Just listen

By Dr. Alan Koenigsberg


It’s something that took me years to learn to do well, and it was an integral part of my psychiatric residency training. I specifically chose a residency that focused substantially on the practice of psychotherapy, in addition to the standard biological, medical training.

As the years passed through my medical school training, I had come to the realization that I wanted to have long-term relationships with my patients, help them heal and lead healthy, productive lives. My clinical rotations through most of the traditional medical fields didn’t appear to provide that kind of practice.

When I did my psychiatry rotation, it seemed like the ideal blend of the medical foundations that drew me into medicine, combined with learning about the whole person in front of me. I was very fortunate to have excellent preceptors who encouraged my interest and guided me to the career that fit.

Through the four years of psychiatry residency, I experienced a full range of people, from all walks of life, with an enormous range of illnesses. The combination of medical school and residency gave me an insight into the human condition that has stayed with me for the ensuing 40 years.

As an integral part of the residency program, we were encouraged to engage in our own personal psychotherapy, which I did. I spent several years, first face-to-face and then on the couch, twice weekly undergoing my own psychotherapy with one of the more seasoned psychiatrists.

The residency program director explained to us that our own therapy would help us discover emotional and mental blind spots which, left unknown, could hamper our work with our patients.

He also said it might help us with our personal conflicts as well as aid us to gain an understanding of how difficult it is to work through personal issues and gain awareness of ourselves.

Looking back, I acknowledge how wise that counsel was and how beneficial those years in psychotherapy were, how they help today and how that awareness allows me to listen all the better. I feel very fortunate to have had that opportunity and to have made that investment.

So, going back to listening: It’s not a natural skill for most of us. When I’m in my office, listening to patients, I sit quietly in my chair, maybe sip some tea. Other than that, I do nothing else. I don’t check my phone, email, listen to music or take notes. Nothing but listen.

One of the most basic of human needs is to be heard. Really heard.

Not have advice given, not have the other person relate a similar story, not to be told to understand anything, but to be heard and validated.

There is indeed a time and place for perspective and advice, but first, we must listen to understand.

So, as this calendar year begins, my wish and request is that we all spend some time learning to listen better. Less multitasking, put the phone down, no doodling, just sincere listening.

If you don’t understand something, ask for clarification or ask the person to say more.

If someone is hurting, start by listening. No advice, no comparing, don’t relate it to something you experienced.

Just listen.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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