90 year old Mary has lived in her assisted living residence for two years. She was admitted directly from hospital, after having fractured her hip. Despite the time that has lapsed, her house sits empty; her art studio is dark, the yellows and greens of dripped paint still mark the floor where she fell. She sighs and turns her head to look out her window when she thinks back on her life. Her doctor tells her she is depressed, but she doesn’t think so. Her daughters don’t know what to do, and when she’s asked, she admits that she doesn’t know either. All she really knows is that she longs for the comfort and familiarity of life at home.
Older people often have the experience of being listened to but “not being heard.” This may happen because they have a disability which makes it difficult to speak or to be understood, because they are in a wheelchair, or because they have some memory loss or other cognitive impairment. Occasionally it occurs just because they look frail and old.
Family caregivers, nurses, physicians, social workers, lawyers, financial advisors– well meaning people trying to help, may tend to develop our own belief about what is best for an older person. The result is that the person feels pushed or that no one understands; they can withdraw or become lonely or depressed. Or, their response can be a resistance which we label as ” stubborn.” Sometimes the results are more serious–symptoms that the older person may be trying to report are not heard; clues about what to probe for are missed, a diagnosis doesn’t happen (or does), or someone can be mis-medicated. The ramification is often that the physical or emotional (or both) condition of the older person will worsen.
Accurate listening is a simple and yet difficult skill. We listen accurately when we give someone the chance to tell us all they need to about what concerns them. That means understanding what it is like for them, what they are really thinking and feeling. We know we have listened successfully by the response we get. The person smiles or looks relieved and says, “that’s right.”
Accurate listening helps to:
- Encourage people to talk
- Decrease tension and conflict in relationships
- Make people feel connected and validated
- Make decisions
- Give better care
- Give clients better service
In order to really listen, we need to be willing to solve problems with someone, not for them. We can’t be listening if we already have the solution. From the connection that this builds, we can come to agreement on what the real concern is. We are in a much better position to discuss options and the best way to proceed. The decision will then have their buy-in, and they will be far more predisposed to embrace the decision and help to make it work.
When our Counsellor sees Mary, he just listens. He doesn’t tell her she is depressed, but he does tell her that her face seems to look sad. He notices she lights up when she talks about her art and music. He tells her that it seems like she feels happy when she thinks of her past, but the feeling seems to disappears when she thinks about her life now. She acknowledges that this is all true.
Mary tells the Counsellor, ” I don’t know if I could live on my own, I would have to have someone with me…my brother tells me I should stay here because I would be lonely at home.”
Her Counsellor responds, ” You’re not sure what you should do, and people are trying to convince you. Is that what it is like?”
She nods, and her face softens.
More on Listening
Diamond Geriatrics was hired to help 85 year old Ethel move from her home of fifty years. She sat down with the Counsellor around the wooden table in the kitchen, the noise of the washing machine in the background. She started telling him, “My husband built this house over fifty years ago. Back then, we were in the middle of fields and farms.” When the Counsellor asked about moving, an almost imperceptibly sad look came over her face and she started telling another story.
Finally the Counsellor said, “Ethel, when I ask you about moving, you look really sad. Is that what happens when people talk to you about moving?”
Ethel nodded and smiled as though she were embarrassed. The Counsellor said, “I can see how it would make you sad to even think about leaving your home after living here so long.”
That gave Ethel permission to talk, but she didn’t need to talk about moving. What she needed to talk about was what her home meant to her, what it would be like to leave it, and about all the things she would miss. When she had spoken about what everything meant to her, she then said, ” But I know it is getting difficult for me to be here by myself.”
With all good intentions, the Counsellor had been asked to “help Ethel move” but that was not what she needed or wanted. She needed to talk about her situation. Through listening, the counsellor heard what Ethel wanted to talk about– what was important to her, not to other people. The connection that came from being listened to allowed her to begin to talk with her Counsellor about the barriers to her making changes. Only then could she talk about moving.
Listening is so simple, yet it is so difficult at the same time. Below are some websites about listening, empathy, and about what some people in history have said about it.
- Assume you don’t know what someone is going to tell you.
- Ask someone to explain what they think or feel.
- Repeat or paraphrase until they and you both know they are understood.
- Wait a few seconds before you respond, to see if they have finished.
- Find out what someone wants–a listener, a problem solved, or both.
- Don’t solve someone’s problem until you know what it really is. The issue may be different from what you think.
- Think about what it was like in your own past to feel “unheard” by someone.
- Remember that problem solving is different from listening.
- Remember that listening to someone doesn’t have to mean you agree with them, it simply means that you are respecting them.
- Think about the last interactions you had with your elderly clients, and ask yourself, “Did I really listen?”