The Most Fundamental Therapy Skills Explained: Active Listening

0:00 Ooh, yay. Checkity-check. Checkity-check. What's up everybody? I hope you're doing well. Today we're going to dive into a new series. It's been a while since I've like truly started a new series. I've been wanting to talk about the fundamentals of therapy for some time now. Like we will apply these fundamentals no matter who we're working with, no matter the modality, and yet we're not talking about it that much, at least not on YouTube. So all that to say we're diving into a new series all about the fundamentals of counseling. Today we're talking about active listening. If you're interested in nerding out on it, I will dive into like all the research and the nitty-gritty pieces of it in the extended cut version of the episode. But in this short version of the episode, we're primarily going to focus on what active listening is, what it isn't, and how to do it well. So if you're interested in that, stay tuned.

0:54 Now I'm going to say something that's a little bit hard to say, but a lot of therapists, I think, have a misunderstanding of what active listening truly is. I've heard therapists explain active listening as paraphrasing back to a client what we think we've heard them say. You know, a client comes in and they say, "I'm not doing well. I've had an awful week. I'm just stressed." If we say back to them, "It sounds like it's been a really hard week and I'm hearing that you're really stressed." That is not active listening.

1:30 That is parroting. Did I burst some bubbles? Ooh, I might have, but that's why we're here. That's why we're here. That's why this episode exists. I think we need to we need more of these things. We need more of this type type of education, okay? Now paraphrasing is a valuable component of therapy. So I'm not saying like there's no situation where like simply describing back to somebody a paraphrase of what they said isn't helpful, but this, my friend, does not equate to active listening. So, if I've already burst your bubble, you're in the right place. We're going to break this down.

2:04 Let's get into what active listening is. The APA Dictionary of Psychology has a concise definition of active listening. They say that active listening is, quote, a psychotherapeutic technique in which the therapist listens to a client closely, asking questions as needed in order to fully understand the content of the message and the depth of the client's emotion. The therapist typically restates what has been said to ensure accurate understanding. Active listening is particularly associated with client-centered therapy. Okay, so the APA's definition here is already kind of reshaping things, adding a little bit more nuance. It's not just paraphrasing and repeating back. Yes, we have to listen closely, but there's also asking questions as needed, and that the intent of all of that is to more fully understand the content and the depth of emotion. And then, once we feel like we have a grasp of those things, then we can restate all of that back to our clients. Okay, so we've already established a bit of what active listening is not. Active listening isn't just listening in silence while nodding our heads, sometimes frantically.

3:13 It is not simply restating or paraphrasing back what we heard a client say. When we are actively listening as therapists, yes, we are listening to what they're saying, perhaps we're nodding along or paraphrasing some of what they're saying, but on the inside, we are actively tracking the content of what they're saying and the client's affect, and trying to make sure we understand the full breadth and depth of what they're saying. This includes things like noticing things that they're not saying, noticing things like body language, also actively tuning out our own internal noise, whether it be judgments or advice or things we're distracted by because we're having a hard day, tuning that out so that we can be actively present to our clients. And then through all of that, we have to communicate it back to our clients that we are genuinely present and attuned to all of these things. Sometimes we can make this error, myself included, where we can get so focused on like what the proper technique is or how to communicate effectively with our words that our active listening can start to look more like performative listening rather than like a genuine like full all hands on deck attentive focus and like very active internal process that we're doing. Carl Rogers and Richard Farson originally coined the term active listening in their seminal 1957 essay titled Active Listening. In this essay, Rogers and Farson emphasize how active listening is very different than parroting where we're simply repeating back what somebody says. In their essay, they say that parroting conveys that we heard the words that somebody said but not that we fully understood the meaning of those words.

5:04 Here's a quote from their essay, "Active listening is an important way to bring about changes in people. Despite the popular notion that listening is a passive approach, clinical and research evidence clearly shows that sensitive listening is a most effective agent for individual personality change and group development. Listening brings about changes in people's attitudes towards themselves and others. It also brings about changes in their basic values and personal philosophy. People who have been listened to in this new and special way become more emotionally mature, more open to their experiences, less defensive, more democratic, and less authoritarian." That sounds nice. That's a real big claim. For the short version of this episode, I'll just read one more quote from this essay. Quote, "Not the least important result of listening is the change that takes place within the listener himself. Excuse the gendered language. Besides providing more information than any other activity, listening builds deep positive relationships and tends to alter constructively the attitudes of the listener. Listening is a growth experience. For us, the therapists, we are growing as we actively listen. Let's talk about like how to do active listening. For this episode, I'll just follow along with the Rogers and Farson essay on their advice on how to implement active listening. First, they say to listen for total meaning. Quote, "Any message a person tries to get across usually has two components, the content of the message and the feeling or attitude underlying this content.

