Jun 10, 2022
Brett and I are often asked, "what is the most important skill for doing therapy?" While therapy cannot be reduced to a single skill, empathic listening is routinely recognized as the most essential therapeutic skill.
https://www.fastcompany.com/90749446/how-to-become-a-better-listener-according-to-science
Transcrpt:
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with mike welcome into
the psych with mike library this is dr michael mahon i'm here with
mr brett newcomb how are you today so you were
saying your your favorite food is chinese i was saying that in my
somewhat
less than extensive travels around the world i've never been in a
town anywhere that didn't have a chinese restaurant
yeah and then i was telling you that jane goodall believes in
extraterrestrials
sasquatch and yetis and so you said what i said i would find
extraterrestrials to be more
believable and acceptable uh as a reality than sasquatch
right
because i think the it'd be really hard for someone that uh or some
thing
that is sasquatch is uh defined to have a place to live without
being noticeable
and i made the racist joke that there's probably a chinese
restaurant in the town near him but right and that the
inference was that sasquatch must eat chinese exactly yeah which i
think that's the breaking news
sasquatch's favorite food chinese well maybe so how are you today
i'm good
yeah um it is uh summertime in st louis missouri which is yeah
it
just happened this weekend yeah two days you know what they say
about st louis weather just wait 24 hours yeah yeah um
but man just the last couple of days it's been just it's been
really hot really humid yeah
so it you know things like that happen and then you start thinking
about oh i could go live somewhere else but then
we never do so well we think about a lot of things we never do that
just makes us normal yeah
if only woulda coulda shoulda woulda coulda shoulda yeah all the
missed opportunities in life
so uh one of the things that
is okay let me start a different way if you
had to off the top of your head say
what is the single most important skill that a person could
have
as a psychotherapist what would that be why
i think the single most important skill i would say is attending
yeah which is
paying attention and listening right uh and then reflecting back to
check for accuracy uh to make sure
that the person that you're attending to feels seen and heard
and accepted so that starts with good listening good listening
and
yet you we read articles and i'm going to enclose an article in
what we do
in in in the the notes that i post with this the show
but i've read hundreds of articles on listening and at their
core
they all have something to do with what you just said which is
attending which is making
the other person feel heard and to me i think that is if we
are
talking about what's the difference between listening and paying
lip service to listening to
me that's the difference is the other person feels actually heard
and seen as
an individual there's been a lot of research that
emphasizes both the verbal component of listening in the non-verbal
component of listening
but the data shows that most of us don't listen we turn talk yeah
so while you're
talking uh because in part because of the science
my mental process can formulate sentences and thoughts and
words
probably six times faster than i can speak them articulately and if
i'm speaking articulately your
mental processes is checking in to see okay what's he talking about
where is he going with that
and then you go away and formulate four or five responses and then
you come back and see if i'm still
saying the same thing as slowly as i was and then you go away and
think about other things wonder what time it is
where you're going for lunch what your wife's doing then you come
back and i'm still talking about the same i still you
already knew the main gist of what i was saying because it was
topically focused so you've gone off five or six times in
a cycle and you're ready with a packaged response the minute i shut
up and if you
get tired of waiting you'll start to signal and cue me yeah
and and whatever nod your head and so that i get the message
non-verbally
it's my turn shut up and then if i don't take that you'll override
it and you'll interrupt me
so then you often so then i do the same thing in reverse i listen
to what you're saying uh but i immediately start going
off and sidelining what i want to say in response or thinking about
something else all together and coming back
checking in checking out checking in checking out that's the way
most people listen and we turn talk right we learn
the nonverbal cues to signal the exchange uh so if i've known you
for a lot of years i know from watching your
body language when it's your turn to talk when you want it to be
your turn to talk right so so in in
therapy yeah one of the things that i'm aware of is that when the
client speaks
there are a lot of times when i have they say something and it
triggers a
response and and i hold on to the response until i find yeah as
long as it remains
relevant i mean then the client could take a shift and then it's
not but but so do you think that that's okay is it
okay for a therapist to be listening to the dialogue that the
client is reporting to come up with a response and to hang
