisions about quitting nicotine. She spends several describing her parents and friends concern over her smoking and recognizes the dangers of nicotine use. However, she also describes that nicotine isn’t all bad and it helps her feel calm at times.

A summarizing statement can clearly outline the dilemma for Abby: “It’s difficult because on one hand there are several disadvantages of smoking such as friends and family not being approving and possible dangers of nicotine use. On the other hand, you do find some comfort in using nicotine”.

In my own practice (not to toot my own horn), many patients have complimented my use of summary statements because they feel that it really helps them clearly think about their current situation and how they feel. By doing so, the patients feel as if the torrent of overwhelming thoughts and emotions are calmed, and they are able to better focus on what their problem truly is.

Listening Skill #3: Empathy Statements

A third listening skill is empathy statements. These statements showcase that you understand and can resonate with the patient’s emotions in a given situation. Examples include “that must make you feel very frustrated”, “you’re feeling hopeless”, or “what a confusing experience!”.

Empathy statements can be tricky sometimes because you don’t want to incorrectly guess their emotions. For example, if you take the example of the patient discussing his father’s unfairness towards him, you might respond with “that must make you feel very sad”. In response, the patient might actually say “sad? No, I am angry with him!”. In order to make sure that you are accurately describing a patient’s emotions, it can be helpful to ask exploratory questions (e.g., what were you thinking at that time? what feelings did you notice?) to ensure that your empathy statements are on point.

How do I know the listening skills are working?

Oftentimes, you’ll hear from the other person a few things that tell you you’re on the right track. For example “yes, that’s exactly how I feel!”, “that’s right”, and “you really help clarify what I’m deliberating” could be possible responses you might hear.

In cases where the person corrects you, that’s okay! It doesn’t mean that the working relationship will break down and it’s all over. Acknowledge your mistake in a straightforward manner, apologize, and continue attentively listening!  

Okay, I’ve used the listening techniques. What’s next?

When I was a junior trainee, I never had too much difficulty with these listening techniques. However, I always wondered – okay, I’ve empathized and summarized their problems. Now what? We’ve developed a strong relationship, but what do I do next?

If you and the patient feel ready, this is where you move into more active therapeutic change. For example, you might encourage the use of thought records in cognitive behavioural therapy to support cognitive change if the person has negative beliefs that are heavily affecting their mood and their life. Or in the case of a huge transition, you might take a problem-solving approach to make sure they feel prepared for things that are coming their way or use relaxation techniques to reduce their stress. This are just possible examples of active therapy strategies you can use.

Listening skills are a great way to develop the relationship and understand more about the patient’s problem, so you have a good idea of what clinical techniques to use to best help support them!

I hope this post was helpful in learning how to use listening skills, whether it’s with your patients, friends, or family members!

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Best wishes,

P