Listening or Telling

by Dr Ollie Hart

I find one of the hardest skills in health coaching is judging when to listen and when to tell.

We come with a huge background of knowledge and experience, from our training and having partnered with often thousands of patients or clients. So commonly we recognise those typical patterns of thinking and behaviour that we know derail good health outcomes. We are desperate to set them on their path to recovery.

The dilemma is we need to know where that path is starting from. What is going on in their world and head, right now? What matters most, what are they already doing, how is it going, what have people tried before? So much of this needs careful listening. Listening for what people say, how they say it, what seems to trigger emotions and those most meaningful feelings.

I recently saw a woman who came with 18 months of investigations, a catalogue of diagnoses, and associated explanations, related to her widespread chronic pain. Hearing her story, they seemed more attuned to the interest of the clinician than to her experiences. She was at her wits end, mostly because once the specialists ‘treatments’ hadn’t worked, responsibility was pushed back with her……’you’ll just have to live with it’…..’nothing more I can offer’.  To me she ticked every box for neuroplastic pain.

It felt important to hear her story, acknowledge her emotions, understand the rollercoaster of feelings she had been dealing with. But as the time stretched on, I wondered when I would be able to offer some insights or input anything that might feel useful. I am sure these are worries we all hold as we listen and wonder how we can be most effective as a helper.

That consultation ended with me ‘doing’ very little. What I felt was that by being listening, her thinking had opened a small crack of curiosity. By being listened to, it seemed her mind had started to think a little differently. Getting things out (words and emotions), validating them, believing her. Perhaps the one seed to plant was reflecting ‘this sounds very familiar to this sort of clinic, and not unlike many others experiences’……opening the door to a little hope……

What we did ‘do’ was to identify some reading that might start to feed her curiosity, and agree to meet again. I hope she will primed to expect more listening, and an expectation that a key part of our work together will be developing positive thinking on her part.

The trouble is when we tell, we often shut down curiosity and good quality thinking. Of course, connecting people with information they weren’t aware of can be a real enabler, but the dose is very important. Judging how much to ‘inject’ as someone’s confidence is re-awakening is a real skill. Too much and people regress to a passive, ‘following instructions’ mode.

Often though, the biggest battle is with ourselves. Are we doing enough with our time? Would it be quicker and easier for them, if we just tell them what they should do. It can seem like the short cut.  Often patients are conditioned to expect this, but in my experience unless they are treading that path with a fully activated mind – thinking well for themselves- it ultimately leads to a dead-end.

So often we hear patients that feel they have had a great interaction, say ‘they really listened to me’. So, growing your confidence that this is a meaningful action is key. I find it can help to share this with people. “I can see how important it is for you to have your story heard”. Sharing the time limits can help and maybe negotiating a joint strategy. “We have 20 mins, perhaps if I listen to you for 15 mins and then we use the last 5 mins to plan next steps?”. Or make use of the 2-appointment strategy “for this session I just want to listen and understand your perspective and experience so far, next session will focus on a plan moving forward……is that ok?”

In our Peak Health Coaching courses, we deliberately put strong emphasis on connecting and building rapport. It can feel like a given, and perhaps less significant than getting into the thick of setting a goal and making a plan of action, but it forms the foundations of the relationship and,  in the end,  enables you both to go further and faster. Listening builds rapport and creates that equal power dynamic, telling puts you (rather than them) in the driving seat and can often undermines that shared autonomy and control.

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