on to that and then deliver it or do you think that you should
listen to the whole message before you even attempt to
try and formulate a reaction so the article that's going to
accompany this
conversation says you there's no such thing really as multitasking
and you shouldn't multitask
but what i used to try to train people who wanted to be therapists
to understand
is that you have to listen on two or three channels at the same
time i listen to your words i listen to
your nonverbals i listen to the patterns of our conversations over
time and i retain those in my awareness
and so if something is off it it's like an alarm going off and
i
notice it and at some point when you stop talking i'm going to say
mike something seems to be off
and i'm not sure what it is can you help me and you'll say oh no no
i'm fine there's nothing wrong okay i just i need
to check because it's really important for me to hear you
accurately that's what you pay me for and that's what we're here to
do
but i have to think about the patterns of i know about which i know
how you live your life
i have to think about the themes that you repeatedly talk to me
about what's going on and you'll have today's focus
you have the crisis of the moment or you'll be focused on something
that's really important to you
but it's one-dimensional and there are other dimensions of you that
i need to listen to and check in with
it's almost like talking to a multiple as if we were all multiples
so i think part of being a good
clinician is developing that awareness that sort of percolates in
the
background of your of your consciousness and will knock on the door
and say hey women ask him about this
so i listen to your conversation and i give you feedback and i
check to say am i so this week you're just really
focused on this my am i getting that right and that's how we teach
couples when we do couples therapy you listen what they
say then you repeat it and you say here's what i heard you say
verbally hear the feelings i got from you when
you said it did i hear you accurately and until the partner says
yes you have
to just keep you say well repeat it again and you ask them to tell
it again then you say okay this is what i heard
you say these are the feelings i got from you as you were saying it
am i hearing you accurately so you teach
people to do that but for a therapist you have to go a deeper level
you have to listen
sort of with your background training uh saying wait a minute
there's a red flag
come back to that and so as you said sometimes you wait you bring
it up later
and sometimes you have to interrupt and say well hold on
something's going on so you do think that there are times in
therapy where it is appropriate to interrupt the client to stop
their flow their free flow of information and then
say hey i need to check in and and see if this is something that i
heard accurately right yeah and uh
my best story about listening is
so when when my kids were little and i used to watch a lot of
football what i would tell people is if my kids walk
into the room and they say hey dad i can hear them
but to actually listen to them i have to turn the football game off
and
i actually have to look at them right and so people
get caught up in the jargon about hearing listening and i don't i
don't care what you call it but what
what it requires is a focus on that individual and a focus on the
individual
not just from the listeners perspective right like i'm watching the
football game i'm saying yes go ahead child talk
to me that's not good enough you have to make the receiver the
person who is speaking
you have to make them believe and feel like your focus is on
them which is easier to do in therapy because obviously you're
sitting in a room with somebody and
hopefully you're only paying attention to that individual but that
doesn't mean that they feel it and so
you as a clinician your job is to make sure that their experience
is that they are
speaking and you are listening to them and the way that you do that
is by what you aptly said is by the attending and
the way you make sure that they feel attended to is that you check
in with them so you're rephrasing things that
they say you're asking them for clarification and those should
always be obviously open-ended questions so when
we do therapy we talk about open-ended enclosed ending questions
and since you're the person that taught me that i
what's the difference between an open ended and a closed-ended
question
well a close-ended question is one that has a definitive answer are
you warm yes
no yeah and that's the end of the thing an open-ended question is
one that invites
you to speculate and continue wherever it is you need to go there's
nothing i want to bring up too
though about clinical skills that is a question for therapists to
be able to answer and
that is there two elements one is things going on your own life i
had a friend that died recently i'm
grieving the loss of that friend i come to work today and you start
talking about somebody dying and it triggers all
kinds of things in me am i listening to me or am i listening to you
and if i if i have a headache
today uh my stomach hurts uh from whatever reason my friend's death
or the grieving that i'm doing or
physically i have a head cold it's a pollen season in st
