Listening Up and Leaning In: Active Listening in Therapeutic Relationships By Tracy Asamoah, MD on 4/16/19 - 11:25 AM

As a brand new, inexperienced first year medical student, I took the required patient interview course. Actors were hired to portray patients with a variety of medical conditions. On my first day, dressed in my short white coat, notebook in hand, I entered the exam room.

“Hi, my name is Dr. Anthony (I was a young, single student at the time),” I began. “What brings you into the office today?”

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As soon as my patient began her story, I started to formulate my next question while anticipating her possible responses. I heard everything she said, evidenced from the copious notes inked in black on the pages in my hands. But, I really didn’t listen to a word she said.

Over the years, I have learned the importance of active listening. As a student, I focused on hearing my patient’s account of her illness, allowing me to gather pertinent details. Now, as an experienced clinician, I have come to appreciate how active listening serves the additional goal of helping the listener gain understanding and trust. I have also come to realize that in most circumstances, how the patient experiences our interaction is as important as what he or she tells me. While my training taught me how to gather details, it did not teach me the practice of active listening.

Studies suggest that the brain’s reward system is triggered during active listening. In a 2015 study published in the journal Social Neuroscience¹, researchers selected 22 participants who were video recorded while reading essays they wrote about a variety of their life experiences. Evaluators (actors hired for the study) were instructed to view these videos and demonstrate either active or non-active listening behavior. Researchers then conducted functional magnetic resonance imaging (fMRI) on participants while they viewed the evaluators assessing their video clips. Participants rated both the evaluators who showed active listening and the episodes where there was active listening more positively. The results also showed enhanced neural activation in both the ventral striatum and the right anterior insula when active listening was perceived. These brain areas are associated with motivation and reward. Both results suggested that the active listening process was rewarding in the truest sense of the word.

Active listening allows us to gain a deeper understanding of our patients. When we understand our patients, we gain insight into their complex lives. We begin to see beneath the layers of their narrative to the “real” story. When we give our full attention to a person, we are able to maximally receive his or her message while decreasing the interfering “noise” of our own thoughts. The noise is all those activities our brains engage in when we are not listening to the person who is speaking. With active listening, our focus centers on truly and deeply knowing the other, instead of being known. A patient labeled as ‘non-compliant’ for not taking their medication becomes a patient who, after losing his job, is too depressed to get out of bed in the morning and muster the energy to take their medication.

When we build trust with our patients, they find comfort and safety as they reveal their concerns. We trust that what they are telling us is their best understanding of what they are experiencing. We are not imposing our agenda on them and are able to receive what they have to share with us. Of course, there are times when our agendas are important as certain details must be clarified and understood in order to allow us to do our jobs. However, active listening helps us forge more holistic relationships with our patients, giving us a clearer picture of the individual sitting across from us.

With intention and practice, active listening helps us become attentive and receptive to what another has to say. Your own emotions might shift in response to what is being shared. You will know another person in a way that you didn’t previously, increasing your capacity for sitting in his or her experience or emotions. Active listening engages empathy, also housed within the brain.

How good of a job are you doing at bringing active listening into your conversations? The International Listening Association suggests asking yourself these questions to understand whether you are engaging in active listening:

Are you giving the speaker 100% of your attention?
Are you listening to understand, rather than listening to respond?
Have you opened your mind to receive what is being said?
Have you rejected the temptation to prepare your response while the other person is speaking?
Are you open to changing your mind?
Are you aware of what is not being said as well as what is being said?
Are you taking account of the degree of emotion attached to the words?
Are you aware of any differences, and similarities (such as culture, age, gender) between you and the speaker which may influence how you listen?
Are you giving signals to the speaker that you are listening?
Are you valuing the speaker and the experience they have gathered in their life so far?

Active listening is an important tool in every doctor and therapist’s toolbox. It can help facilitate more trusting and deeper therapeutic relationships. In our professional and personal lives, active listening can lead to more connected and rewarding interpersonal interactions allowing us to experience even greater fulfillment.

  1. Perceiving active listening activates the reward system and improves the impression of relevant experiences. (2015). Kawamichi, H., Yoshihara, K., Sasaki, A T., et al. Social Neuroscience

File under: The Art of Psychotherapy