6:29 Both are important. Both give the message meaning. It is this total meaning of the message that we try to understand." So, step one of active listening is when our client is speaking to us, we are trying to track both the content of what they're saying, but also what's going on emotionally for them. I can kind of imagine two scenarios where a client is presenting the exact same content, but with two completely different emotional tones. And if we're not paying attention to the emotional component and we only present like active listening towards the content of what they're saying, we might really miss it. If we were to imagine sitting down with a client we see regularly and asking how their week has gone. Hey, good to see you. So, how's your week been? And in one scenario, they say, >> It's been okay, I guess.

7:14 I finished that work project I'd been working on for a while. >> And in another scenario, they sit down and answer the same question by saying, >> it's gone okay, I guess. I finally finished that darn work project. >> We're going to respond to each of those scenarios differently, even though in both situations they the content is they had an okay week and they finished this work project, but in the second example, they clearly are feeling some type of way about it.

7:41 >> >> And so, I would imagine in the second scenario, I'd be more likely to ask follow-up questions about the affect going on. And if we just responded to it like, "Oh, great. You finished that work thing. That's awesome." Then we'd really like really be missing something there, right? So, when we're listening to our clients in any scenario, we want to try to make sure we are grasping the total meaning of what they're saying. And that leads us to the next component of active listening that Rogers and Farson suggest, which is to respond to their feelings. We know this, right? If we just speak to the content of what our clients are bringing on and we ignore the emotions, we're not going to get anywhere. Now, with that said though, sometimes the feelings might be more apparent or less apparent. Like if somebody walks in saying that they're feeling sad, but that's both the content and potentially the affect, and we can address that directly. But sometimes, the emotion of it comes through kind of between the lines. So, in that earlier example that I gave about like somebody saying that they had an okay week and they finally finished this work project, but they framed it in like, "Ugh, I finally finished that darn work project." There are a lot of ways to respond that acknowledge that there was some sort of emotion going on there, and we would want to tend to that first before we say like, "Oh, great. You finished that work project." All right, depending on my relationship with the client and my personal style, I might tend to just very directly and maybe even a little bit humorously engage with that piece that was clearly between the lines. You don't seem too excited to have finished that work project, and I'm kind of wondering what else is going on there. Or just any sort of invitation to invite more information about the affect that clearly was there but not yet spoken in this situation. And sometimes it might take a series of multiple questions to really feel like we understand what the emotional state is. I mean, if we were to imagine that same scenario where the client says, you know, they finally finished that darn work project and I say like, oh, yeah, wow, you really don't seem too excited that you finished that. What might be going on there?

9:48 If they were to say something like, >> >> >> it's just been a long week at work, I guess. >> Like, this might be the first time the client is even pausing to ask like, yeah, what am I really feeling with this? That's probably important. Thank you for the reminder. There's probably going to be more follow-up questions just for us together with our client to get to the bottom of what emotions are going on there. And then when we feel like we can finally see it, whether we see it first or our client is able to name it, then we can say, so it's feeling like this. And sometimes it can even make sense to follow up again. Like, if we finally get to the point where we're saying to our client like, okay, so I think I'm hearing you say that you're really feeling the pressure at work. You're wondering if this is even the place where you want to stay long-term, but you're also really feeling that pressure to generate income for your household.

10:38 Does it feel like that captures most of what you're feeling or is there more to it than that? >> Sometimes just phrasing it back and having that invitation for them to think through it again and double-check is that what's really going on? Like, that is an important part of the client being able to have that mirror of themselves and think like, oh, no, yep, that's that's definitely what I'm feeling. Wow. And that can sometimes be its own sort of reckoning but healing valuable experience that maybe they didn't have the opportunity to get to if you were to just say like, wow, it was a really hard week at work.

11:12 Okay, like, what do you want to talk about? And the last component of active listening that Rogers and Farson name is to note all cues. There might be a lot more going on that our clients are communicating to us through ways other than their words. Of course, things like tone of voice and body language can be big ones, but sometimes it can come through even through other behaviors like suddenly I don't know, let's say they're cons- consistently late for session when that didn't used to be true for them or you know, there could be other variables at play outside of the words that they're saying. And it's important for us to tune into those. You know, I'm going to pick on the same example since I have it like if let's say the client had come in and said, you know, "I guess I'm okay.

