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The Subtle Art of … Listening

Theologist Professor Henri Nouwen once said that “anyone who willingly enters into the pain of a stranger is a truly remarkable person”. Whilst I wouldn’t take that plaudit too literally (did I just dislocate my shoulder patting myself on the back? *facepalm*) I do think that Healthcare professionals are a special breed.

We are helpers. We are carers. We are fixers.

The phrase “righting reflex” is sometimes used to describe something that happens quite commonly during traditional advice giving, particularly in the Therapy setting. It is the tendency to identify another person’s problem, and immediately try to fix it. There is a sad truth that people can sometimes be indifferent or ambivalent about change, regardless of current situation; they see the arguments both for and against change and have often heard the logical arguments in favour of change many times before. Have you ever started a sentence, or thought process, with “Yes, but…”?

With the best intentions of the Therapist always in mind, this “righting reflex” can inadvertently cause the person to focus on all the reasons not to change. This is called “sustain talk”.

Motivational interviewing (M.I) relies on using the other people’s own reasons to change. It suggests that ambivalence about change is a completely normal human reaction, and is often a necessary step in the process of change.

M.I encourages clinicians to work with patients’ ambivalence rather than viewing it as a problem. The more people hear themselves talk about change, the more likely they are to do it.

It also aims to encourage the patient’s autonomy in decision making


There are a number of theories for how and why motivational interviewing works. Self-determination theory states that people are more likely to change if three basic needs are attended to;

  • Autonomy in making decisions – “do I want to do this?”
  • A sense of their own competence in making the change – “can I do this?”
  • Relatedness – are they being supported by key people around them (including healthcare professionals)

Another theory is that when patients hear themselves (as opposed to the therapist) speaking about change, then their motivation improves and outcomes are better.


Mary Lou Casey once said “What people really need is a good listening to.”  

Philosopher Albert Schweitzer stated “Each patient carries his own doctor inside him.  We (Therapists) are at our best when we give the doctor who resides within each patient a chance to go to work” 

How true these 2 statements are combined.

The intrinsic motivation to do something must be more than the perceived risk – it is the therapists job to find that motivation, not to simply criticise any lack of compliance.

As this paper – Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review – says; “…therapists should be concerned about the attitudes, beliefs and barriers facing their patients and act collaboratively with their patients to design realistic treatment plans which are customised to the patient’s life circumstances…”

I have always said to people in the room with me (be that 1 on 1, or 100 people at a seminar) that you always have all the pieces of the answer, you just, perhaps, don’t know how to order them yet.

What we Therapists do is rearrange those puzzle pieces into a coherent picture, which makes sense to you. But you complete the puzzle – it is your picture.

Once that picture makes sense, I cannot over-emphasise how empowering that is.

One more quote – as Psychologist Carl R. Rogers once said;

“The curious paradox is that when I accept myself just as I am, then I can change”

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

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