[Feel-Good Friday: How to Listen]

It seems silly, right? I mean, barring our deaf community, we're all born with two working ears, so we all know how to listen. But one of the most valuable things I learned in medical school was how to really listen. From nearly day-one, the faculty drilled into us this shocking figure: physicians listen to their patients an average of 18-23 seconds before interrupting them. What's more, "only 28% of doctors know their patient's full spectrum of concerns before they begin to focus on one particular concern, and once the conversation is focused, the likelihood of returning to other concerns is only 8%." [1] To counteract this, we were taught to wait until the patient was done speaking, pause a beat to make sure they were, in fact, finished, then follow-up with clarifying questions. The idea is obviously to not cut them off and hear their whole story, but I began to realize that there was more to this.

The power of the awkward silence.
What I noticed is that this beat is not only important as a check-point to make sure that the patient is done speaking, it also provides a very rare experience we all try to avoid as much as talks about puberty from our parents: lulls in conversation. It's that awkward silence, and no one likes it, which is exactly why it's so precious. In order to fill that uncomfortable moment with something, people are often likely to blurt out something they might not have otherwise, including divulging something critical they were perhaps too shy to say initially. They may also elaborate on a point that they downplayed at first mention. These "afterthoughts" are often where the most telling, vital information from a patient comes from, and it can break the entire case wide open, allowing you to focus on what the real issues are. "I have headaches, doctor. Can you give me some pain killers? *beat beat beat awkward silence beat beat beat* I think it's because my husband and I are arguing so much. He pushed me down the stairs last night."

Now, in principle this waiting process seemed like a good idea, but in some ways it stuck me as completely ineffective. I distinctly remember calling my dad and running it by him, along with my frustrations with it, particularly after a faculty member reprimanded me for interrupting him when he was on a long tangent. I vented, "Sometimes it just seems like such a waste of time. I mean, I knew exactly what he was going to say, so I politely stopped him and told him I wished to clarify before he went any further. Why should I waste his time and mine if I can nip it in the bud right away and we can keep the conversation progressing in a more focused manner?" Seemed logical to me.

Oh, I'm sorry... Did the middle of my sentence interrupt the beginning of yours?
My dad chuckled and said that this tendency to interrupt one another was a trait noticeable in younger generations, and that it was very rude and impatient of us, perhaps a symptom of our multitasking, instant-gratification mindset. But what I explained to him was I often interrupt people while they're talking as a way of reaffirming to them that I'm listening, that I understand what they're saying, or even that I empathize. It's a way of us building the conversation together in a parallel fashion. For example, my best friend might say, "My boss is so aggravating. She always treats me like I'm incompetent. It's like, she thinks I'm an idiot or-" and I'll jump in with, "Like you just don't care?" It's not that I'm too impatient to hear the rest of what she's saying. It's that I'm demonstrating that I'm following what she's saying, and I sympathize. What I offer may be wrong, but perhaps that will provide a junction point at which to clarify. Obviously my suggestion was what I thought she was getting at, so if my "fill-in-the-blank" was incorrect, then this signals that she might need to back up and reexplain.

But what I've noticed is that the problem with this is that you lead the conversation. You may direct it somewhere that is completely irrelevant to what the person wanted or needed to discuss. Even worse, you may convince them that they feel a certain way that they don't. Furthermore, you interrupt enough times with the incorrect assumption, at a certain point that person is going to grow frustrated and feel like they aren't being understood. Eventually they just give up, or cave into the false assessment you're projecting onto the conversation. "Yeah, I guess you're right. I am just incompetent and that's why my boss is mean to me." But is that really true? Did you really even hear the whole story, or solve the correct problem?

Active listening: Seek first to understand, then be understood.
More recently, I read the famous Seven Habits of Highly Effective People (http://www.amazon.com/Habits-Highly-Effective-People/dp/0743269519/ref=sr_1_1?s=books&ie=UTF8&qid=1328930091&sr=1-1), a chapter of which dives even deeper into effective communication, especially the way that patiently listening allows you to really address and comprehend the true problem at hand, instead of the first one mentioned, which usually isn't the actual concern at all, as is often the case with patients. (See above example of headaches vs. spousal abuse.) The tendency is to immediately focus on the first problem mentioned, then promptly assign a judgment, opinion, evaluation, or solution to it. "You should probably just find a new job. Sounds like your boss is an ass hat."

