Compliance is a big issue in the medical world-and listening may offer a solution.

When Harry goes to see a doctor because of a bad, persistent stomach ache, the doctor may spend a lot of time diagnosing, explaining the problem, and prescribing a course of treatment – and after all that, Harry may never follow up on the treatment, and may even continue to engage in health-risking behavior.

Showing up for follow-up appointments is one form of compliance – potentially one of the simplest ways a person can invest in his or her own health. And yet, an astonishing number of people do not show up (or even schedule) a follow-up appointment that a physician recommended.

Understandably, the medical community is eager to understand how to improve patient compliance, or at least to predict when patients will comply with the prescribed course of treatment. In a study by Federman-Cook et al. (2001), researchers were curious to learn more about how patients decide not to go to their follow-up appointments. To this end, they surveyed more than 2,700 primary care patients, and asked them about a variety of factors that may influence their decisions.

One of the two most important factors was “perceptions that physicians had not listened to them.” The other was “dissatisfaction with the duration of their contact with physicians.”

In a related study by Moore et al. (2004), researchers explored these two factors more in depth, in order to see if they could pinpoint the exact aspects interactions with physicians that would predict treatment avoidance. This study did not specifically look at people whose doctors recommended follow-up appointments. Instead, they focused on people who had a medical problem which they would’ve liked to receive medical attention for, but instead chose not to. Could this behavior be explained by the nature of earlier patient-physician interactions?

After surveying more than 1,100 participants, the researchers determined that the most important factor predicting medical treatment avoidance was… (Any guesses?) The extent to which participants felt that their doctor “listened to their health concerns and took them seriously.”

It doesn’t get much clearer than that. Your ability to aid a person who came to you in search of help–even when you are the expert and are expected to know better–can still benefit tremendously from your ability to listen to the person standing in front of you, and accept this person’s experience as real and meaningful. By applying the simple, direct principles of Supportive Listening, medical service providers can help their clients feel heard and respected, and improve the likelihood of compliance with their professional recommendations. Everybody wins.

– Eran

Bibliography:

Federman, A. D., Cook, E. F., Russell, S., Puopolo, A. L., Haas, J. S., Brennan, T. A., & Burstin, H. R. (2001). Intention to discontinue care among primary care patients: Influence of physician behavior and process of care. Journal of General Internal Medicine, 16(10), 668–674.

Moore PJ, Sickel AE, Malat J, Williams D, Jackson J, Adler NE. Psychosocial factors in medical and psychological treatment avoidance: the role of the doctor-patient relationship. J Health Psychol 2004;9: 421–33.

We at Supportive Listening recently declared on a t-shirt “Listen like a NINJA.” And we mean it.

Imagine being more than just a “good listener”–imagine being an AMAZING listener. Having a broad capacity to naturally listen to someone, really be present with them, see the world through their eyes. And with a certain flow–not completely effortless, but neither full of effort. A highly skilled level of listening that leaves a wake of relief, new thinking, and self acceptance in its path.

I don’t know if the old-time Ninja’s got formal training in listening but if they did, Eran and I think it would cover the material we’re teaching. We go far beyond “OK, now listen closely” and we get deep into technique, theory, and lots of focused practice for how to get to that higher level of ability.

As Eran says “anybody can become a Supportive Listener”–and he’s right. We have the technology, we have the exercises–you bring the desire to become an AMAZING listener, the energy to do it, and a love of learning, and we’ll help you get there.

We are planning to offer several more classes later this year. To be the first to get class announcements, sign up for our newsletter! A powerful listening tip, the latest research, and class announcements–once a month. Join us!

So I’m moving up the road to San Mateo this week, and I’ve been chewing over a decision I need to make. I finally decided to ask Eran about it–directly.

“Eran, I want your advice. Should I ask for 2 moving guys or 3?”

And so very naturally he said:

“Could you explain to me the factors you’re looking at with 2 versus 3?

And I was off, recounting the thinking I’d done, going through the decision trees. And sure enough, as I talked, I had some new insights, got new ideas on how to look at the question. Those insights didn’t come directly from Eran–they came out of the relational presence he offered.

What do I mean by relational presence? I mean a special combination of attentiveness, genuine concern, plus no attachment to me making one decision versus another.

