Ethical Listening - What is it and How Do I Do it?

As healthcare professionals, we are well aware that ethics are a cornerstone of our practice.

Not only are we regulated by a body that requires ethical practice as standard, we also have ethical obligations as humans, colleagues, family members and friends to listen effectively. Additionally, the stronger or more intimate the relationship, the more we owe it to the speaker to be an ethical listener.

We have two ethical obligations when listening:

1. Honest hearing – we must listen without judgement and preconceptions, as we owe it to our speaker to try to understand what they mean without or own opinions biasing the understanding; and
2. Honest responding – we also must give open and honest feedback to the speaker so that they can understand their situation and how their intent may affect others. Simply agreeing with the speaker is not always the correct type of feedback.

Four Types of Listening Styles

Like personality styles, there are also listening styles. We may naturally gravitate to one style as it relates best to us, but sometimes different conversations can require different styles of listening as well. For example, you wouldn’t converse with a patient who’s just received a terminal diagnosis in the same way as an employee who comes to you with a serious allegation against another colleague. Being able to recognise each style of listening and when it is appropriate to use them is an important aspect of ethical and therapeutic listening.

1. Empathetic Listening

Listen with empathy if you truly want to understand what a person means and how they feel. To ‘empathise’ means to feel what someone feels, understand what they mean, and live what they’re living, in a way that respects that it is not actually happening to you, but to them. In a therapeutic situation, empathy is central to the development of the therapeutic relationship and is the factor most likely to enable a person to change.

2. Polite Listening

This style of listening can be used when it is not required of you to either agree or disagree with the speaker – for example, if the speaker 'just needs to vent' and needs someone to listen. Try avoiding interrupting the speaker or changing the topic, and wait until they’ve finished before speaking. Provide supportive listening cues (note: these do not have to infer agreement, but may simply be nodding or saying, 'I see'), show empathy, maintain eye contact, and give positive feedback.

3. Critical Listening

In situations where you must think logically to appraise a situation, it is imperative you listen with an open mind and delay judgments until the end of the speaker’s message. Avoid filtering out complex messages – hear the whole conversation, not just aspects, and listen to what is not being said. Additionally, be aware of highlighting or embellishing one or two smaller aspects of the speaker’s message, and risk missing the big picture. Take note of your own prejudices and biases and do not allow these to enter into the conversation – the speaker’s views and beliefs are their own, and the only preconceptions that matter in this context.

4. Active Listening

Active listening does not just involve repeating back to someone what they’ve said, but constructing a meaningful understanding and sending it back to them. Therefore, a key process in active listening is checking your understanding of their message. Try feeding back what you think you’ve understood their message to be, and ask them to correct you for any misunderstandings.

People have a tendency to downplay, provide reassurance, or put a positive spin on the conversation when they’re actively listening. The listener probably means well, but ultimately, they don’t encourage the person to explore their feelings in more depth. Instead, you’re trying to send them a solution message that tells the speaker how they should feel or what they should do.

What is Empathy?

Basic empathy skills are essential when improving your listening ability. Empathetic conversations involve the speaker sharing their message, and the listener picking out certain emotions and restating, paraphrasing or reflecting these back to the speaker, i.e. 'Are you saying you feel…' or 'It seems to me that you’re saying that you’re feeling…'.

Advanced accurate empathetic listening is the gold-standard in therapeutic and ethical listening, and involves indicating a true and real understanding of the person and their thoughts, feelings and behaviours. Advanced empathetic listening can enable the speaker to see a new perspective or gain greater insight (congruence) of their feelings and behaviors. It’s the listener’s sense or perception ('felt sense') of the speaker’s message that ultimately leads to better insight and outcomes from the conversation.

However, advanced accurate empathy can be seen as ‘probing’, and may be risky. For example, if you have misunderstood the speaker, they may get a sense that you aren’t fully present, have not ‘got it’, don’t understand, or aren’t listening. This is recognised as then possibly leading to a 'false start' and breakdown of the 'therapeutic alliance' (i.e. between health professional and patient), particularly if this technique of advanced accurate empathy is overused. Therefore, this technique should be used wisely, and should only be reintroduced once the therapeutic bond or alliance has been repaired.

How Do I Listen More Effectively to Emotions?

Advanced accurate empathy can be thought of as ‘becoming more effective at listening to emotions’, and being able to apply this technique correctly and appropriately. In order to do this, try:

• Confirming the emotion ('are you feeling…?');
• Showing interest and encouraging the person to explore the emotion ('Why do you think you feel…?');
• Gaining permission to explore the emotion further ('Would you like to talk about why you feel…?');
• Not refocusing the conversation or message on yourself;
• Not to solve the problem or fix the person/situation; and
• Feeling comfortable with silence and pauses. Silence can be a powerful tool to encourage the speaker to say more, or reflect on what has been said.

Ethical listening should not focus on finding a solution to the problem. You are not there to fix the situation that the speaker is presenting, you are there to try and understand how they’re feeling and allow them an opportunity to make you see the problem from their point of view. In order to avoid sending a solution message, statements such as 'Do this…', 'Don’t do…' (‘ordering messages’), warning or threatening statements such as, 'If you don’t do/do this, you’ll…', statements like, 'Everyone does this…' (‘preaching messages’), or advising messages such as, 'Why don’t you…?' should not enter into the conversation.

Ethical listening is important in creating a therapeutic relationship with our patients and improving the patient’s experience of healthcare. Simple techniques such as paraphrasing the speaker’s message, expressing understanding for how someone feels and asking questions will ensure your ability to listen effectively is improved and may reveal messages that you might previously have been missing.

References

• AlfredHealthTV 2017, Patients come first – Caring with compassion and respect, Alfred Health, Melbourne, viewed 27 April 2017, https://www.youtube.com/watch?v=YEFW28wzwig&feature=youtu.be
• Birks, M, Chapman, Y & Davis, J 2015, Professional and therapeutic communication, Oxford University Press, Melbourne, Australia.
• Chapman, YB & Robertson-Malt, S 2015, ‘Frameworks for communication’, in M Birks, YB Chapman & J Davis (eds), Professional and therapeutic communication, Oxford University Press, Melbourne, Australia.
• DeVito, JA 2016, ‘Listening in Human Communication’, in JA DeVito, Essentials of Human Communication, 9th edn, Pearson, New York, NY.
• Kelley, JM, Kraft-Todd, G, Schapira, L, Kossowsky, J & Riess, H 2014, ‘The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials’, PLOS ONE, vol. 9, no. 4, viewed 27 April 2017, https://doi.org/10.1371/journal.pone.0094207
• Riess, H 2013, The power of empathy, TEDx video, viewed 27 April 2017, https://www.youtube.com/watch?v=baHrcC8B4WM
• Topol, EJ 2015, The patient will see you now: the future of medicine is in your hands, Basic Books, New York, NY.