louis
do i need to take the day off because can i responsibly listen to
you and take your money
if i'm not able to attend so that's one thing the other thing is as
i've gotten older
my hearing is diminished i can't discriminate your voice out of
background noises if i'm watching the tv
show and you say something to me i would literally have to turn the
tv show off i
do now in order to listen to you my wife and i are learning this as
an ongoing
thing we've been together for 35 years and i'm used to hearing her
and talk to me in the background and track
something else because i was able to do that no i'm not and and i
asked her to repeat
things uh because she speaks softly and she gets frustrated with
all those three or four repetitions i'm not getting and
and i watch her get frustrated and i apologize i'm really sorry you
know i'm
just struggling to hear as a clinician do i bring that to work for
me to do it
that's actually something that i've never considered before but as
a super relevant point
uh yeah if if you are having difficulty and obviously
i guess what my recommendation would be that if you're having that
experience the first thing you do is go see a
doctor go see an audiologist and see if there's something that can
help you be able to hear
better but yeah if you're really really i remember um do you
remember when um
uh russ limbaugh died rush limbaugh died
okay it wasn't significant in my car yeah right rush limbaugh is a
conservative talk show guy tony snow who
worked in the white house for a long time took his place and the
reason that i remember this is because originally
and and not when rush limbaugh died but he stopped doing his show
this was before he passed away uh but he stopped
doing his show and the reason was because he couldn't hear and when
that happened i actually
thought that i was losing my hearing like it was happening at the
same time tony snow took over brush limbaugh's
show rush limbaugh was talking about he couldn't hear and it wasn't
because you know i was
simpatico with rush limbaugh i went to the doctor and i said hey
what's going on i'm having problems hearing people
and that's my whole livelihood i can't i could work blind i could
work paralyzed
i can't work deaf and the doctor uh did a cursory examination and
said
michael you're getting older and the allergies that you have that
didn't bother you when you were younger now are
having an effect on you and he prescribed me a decongestant and i
was fine
so the first thing to do is go to the doctor and get it checked out
because maybe something is going on which again
clinically is the thing we recommend to clients all the time they
can complain about things and and they're struggling with things
and you say let's get a
physical checkup and refer them out to a physician if that solves
the problem they don't need to come and pay you money right
well or yes but i'm thinking more in terms of the clinician yeah
taking their own
advice and going and getting it checked out okay let's take our
break and when we come back i'm going to ask you a question
hey everybody dr michael mahoney here from psych with mike and i
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it's friday it's psych with mike okay we're back and so you know
then if
the therapist goes to the doctor they get it checked out and the
doctor says well you
know it's just a natural form of aging and you are losing your
hearing
what would you say to a therapist what would a therapist in that
situation do so again at the end of the day
are you ethically functional to do your job but there are things
that you can do
for instance if you traditionally have low grade background music
playing in your sessions turn the music off
if you're set 10 12 feet away move four to six feet away
and then make sure you're looking at them make sure you're
physically looking at them i've had clients throughout my
career that come in and at some point they'll interrupt themselves
and say stop looking at me because i i look at
them and i pay attention i'm watching their body language i'm
watching their facial expressions but more than their face because
their body will tell you
more right their breathing will tell you they're fidgeting their
knee bump their hand movements their stereotypical
pattern movements whatever they're telling you something and you're
listening to hear what it is that it's
saying right and i've always been a big believer that nonverbal
behavior is much more relevant
in psychotherapy than the verbal message uh you know even if that
isn't true
accurate yeah and gives you more information i think because
there's more of it i mean people don't recognize that
only 15 percent at most of the communication that we have as human
beings is that verbal spoken message
everything else is all nonverbal information and so the
overwhelming
majority of information that we get from other people is non-verbal
which we just
did recently did a show on you know talking over screens and what
is the
impact that that's going to have on how we communicate because i'm
very very
concerned about that and in that show i was much more dark and
negative than you were and you
were talking about all of the good things that the evolution of
technology has brought
us and i just see it as a real negative because i see people