But this is a fool's errand, and here's why, in Covey's own words:

"If you're like most people, you probably seek first to be understood; you want to get your point across. And in doing so, you may ignore the other person completely, pretend that you're listening, selectively hear only certain parts of the conversation or attentively focus on only the words being said, but miss the meaning entirely. So why does this happen? Because most people listen with the intent to reply, not to understand. You listen to yourself as you prepare in your mind what you are going to say, the questions you are going to ask, etc. You filter everything you hear through your life experiences, your frame of reference. You check what you hear against your autobiography and see how it measures up. And consequently, you decide prematurely what the other person means before he/she finishes communicating." [2]

So what if instead you took a different approach? What if you tried active listening, in which you stay focused on... you know... listening, rather than assessing and fixing?

Here's how it works:
As the person is speaking, periodically repeat back what they are saying. Usually it is best to do this in the form of a question which paraphrases their statements. "So you feel like your boss thinks you're incompetent?" Do this without any statements of judgments, opinions, evaluations, or offering solutions. Let them respond, then just keep going like this until you (or ideally, they) feel like things reach a point of completion, e.g. you're looping back to the same content, a breakthrough was made, or even better, the other person asks, "So what do you think?" At that point, you can offer a solution or your opinion.

Here's why it works:
1) By repeating the statements back, you're both reaffirming to the person that you're listening, and you understand them- which builds trust and confidence- and also reaffirming this understanding for yourself. By stating out loud what they said, you actually experience it yourself, and really hear it with new ears. It's sort of the idea of learn one, do one, teach one. You learned what they said, and now you are teaching it back to them, which cultivates an even deeper understanding of the issue both for you and them. Because just like you are hearing it with new ears by speaking it aloud, they hear it differently when it is spoken back to them. "Oh, I mean... I guess it's not that I think she thinks I'm incompetent. I guess I just feel like she puts a lot of pressure on me."

2) By withholding judgments, opinions, evaluations, or offering solutions, you leave the conversation open to go in whatever direction it needs to, however far along is necessary. Again, if you had immediately responded to the first statement about the manager being aggravating, you might have said, "Yeah, definitely get a new job. What a jerk face your boss is." But if instead, you just listened and allowed the conversation to naturally take its course and explore those initial statements, the individual might reveal more even they weren't aware of. "So, yeah, maybe the aggravation is just the pressure that I'm feeling. I feel like I never have enough time to do things. I actually really love my boss, and she's so nice to me. I just feel like I let her down sometimes because I have too few hours to complete my work."
"So you don't have enough time to get what you need done?"
"Yeah, ever since I offered to head up the new office planning committee, I've felt stretched thin. I'm still getting my work done, but I don't think it's the same caliber it was, and I'm disappointed in myself. I know I can do better, and I don't want to screw things up for my manager. I think I need to quit the committee."

Now compare this to the original scenario where I jumped in right away and made an immediate assessment. "Your boss sucks. You should quit your job." Instead, we've gotten down to what the real problem was (feeling stressed because of the new obligation) and the real solution: "Your boss seems great. Quit the committee, not your job." What a potential disaster we just averted!

3) Because during the course of the conversation, your active listening helped build up trust, confidence, and understanding, when it is your chance to respond with either your opinion or a potential solution, you are more likely to reciprocally be understood. This is not only because they felt understood. but also because your deeper and correct comprehension of the issue means that what you offer up is more likely hitting the target. It's not misdirected toward an incorrect problem.

It works, I swear!
I tried this method recently for the first time and I ended up in tears. I was so moved by the connection and empathy I felt for the other person, and the honest, open communication we were having. It was an issue we had discussed many times before, but I felt like I was really hearing the person for the first time and truly understanding. Not only that, but the conversation moved into new, unaddressed territory and discoveries were made that I would have never expected. I felt horrible for not previously recognizing what was going on, and so grateful for the opportunity to now make that right. We were finally getting to the heart of the issue, and thus the correct approach to resolving it. Just as with a physician and patient, a prescription of extra strength advil isn't going to help if the problem is bigger than just a headache.

And I remember thinking that eventually the person would catch on to what I was doing. It almost felt silly and awkward. "Why do you keep just repeating back to me what I'm saying? Are you mocking me?!" But because I did it from a genuine place of compassion and eagerness to understand, it never felt contrived or forced. I think the person never "caught on" because it felt good and it was working. Why question that? Why should that raise any alarms?

So I definitely encourage it, even just once to give it a shot. I started doing this at work, and have likewise had amazing results. It's incredible what you find when you just start listening. In the words of my Arapaho grandfather, "Sit down and shut up. You just might learn something."

[1] http://articles.mercola.com/sites/articles/archive/2008/01/02/doctors-interrupt.aspx

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