At one level it doesn’t make sense–if the answer were within me, wouldn’t I have thought of it already. And yet from my experience, having that great Supportive Listener brings out new thinking and ideas within me.

Bottom line is that putting the ball back in the speaker’s court, through a well placed invitation, which in this case was a question, is the gateway to activating the speaker’s internal smarts.

“The best of intentions” can sometimes get me off track as a Supportive Listener. When the speaker gets really distressed, I tend to console.

Let’s face it: it can be tough to be in the presence of somebody who is distressed. And I may even FEEL their distress, as if it’s my own. When that happens, to deal with my own distress I sometimes attempt a “soothing” comment:

• “Oh I’m sure things will work out.”

• “Well you’ve been through this before and you did fine.”

• “I bet you’ll feel better tomorrow.”

You know I really mean the best with the statements, but I’m afraid they have an unintended consequence: they signal to the speaker that the distress they’re experiencing isn’t okay. And so the speaker is caught feeling bad on the one hand, and being pushed to ignore that feeling on the other hand. That squeeze creates a lot of stress.

On the other hand, when I really accept this person’s experience of distress, they’ll often move through it surprisingly quickly, leaving them much more capable of moving forward.

Paul.

I may teach supportive listening, but I don’t want to give the impression that it’s something that comes naturally or easily to me. As Eran has made amply clear to me, getting really good at something like listening comes from a lot of practice, as opposed to say “good listening genes.”

Thus I think it’s appropriate today for me to talk about one of the ways that I get off track by talking when I’m in the role of listener. The reality is that even as a dedicated listener, there comes a time when I need to talk. And so in Supportive Listening we have the WIG (“what I got”) to help us stay on track as listeners when it’s time for us to talk. But sometimes I forget, and here’s what I do instead.

I share my own story.

No sooner has the speaker finished their story, and in fact they are still exhaling from their last word, that I am jumping in with my story. It just feels like such a rush to connect with someone else’s story.

And while it doesn’t work in supportive listening, in everyday conversation it can work nicely. But I’ve been thinking that I’d much better serve the connection with the other person by staying with their story, perhaps with a WIG or two, before sharing mine.

Paul

There was a fascinating article in the New York times about a program to provide psychotherapy services, at a very low cost, in Goa, India. The model has two parts, medication and “talk therapy” and involves giving simple training to locals who go out and provide the services.

And it works! An excerpt from the article:
Speaking in Konkani, the predominant Goan language, she told the counselor that she was not getting along with her four children, especially her son, who had recently beaten her up in a drunken rage. She said she had no one to talk to. Holding tightly to her handkerchief, she began to cry.

Within minutes, she began to relax. Her expression loosened.

‘I feel better when I tell my problems to somebody else,’ she said.
Now granted, Supportive Listening isn’t therapy, and of course doesn’t involve medication. But the idea that simple training could be rolled out, at low cost, to many people, that would enable them to support others–now that sounds both familiar and exciting.

This reminds me of a funny story about technological change. Back in the very early days of the telephone, any time you made a phone call, you talked to an operator who manually connected cables so that the call could go through. As the volume of calls grew, it was projected that there would be a great shortage of operators–so much so that “to support the call volume, every man, woman, and child would have to become a telephone operator.”

And as the story goes, that’s exactly what happened–new technology was invented (i.e. the rotary dial phone) that enabled you to connect your own call, and in effect become your own telephone operator. Those operators haven’t gone away, but they do much more specialized things now.

I see a clear parallel with Supportive Listening. Effective psychotherapy can be fantastically effective for a wide range of life issues, from small to large. However it is expensive, making it out of reach for many. While there many serious issues that require professional help, there is a much broader range of every day life challenges that can be effectively supported by those around us.

Thus, just as the rotary dial telephone made telecommunications available to more people, I think that the “technology” of Supportive Listening could make effective emotional support much more readily available.

Now imagine the impact on the world, or your local community, or even just your circle of friends, if everyone had people to turn to, who could reliably support their growth, plus offering short term relief, through great listening.

Thus, it is with great excitement that I read this article about a project to bring the benefits of emotional support to a large population of people. These are the early days, and the possibilities are energizing.

Paul

Critical Incident Stress Management (CISM) is a debrief method that was created in order to help people cope with traumatic events. The idea is straightforward: A trained person arrives at the site of the event, gathers people who may have been traumatized, and walks them through a debrief process in a number of well-defined stages (including giving details of the event, discussing personal reactions, and assuring people that what they’re feeling is normal).