changing the ways that they interact and
filling in the pieces of missing information with assumptions which
i
think is just a very dark road
i think assumptive communication is a topic for another day because
it's an
incredibly important topic when you talk about learning how to
communicate with people because most of us do that and again it
goes back and
who was it albert morabian and ken cooper did a study and they said
when you break down
a non-mediated conversation mediated conversations something uses a
piece of technology like
writing on a page a phone
walkie-talkie something like that there's a device or an
intermediary between you and the
recipient of the message non-mediated face-to-face conversation you
hear me
you see me so if you break down those communication components they
said only seven percent
was the words themselves and the rest of it is tone facial
expression volume right whatever so i
it's important that even as we move in some ways to
uh teletherapy zoom
whatever we have to factor that into our understanding of
and and evaluation of how do i know what i'm hearing i don't know
what i'm seeing
are you suicidal would i know that would i recognize that how what
if i'm in another state i'm in missouri you're in
colorado you call me sam the press and i know you live in the bump
still colorado
do i have the police department's phone number can i send somebody
over to to check on you uh do i have responsibility
legally can i be sued have i done my job there are all kinds of
questions right right so the first
really big factor that is about listening we've already talked
about which is
focus you have to pay attention to the other person in a way that
that person recognizes that you are attending to
them and we've talked about some of the ways that you do that then
the second big thing for me is empathy that that a person has
to
experience an empathic connection and i think that this is
really
the difference between therapy that's going to work for you as a
client in therapy that may not is the
and some people don't want that if you know if they feel that
empathic connection they may go find a different
therapist because that may be scary so i have two reactions now one
is a lot
of times people find a different therapist for different issues so
they may be comfortable talking to you about
their marital problems but they won't talk to somebody else about
their child abuse uh and that's fine i mean you should go
where you feel hurt um but so the safe holding environment
is that term that i use for the reflection of empathic listening if
you feel like i
really see you i really get you and that i not approve of
everything about you but i accept you
as you are then that is the safe holding environment it's my job as
a therapist to create that experience for you with
my training with my personality with my expectations with my
attending and listening
and so the creation of that unconditional positive regard
universal acceptance however you want to phrase that you believe
that that is how
the client feels empathically connected to them so i think you may
have to make
the distinction uncond carl rogers term unconditional positive
regard doesn't mean approval right doesn't mean
that i accept or agree with your value judgments or your behavior
but it means
that i globally accept you as worthy of right acceptance and my
attention right
so somehow i have to communicate that even if i then have to say
you have to stop hitting your child
that's not going to go nothing's ever going to get better it's only
going to get worse so if we want to make progress here
that's a behavior that you have to recognize you can no longer do
right if i have to say that to you and not in
terms of of me condemning you you're a bad parent you're an abusive
parent although i may have to warn you i'm a
mandated reporter if you tell me this i may have to call it in but
what i am trying to say is i
recognize that you are struggling with this and i still accept you
as a person who's
trying to make their way with failings but part of what i believe
is you can
change right this is a piece that must change how can we find a way
that you
can attempt to change this piece and still be okay with who you
are
and i i think that that for me when i'm was listening to you
speaking there it really
drew to mind your joke about when people say are you a christian
therapist and you say yeah i
work with christians and and i think that that's really relevant
that you know sometimes
you have to get out of a specific comfort zone if you're just
looking for confirmation bias you're not really
looking for therapy if you know you're struggling with an unwanted
pregnancy and you're going to somebody who
thinks like you i'm not saying that's wrong i'm saying that that
shouldn't be
the reason why you decide to go see that person
absolutely and that's still talking about clinical issues uh it's
more likely to be a problem if
you are an agenda therapist if i've got an agenda to prohibit
abortions or to
promote abortions that i'm listening for an angle that i can pull
you in the
direction that i want you to go that's not therapy that's right so
if you're if you are listening for the
opportunities to confirm the therapist i'm talking about to confirm
your
