listening to the patient
TRANSCRIPT
Listening to the patient
The key skill in psychiatry
It was Freud who raised the psychiatric technique of examination-listening-to a level of expertie unexplored in
earlier eras.
ALL PSYCHIATRISTS, REGARDLESS OF THEORETICAL STANCE, MUST LEARN THIS SKILL AND STRUGGLE WITH HOW IT IS TO BE
DEFINED AND TAUGHT
• LISTEN S FOR HIDDEN DISTORTIONS, IRRATIONAL ASSUMPTIONS, OR GLOBAL INFERENCES
• LISTENS FOR HINTS AT UNCONSCIOUS CONFLICTS
Socratis method of questioning
• Soc-Come, lie down here• Strep-What for?• Soc-Ponder awhile over matters that interest you.• Strep-Oh, I pray not there• Soc-Come on the couch!• Strep-What a cruel fate.• Soc-Ponder and examine closely, gather your thoughts
together, let your mind turn to every side of things. If you meet with difficulty, spring quickly to come other idea: keep away from sleep.
• LISTENS FOR COVERT PATTERNS OF ANXIETY AND STIMULUS ASSOCIATIONS
• LISTENS FOR HIDDEN FAMILY MYTHS AND STRUCTURES
THE LISTENER’S INTENT IS TO UNCOVER WHAT IS WRONG AND TO PUT A LABEL ON IT.
LISTENING WORK TAKES
• TIME• CONCENTRATION• IMAGINATION• SENSE OF HUMOR• ATTITUDE OF MAKING THE PATIENT AS AN
HERO OF HIS OWN LIFE STORY
THE BEST LISTENERS HEAR BOTH THE PATIENT AND THE DISEASE CLEARLY, AND REGARD EVERY ENCOUNTER AS POTENTIALLY
THERAPEUTIC.
PATIENTS ARE STORYTELLERS WHO HAVE THE HOPE OF BEING HEARD AND UNDERSTOOD.
THE HEARERS ARE PHYSICIANS WHO EXPECT TO LISTEN ACTIVELY AND TO BE WITH THE PATIENT IN A NEW LEVEL OF
UNDERSTANDING
ACTIVE LISTENING REMAINS ONE OF THE CENTRAL SKILLS IN CLINICAL PSYCHIATRY
Blocks to effective listening
• Patient-psychiatrist disimilarities• Superficial similarities-incorrect assumption and
shared meanings• Countertransference-un resolved conflicts in
psyciatrists mind which makes him to fail to hear
• External forces-emergency dept• Attitudes-need for control, psyciatrists having a
bad day
Attitudes important to listening
• The centrality of inner experience• There are no bad historians• The answer is always inside the patient• Control and power are shared in the interview• It is OK to feel confused and uncertain• Objective truth is never a simple as it seemslisten to
yoursel, too• Everything you hear is modified by your own filters• There will always be another opportunity to hear more
clearly
Attitudes of psychiatrist which help them to be a better listener
• Focus on inner experience• Encourage the patient to be a better historian• Encourage them to search their mind for an
answer• Listen to your inner voice un modified by the
filters
Psychiatrists come to the patient as the product of their own life experiences (filters)though which they hear the patients story .
These filters distort the truth.
TO KNOW OURSELVES IS TO BEGIN TO KNOW OUR PATIENTS MORE DEEPLY
• PERSONAL THERAPY• ONGOING LIFE EXPERIENCE • SUPERVISION
GOAL OF LISTENING
• LISTEN TO THE INNER EXPERIENCE• HELP THE PERSON TO FIND THE LOST ONE
Q. DOCTOR HOW DO YOU PATIENTLY LISTEN SO MANY PERSONS STORY WITHOUT GETTING BORED?
A-WE ACT AS IF WE ARE LISTENING