Active Listening: A Classic Counseling Skill, Revitalized and Measurable

Kris Engish, PhD

Professor Emeritus, Audiology

University of Akron

Scenario: an audiologist greets a new patient. She introduces herself, gestures towards chairs and, once seated, asks, “Now then … what brings you to our clinic today?” The patient shares recent observations from loved ones about his hearing, expressing some skepticism while acknowledging a small degree of personal concern. The audiologist maintains eye contact, does not interrupt, nods occasionally, takes a few notes, and then stands up. “This is very helpful. Let’s move forward with some testing now.”

Analysis: Did the audiologist listen? Yes, to a limited degree. She did demonstrate “cognitive listening,” a passive process of attending to and processing input.1 But passivity creates a problem: during this encounter, did the patient feel heard? Does it matter? And how does it compare to active listening?

Active Listening = Listening + Engagement

Taking the last question first: active listening is not about listening per se, but about interactivity. (It has been suggested that the term “conversational listening” might be more meaningful.1) While attending to a patient’s narrative, active listeners also verbally respond – with paraphrases, questions, affirmations, requests for clarifications, call-backs to previous topics – to assure patients that they are being heard.2,3

For our listener to feel heard, our reactions and thoughts must be perceptible, via expressions of interest, empathy, respect, and care.4 Our hypothetical audiologist did not convey any of these responses; in fact, as far the patient could tell, she might have been only pretending to listen, pretending to care.

“Feeling Heard” Matters

We know from our own experiences what it is like to not feel heard… a bundle of negative reactions from being ignored or dismissed, resulting in resentment and distrust. In healthcare, these consequences are serious: research indicates that patients who do not feel heard are less likely to adhere to healthcare recommendations.5-8

A New Emphasis on Active Listening

Active listening is not a new concept.9  Perhaps as a sign of the times, it is being reintroduced with a particularly timely focus, as a means to reduce clinician bias.10

11. Smiley (2024)

When persons are internally motivated to work through and past their biases, it helps to focus less on “self” and more on another’s dignity and human desire to be heard.12-19 The commitment to actively listen-empathize-care supports those goals.20

Measuring Active Listening Effectiveness

A new tool called the Feeling Heard Scale (FHS) provides the opportunity to collect feedback regarding our Active Listening efforts.21 The FHS has been evaluated for reliability and validity, and, importantly for busy work settings, is brief. Eight items are measured on a five-point Likert-type scale (1 = Strongly disagree to 5 = Strongly agree), to wit: “In this conversation” or “in this meeting”…

  1. I felt heard by the other person.
  2. I could say what I really wanted to say.
  3. the other person was more concerned with him/herself than with what I said.
  4. the other person listened to what I said.
  5. the other person tried to put him/herself in my shoes.
  6. the other person was insensitive to my thoughts and feelings. 
  7. the other person treated me with respect.
  8. we understood each other.

There is also a single-item alternative to the full scale: “In this conversation, I felt heard by the other person.”

The manual on how to use the FSH22 can be found here (permission granted by author).

Conclusion: Engaging in active/conversational listening rather than mere “data processing” humanizes the patient, the clinician, and the process. There are many reasons why our responsiveness can lag (fatigue, distractions, personal challenges). There are also many reasons to continue striving for equitable treatment regardless of interpersonal differences. The FHS has not yet been evaluated for clinical use — but what an opportunity for audiology to take the lead, given our commitment to listening as well as hearing!


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