So far so good. But a large meta-analysis by Bisson et al. in the Cochrane Review (more-or-less the final judges in evidence based medicine) concluded that it’s not working. In the authors’ own words:

No improvement if people received a single session of “critical incident stress debriefing” (CSID) as compared with controls. In fact, the long-term consequences of CSID appear to be deleterious for people that had a greater negative response to the event.

(Note: The review didn’t include any studies with children, who may respond differently to debriefing)

What can make things better? One of the main recommendations that the authors provide is to try having client-led sessions (as opposed to counselor-led). Another recommendation is to think beyond single-shot interventions – perhaps people need more than just (re)processing a traumatic event once.

This is really important. Most people will face a traumatic event at some point of their lives, often more than once. The stress that arises as a response to these events can be very disruptive to people’s lives, and may have negative emotional, social, and economical implications.

So how can people be in charge of their own “critical incident debrief” and have an opportunity to do this on an ongoing basis?

Enter Supportive Listening. Teaching people to debrief with one another could satisfy all of these requirements, in addition to strengthening the community in which the traumatic event occurred. In the Supportive Listening framework, conversations are led by the “speaker” rather than by the “listener.” Because these conversations often take place between friends and family members, it’s possible to find a willing listener on multiple occasions, thereby having an opportunity to reprocess the event and the reactions that came after it as many times as necessary. In the months to come, we hope aim to test the efficacy of Supportive Listening, using scientific methodology and standards – and, rest assured, we will let You know what we discover. In the meantime, take good care of yourselves, and of each other. 🙂

– Eran

At a recent workshop I was giving a demo of Supportive Listening. Granted it wasn’t a totally natural scenario, with a crowd of on-lookers, but it was close enough.

I let her carry through the momentum of her first thoughts, and I didn’t interrupt. There were places where I could have jumped in, but I chose not to. So far so good.

Then as that initial momentum started to dissipate, I was tempted to jump in and fill the silence. I had a sense there was more, though. So I waited. It was a little more uncomfortable.

And then she seemed to have stopped. And I waited a little more. This was even more uncomfortable. And she talked a bit more and then stopped.

After a good deep breath, I shared with her a brief piece of “what I’d got” from what she’d said, and she picked up on it and further developed that thinking.

By leaning into the silence, and only talking when I really thought it was needed to help the speaker pick up again, she relaxed and came up with some creative ideas for her challenge.

To a casual observer, it might appear that I’d done “nothing.” But I knew better. 🙂

Paul.

It’s easy to think of supportive listening as this simple thing that people do–pay attention, nod, show that You care, and they’ll feel better–the emotional equivalent of a pat on the back and a “there, there.”

But there’s a lot more to it than that. As I see it, supportive listening is an application of timeless therapeutic principles that are usually ascribed to luck, or to mysterious intuition and talent (“She’s just such a good listener… Whenever we talk, I come up with all kinds of solutions for my problems”). Carl Rogers (have You had a chance to read any of his stuff?) wrote beautifully on the incredible impact that unconditional positive regard, accurate empathy and authenticity can have on people. He also suggested (very convincingly, in my opinion) that in the vast majority of cases, people can find their own integrated solutions without requiring the guidance (subtle as it may be) of an external, omniscient parent/teacher/therapist.

There are times when external guidance may be necessary, of course, but we are often all too quick to tell people what to do, how to think, and whom to believe. The idea that people can figure stuff out for themselves seems to be, for the most part, unfashionable. In my opinion, people can do a lot more for themselves than we’re commonly led to believe – given the right support structure.

Paul and I have been very encouraged with the positive responses we’ve received from workshop participants, and are now working to design a more in-depth class. The class will meet over a number of sessions, provide more specific techniques for Supportive Listening and explain the principles and philosophy behind this approach. Most importantly, we’re building the class to provide lots of opportunities to practice. We will add details about registration for the class as time goes by – stay tuned! And, in the meantime, take good care of yourselves and of each other.

– Eran

A colleague just forwarded me a link to a beautiful article on the listening, and the magic that can result. You can find the article here:

by clicking on “Tell me More on the Fine Art of Listening.”

This same article is available as a 6 page “book” on Amazon, by the same title.