The Power of Deep Listening in Healing

How do you listen to your patients?

Source: Photo credit Dr. Jan Bonhoeffer, Heart-Based Medicine

If you were lucky enough to be read to as a child, deep listening will not be an alien concept for you. Do you remember that cozy, safe feeling as you settled in for the next fairy tale or installment of a long-running narrative? I will wager that the wonder experienced in those moments was not just due to the skill of the author, but because every cell of you was listening without judgment.

Yet this is rarely the case in adulthood. Fast-forward to medical school, for example, when medical students are taught to listen very differently. Gone is the sense of wonder and exploration. In its place is radical efficiency. Our training prepares us to ask questions, recognize patterns, and solve problems. When we take a patient history, any whiff of imagination or subjective emotion is brushed aside in favor of objective evidence. As we race down the rabbit hole of diagnostic questions our only aim is to eliminate possibilities and come to a watertight conclusion as quickly as possible. This mechanistic approach gives us a valuable skill that can be very effective. It is also a skill that can be carried out by a computer!

Where the real treasure can be discovered is in the ability to connect. In my humble opinion, this is where the art of healing meets the science of medicine. When two human beings meet with the time and presence available to really bond, the healing potential of that encounter is magnified. That’s because a kind of resonant field is created between the two. With the practice of deep listening, the doctor and patient enter a therapeutic alliance, an agreement to be fully seen and heard.

Deep Listening vs. Active Listening

Drawing out important information from people doesn’t just depend on the questions you ask; it also depends on the attitude you bring to the listening. Whereas active listening is defined as using your language to affirm that you’ve fully heard what the other person is communicating, deep listening involves paying attention with all of you, not just your mind.

In our book Dare to Care, I share the story of Tina, one of my patients who presented with a myriad of symptoms. Her mother was perplexed and keen to get to the heart of her daughter’s various conditions. Tina shuffled into my practice staring at the floor, her body language clearly indicating that she felt uncomfortable being put “under the microscope.” Over the course of two appointments with her, I took a patient history, performed a full examination, and ordered lab tests, but nothing was conclusive. I had a distinct gut feeling that we were not asking the right questions.

We scheduled Tina’s third appointment for the end of the day when I knew we would have more time together. I decided to take an unconventional approach. “Tina, we’ve only known each other for a few hours, but I feel there is something you know that I don’t which might explain a lot of your suffering. Is that possible?” I asked.

With a nod of encouragement from her mother, Tina eventually looked at me with tears in her eyes. Very quietly she said, “I feel... like a man in a woman’s body.” She confided, “I am ashamed and I don’t know what to do.”

I took her hand. For five minutes nobody said a word. While she settled, I continued to give her my full attention, listening to the resonant field we’d created between us. “Congratulations! I’m so proud of you. You just took a tremendous step,” I told her. I assured her that we were on this journey together and could assemble a team to find the best route forward.

Her whole posture had changed. The slumped, awkward teenager was now sitting up straight in her chair, her gaze penetrating, her voice deeper. When I asked her how many of her symptoms she attributed to feeling this way, she didn’t miss a beat: “All of them, Dr. Bonhoeffer.”

Every cell in my body knew she was right. Yet if I had followed my familiar training and not listened deeply, my initial list of suspected diagnoses would have included chronic gastritis, juvenile arthritis, atopic dermatitis, anorexia, and many more, followed up by extensive lab tests, an MRI, and gastroscopy. I could also have prescribed antibiotics, antacids, and anti-inflammatories to treat her symptoms. Instead, I suggested she listen intently to her body and her feelings, inviting her body to realign with this new perspective.

Rather than making suggestions for her treatment, I decided to ask her what the best next step might be for her. She responded immediately, advocating rest, eating lightly, and taking walks in nature. I encouraged her to sketch her thoughts and feelings as they arose and recommended a series of soothing massages and Feldenkrais movement exercises to help her inhabit her body with more confidence. By now my teenaged patient was smiling broadly.

Trust Essential Reads

Why Do Smart People Fall for Stupid Ideas?

Only by Trusting Others Can You Get Their True Measure

As I reflected later, Tina had taught me a valuable lesson. Exploring traditional diagnostic pathways and employing active listening techniques would have only given us a partial picture of what was really going on. Only by taking the time to build a more heart-centered relationship, engaging her trust by listening deeply without judgment, and inviting her to co-create her own treatment plan was I able to support her with my knowledge and experience.

Deep listening is a skill that can be learned, but only with the sincere intention of practicing it from the heart. It cannot be faked. When you have a profound desire to fully understand the other person, deep listening becomes second nature.

How Can You Practice Deep Listening?

When you’re with a patient, colleague, or loved one, first practice noticing every single detail around them and paying undivided attention—not only to the words they are speaking, but also to their expressed and implied emotions and their body language. Notice how this contributes to your understanding of your patient and their current condition.

Second, allow yourself to become deeply absorbed in the person in front of you and adopt an attitude of genuine curiosity. This is a precious opportunity to shift into seeing the world through your patient’s eyes. It also means taking the risk of relinquishing your medical interpretation and daring to let the insight change you and how you relate to the patient.

Third, if emotions surface in you, check in with yourself to see if they belong to you or your patient. If you suspect you might be mirroring emotions, you can gently verify how it feels for them. If you become aware that your feelings are personal and reactive, you were just gifted a tremendous opportunity for growth! Make a note and embrace it in your reflective practice.

Fourth, when judgments or divisive emotions threaten to separate you, you can step forward with compassion without letting go of your center. Here, compassion is the key to moving from judgment to understanding. You can become aware of both your own and your patient’s over-identification and dissolve separation. In practice, this may feel like seeing the situation from above with loving kindness for both.

By practicing deep listening in this way we can be fully present, returning to our sense of wonder and exploration and learning to trust in the innate wisdom of our patients and their own journey towards greater health. It’s my sincere desire that the field of medicine embraces this heart-based approach as we move forward into a co-creative future.