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Active empathic listening (AEL) is the cornerstone of effective therapy work. Active listening helps therapists understand who they’re working with. Empathic listening lets patients know we’re hearing their concerns and wish to be helpful. It also offers validation, which can be therapeutic unto itself, but validation alone doesn’t constitute treatment, like in the example of Jenny, below.
AEL skills are part of your therapy kit, and it’s good to hone them. It’s just as important to make sure you’re not falling into one of the five AEL traps as you start practicing.
1. AEL is not a style of therapy or treatment unto itself.
Some new therapists, like Jenny (pseudonym), though well-intended, can initially fall prey to the following scenario:
Reviewing a treatment plan, I noticed Jenny, a beginner supervisee, described AEL as her treatment approach. “He needs someone to listen, hear him vent,” Jenny said.
“Definitely part of treatment,” I replied, “But what’s your plan to help Alex (pseudonym) improve his relationship?”
“He’s never talked about this with anyone else,” explained Jenny. “I want him to get it all out and know that his feeling down is normal. Let him know he’ll get through this.”
“Certainly normal,” I noted, “and appropriate you’re so supportive. But it seems from your write-up that the crux is poor communication with his girlfriend. Can we give Alex a cathartic experience while pointedly addressing the communication conundrum in the relationship?”
Jenny quickly realized what was missing.
2. AEL is not smiling and nodding.
Giving silent, affirming recognition has its place to show we’re following along. Other than this, it shouldn’t be a therapist’s main action in active listening. It may seem enough, especially if you’ve seen too many therapy TV shows, but in real life, patients need more robust interaction. This can be paraphrasing to let them know they’re understood, a validation statement, or requesting expansion on something that got your attention, for example.
3. AEL is not agreeing or advice-giving.
While it may seem that being agreeable is good for the rapport/alliance, blindly agreeing with complaints or reports can be problematic. A therapist may, for example, agree that someone in the patient’s life is a jerk and speak negatively of them along with the patient. This renders the therapist as more of a friend, unable to be objective and empower the patient. Perhaps X person isn’t the problem, but rather it’s the patient.
Also, a patient may take a therapist’s agreement as evidence they should make a certain decision. The point of therapy is to help the patient reach their own decision. There is a simple way to bridge this gap, meaning you’re sympathetic/supportive to the patient’s perspective (good for rapport) but leaving room for objectivity. Enter the little word “if.”
Take the example of Alex, who was on the fence about leaving his girlfriend because he felt she was becoming emotionally cold: “Wow, Alex, if that’s how your girlfriend has been responding when you offer tender interactions, I can see why you’re wondering if you have a future together.” Should the therapist have replied, “Leaving her does seem like a good idea,” though it was well-intended, is harmful. Not only may Alex not learn how to arrive at his own decisions, but it opens the therapist to liability. If something serious resulted from Alex’s leaving, he can say, “The therapist advised me to.”
4. AEL is not saying how the therapist would feel or act in similar situations.
It’s natural to feel compelled to share how we’d do something or how we’d feel when someone describes something troubling. But that’s in a social situation; this is therapy. Offering such commentary can make it seem like you’re no longer listening to the patient, and the discussion is becoming about the therapist.
5. AEL is not trying to reason with the person about their emotions.
Surely you’re familiar with someone, well-intended, saying to you, “What do you have to be upset for?” if you’re having a bad day. Irritating and invalidating, is it not? They didn’t have your day, how can they say that? Similarly, should we perceive a patient’s emotional state as excessive and irrational, we might feel compelled to reason with them and talk them out of their charged state. However, interjecting, “Why are you letting such a small thing get to you?” for example, is a recipe for making someone feel invalidated, and possibly for escalation, especially if the emotion is anger.
AEL is about understanding what’s occurring for the patient. There’s plenty of time to explore irrationality and make changes. Instead, encourage the person charged over the seemingly small trigger to share what’s going on: “Alex, your girlfriend’s text message was only a few words, but that really shook you up. Fill me, what’s going on in you right now?”
That one phrase does four helpful things. It validates Alex’s experience, shows you’re paying attention, that you want to help, and, perhaps most importantly, that you’re interested in learning about his experience. If a patient doesn’t sense a therapist is interested, they’re not going to give much, and as a result, you may not be able to help much.
This post also appears on Newtherapisthub.com