Listening: An Underlying Competency in Psychiatry Education.

Abstract

According to dictionary.com, hearing is “the act of perceiving sound,” while listening means “to give attention with the ear; to attend closely with the purpose of hearing” [12]. Merriam-Webster online provides an additional element in their “Simple Definition of listen” that has to do with the quality of what is listened to: “to hear what someone has said and understand that it is serious, important, or true” [13]. These definitions imply several key aspects. First, unlike hearing, listening is always active. You can hear passively and can therefore overhear something unintentionally. You cannot listen to something unintentionally. To listen means to direct your attention, to want to hear what is important or true. Second, listening involves an aspect of mutuality, an exchange between two people. Jackson suggested that listening evokes a “compelling effect” on the sufferer. A mutual attachment occurs as the patient responds by telling more and revealing more, which has a reinforcing effect on the listener [14]. Listening is related to empathizing, which has had a great deal of discussion in the medical education literature [15, 16, 17, 18]. Empathy is best understood as a complex construct. There is a cognitive component that involves imaginatively constructing an internal representation of another person’s experience and an affective aspect that involves some resonance of emotion with the other. In addition, clinical empathy is also thought to contain a moral element of feeling concern or compassion for the other, as well as a communicative piece where the clinician shares their empathy with the patient. I would suggest that listening is a necessary precondition for both the cognitive and affective aspects of empathy, in that both assume that the clinician has successfully received whatever the patient is trying to convey.