Thread by @tylerblack32

REFLECTIVE LISTENING Mini🧵
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Quick #meded / #psychtwitter teaching

"We need to listen to our patients," right? But *HOW* we listen matters! Many annoyingly *parrot*, which makes the person feel UNHEARD.

This is called "reflecting" and it is ANNOYING AF.
/1

"I feel angry."
"It sounds like you feel angry."

"My wife left me."
"So you're telling me your wife left you."

It's really really really annoying.

/2

There are good and easy modifications that REQUIRE THOUGHT AND EFFORT but both demonstrate to the patient that you've heard them, but also advance the conversation and allow the patient to think/reframe what they are saying.

Let's look at the statement.

/3

What's the theme?
"You're useless."
"You can't help me."
"Don't bother helping me."

HOPELESSNESS.

So you can respond with **REFLECTIVE LISTENING**:

"Wow, it really sounds that you feel hopeless." or

"I can hear how helpless you feel, the idea that nobody can help you."

/4

Remember that conversations have two agendas, and an advanced move is to add your own agenda (in the case of someone trying to be helpful to someone hopeless- to provide hope).

So how about, "It sounds like nobody has helped you so far."

SO FAR
eh?
see what I did there?

/5

An even more advanced move is to be explicit in the agenda with CONFIDENCE and COMPETENCE:

“It sounds like you feel nobody has helped you so far, but I'm here to try to change that! I have expertise in helping people find ways to change things that even feel hopeless."

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Patients do NOT feel soothed by reflection, in fact, it can exacerbate and worsen entrenched beliefs. Think long and hard about what you're saying, and practice different forms of reflective listening when you hear someone talking about something that bothers them.

/7

In WELL ESTABLISHED therapeutic relationships, it's also possible to challenge. Note: this requires competence, training, and should NOT be done if you have not done so.

"I get it, you feel unhelped. But why would you tell me that? You came to see me."

/8

Adapted from my UBC PGY-2 lecture: "Crisis Intervention in the ER"