beliefs and your worldview that's not listening i used to work with
a partner
that was a very strong religious orientation really active in his
church and
a part-time minister and so on and he would talk in our
conferences
because we do supervision with each other uh he would talk about
getting into
these debates with people and bringing out his bible and reading
quotations that seemed relevant to him to whatever
they were presenting and i kept telling them that that's not your
job you're not here to proselytize
you're not here to convince or persuade to your religious
perspective you're here to hear what the client needs to
heard and help them find a way forward that works for them not for
you right right
and so and this is a little bit tangential off topic but you know
so do you ever see
that as being therapeutically valid let's break out the bible and
see what the bible has to say i think it's a
reasonable thing to do if you have a client with a religious
orientation that's struggling with something
my church condemns this behavior i've done this behavior and and
the bible
says blah blah blah well let's see if the bible says that tell me
how you understand this phrase what were you quoting what's it
coming
from oh it's a king james version it's a first corinthians or
donald trump would
say two corinthians uh and he said well what does your church say
about that
and how do you understand what they mean and have you spoken to
someone within
the hierarchy to explain your confusions or your turmoil
how do you so so again i'm not proselytizing my perspective i am
saying
use your own experience use your own education your own background
your own connections to
find a way to process what you're struggling with that can lead you
to peace it can lead you to
change if change is necessary acceptance if it's not so
who when would the therapist make that decision that okay this is
the time to
bring so let me start differently so i kind of think of that
in a similar way as i think of the big book when i'm dealing with
people who are substance abusers there are times
when people want to talk about you know what's written in the
literature of the recovery community and i don't typically
do that but there are times where i say okay this person is making
a relevant
request about understanding or trying to process something and
we'll look in the
big book and read what the big book is you're more comfortable with
the big book and your experiences with it
i would be less comfortable i mean from my background my training
my education my life i would be less comfortable
explaining to somebody something from the bible i would recommend
that they go
to their minister or someone that their minister would recommend
for
interpretation where i use it clinically is more when somebody
says
i've sinned yeah and i can't be forgiven i've done this horrible
thing and i said what does your church teach you about
forgiveness what does your church or your religion teach you about
forgiveness can can we find documentation can we find quotations
can
we find something but how do you understand what that means and
they'll say well typically they'll say well god
forgives all sinners who come to him all right so why aren't you
included you know what is it about you that's so
bad and so ugly and so unacceptable that even god would reject you
you know isn't that an arrogance on your part in that
conceit on your part what does your church say how do you find
comfort i mean so grieving yeah
let's talk about the grief less feel the grief but
self-punishment
uh self-entrapment and you know i can't change now i have to carry
this and i'm i'm stained and i'm unacceptable
that's going to get in the way of you living your life can we find
a way to put it down
so kind of just to to wrap this up if you had to
give somebody doing therapy a a primer on
good listening how would you define that for somebody doing therapy
don't get in
the way pay attention read the non-verbals check for accuracy
get feedback and i would say make sure
that whatever you're doing the attention that you are paying
to the client is focused on them and what their needs are and not
focused
on you like you're not dropping pearls of wisdom you're not yeah
but also like so i taught in a
graduate program for 35 years and the classes were at night they
were from 5 30 to 9 30 at night people that
came to those classes had worked a full day i remember regularly
they would 7 30 8 o'clock start saying
can we go home i'm tired this is boring you know or they'd start
playing especially when computers became
pervasive they'd be checking their email or checking the bank
ballgame score stuff like that and i would tell them
this is a training opportunity your job is to park your stuff and
pay
attention to mine and if you can't do it in this class how are you
going to do it in an office with somebody right so you
need to look at your own behavior you need to learn your own
self-control you need to learn how to pay attention on
demand because you're on the clock exactly somebody's paying you
money right and so you can't just do it when
you feel like right right you got to learn the skill that's right
so hopefully that was beneficial for
somebody out there and you can always get a hold of us at
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