11:56 I finally finished that darn work project." And they have a big smile on their face while they say that whole sentence. Well, that's also really interesting, right? The words were exactly the same, but they're smiling. And I like to just ask gentle questions when I see things like that simply observing what I witness so far and asking for clarification. Like I might say, "Wait, that's really interesting. I mean, you're saying you finally finished that darn work project, but I don't know if you know what you're smiling while you said that. Could you tell me more about what's going on with that?" And if we miss the smile, then we might miss one of the kind of complex nuanced components kind of feeding into all that's going on as our client is just telling us this piece of information that they finished their work project.

12:43 This also comes up a lot if I see that a client is hesitating a lot to tell me something or maybe you know, suddenly they're avoiding eye contact. I'll tend to pause whatever we're talking about and even name that I'm pausing because I'm noticing some of these cues. Like I might even interrupt and say something like, "Okay, I'm going to chime in before you keep going. I'm seeing some signs that you're hesitating, you know, you're looking away. So, I just want to pause before you continue to share because I'm not really sure how you're feeling before you keep going. Can we just kind of check in first?" And that is a form of active listening, right?

13:21 Like I you didn't even say words yet, but I'm and all these cues. Let me follow up on those because they're important before we talk about the content that you're about to say. Now, even though on the one hand we might say like, okay, that's three simple tools to lean into active listening, like this process takes a lot of deliberate practice because it's not just say these words or, you know, say it in this sentence structure, it's a deliberate internal process where we are navigating a whole bunch of things at the same time, right? That we're keeping in mind, you know, of course things like our treatment plan or this client's goals, what we're what we've assessed so far about them, that sort of things. While we're also holding it openly knowing that all of treatment is a continual assessment journey, so we're open to our thoughts and our understandings of our clients shifting with the presentation of new information. We're also holding our own biases in mind where we might say like, you know, not this again, this client bringing up their workplace. I'm so sick of this.

14:30 Why don't they just blah, blah, blah, you know, whatever mind inserts as some sort of judgment, which is usually a result of misunderstanding or potentially not leaning into active listening fully because the whole goal of active listening is to do what we can within our reasonable power to step into our client's shoes and try to truly imagine a full understanding of what it's like to be in this moment right now for them and then mirror that back to them. It takes a significant amount of work and so I don't want to miss that piece. Like it's not just sort of like a cute fundamental of therapy that we need to be really active while we're listening to our clients and say things back to them. But we really have to work on ourselves a lot and I think if we do lean into this kind of deliberate practice of actively listening, it truly helps us grow in our sense of compassion. It allows us to access that authentically non-judgmental frame, even if our client is coming in with a very different set of values or beliefs, maybe politically political persuasions, or whatever it might be, whatever differences exist between us and our clients, it can allow us to suspend those and join them, which is incredibly powerful, but it takes a lot of work.

15:56 So, I hope this was a helpful, kind of short overview of active listening, while also doing a bit of a deep dive on like what Like what actually is active listening though? And we obviously didn't touch on everything there is to touch on with it, but I hope this got your thought juices flowing, whether you've been a clinician in practice for a long time, or you're a brand new trainee. Like I find these conversations so helpful, and to just observe ourselves as we're interacting with our clients. Like are we implementing some of these approaches as we're working together, and are there spaces where we could kind of focus our energies on and practice a little bit more? Cuz all of this is always a continual practice. Like there isn't really a point where active listening just becomes easy default. Like we're working we're working we're working on the inside, you know? And before we close, I'd like to thank therapynotes.com for sponsoring this video. Therapy Notes helps with all of your practice management needs from scheduling to notes to billing. They have a HIPAA secure telehealth platform included for free for all users, and a whole suite of AI features to streamline your documentation process. If you'd like to check out Therapy Notes, you can get 2 months to try it for free with no commitment just by clicking the link in the description of this video. Well, thank you for joining me on this seminal episode of our new series covering the fundamentals of therapy. What are some tools you found helpful when it comes to helping yourself lean into active listening? Feel free to leave those in the comments below so we can all learn from each other and I look forward to continuing this series down the road. And until next time, from one therapist to another, I wish you well.