The Most Important Skill for Therapists

Brett and I are often asked, "what is the most important skill for doing therapy?" While therapy cannot be reduced to a single skill, empathic listening is routinely recognized as the most essential therapeutic skill.    https://www.fastcompany.com/90749446/how-to-become-a-better-listener-according-to-science   Transcrpt: you're listening to psych with mike for more episodes or to connect with the show with comments ideas or to be a 0:06 guest go to www.cyclicmike.com follow the show on twitter at psych with 0:13 mike or like the facebook page at psych with mike now here's psych with mike welcome into 0:19 the psych with mike library this is dr michael mahon i'm here with mr brett newcomb how are you today so you were 0:25 saying your your favorite food is chinese i was saying that in my somewhat 0:30 less than extensive travels around the world i've never been in a town anywhere that didn't have a chinese restaurant 0:35 yeah and then i was telling you that jane goodall believes in extraterrestrials 0:41 sasquatch and yetis and so you said what i said i would find extraterrestrials to be more 0:48 believable and acceptable uh as a reality than sasquatch right 0:54 because i think the it'd be really hard for someone that uh or some thing 1:00 that is sasquatch is uh defined to have a place to live without being noticeable 1:07 and i made the racist joke that there's probably a chinese restaurant in the town near him but right and that the 1:12 inference was that sasquatch must eat chinese exactly yeah which i think that's the breaking news 1:19 sasquatch's favorite food chinese well maybe so how are you today i'm good 1:26 yeah um it is uh summertime in st louis missouri which is yeah it 1:33 just happened this weekend yeah two days you know what they say about st louis weather just wait 24 hours yeah yeah um 1:39 but man just the last couple of days it's been just it's been really hot really humid yeah 1:46 so it you know things like that happen and then you start thinking about oh i could go live somewhere else but then 1:53 we never do so well we think about a lot of things we never do that just makes us normal yeah 1:58 if only woulda coulda shoulda woulda coulda shoulda yeah all the missed opportunities in life 2:05 so uh one of the things that 2:11 is okay let me start a different way if you 2:16 had to off the top of your head say 2:22 what is the single most important skill that a person could have 2:28 as a psychotherapist what would that be why 2:35 i think the single most important skill i would say is attending yeah which is 2:40 paying attention and listening right uh and then reflecting back to check for accuracy uh to make sure 2:47 that the person that you're attending to feels seen and heard 2:53 and accepted so that starts with good listening good listening and 2:59 yet you we read articles and i'm going to enclose an article in what we do 3:07 in in in the the notes that i post with this the show 3:12 but i've read hundreds of articles on listening and at their core 3:19 they all have something to do with what you just said which is attending which is making 3:25 the other person feel heard and to me i think that is if we are 3:32 talking about what's the difference between listening and paying lip service to listening to 3:39 me that's the difference is the other person feels actually heard and seen as 3:45 an individual there's been a lot of research that 3:50 emphasizes both the verbal component of listening in the non-verbal component of listening 3:56 but the data shows that most of us don't listen we turn talk yeah so while you're 4:02 talking uh because in part because of the science 4:07 my mental process can formulate sentences and thoughts and words 4:12 probably six times faster than i can speak them articulately and if i'm speaking articulately your 4:19 mental processes is checking in to see okay what's he talking about where is he going with that 4:25 and then you go away and formulate four or five responses and then you come back and see if i'm still 4:32 saying the same thing as slowly as i was and then you go away and think about other things wonder what time it is 4:37 where you're going for lunch what your wife's doing then you come back and i'm still talking about the same i still you 4:42 already knew the main gist of what i was saying because it was topically focused so you've gone off five or six times in 4:48 a cycle and you're ready with a packaged response the minute i shut up and if you 4:53 get tired of waiting you'll start to signal and cue me yeah 4:59 and and whatever nod your head and so that i get the message non-verbally 5:04 it's my turn shut up and then if i don't take that you'll override it and you'll interrupt me 5:09 so then you often so then i do the same thing in reverse i listen to what you're saying uh but i immediately start going 5:15 off and sidelining what i want to say in response or thinking about something else all together and coming back 5:21 checking in checking out checking in checking out that's the way most people listen and we turn talk right we learn 5:26 the nonverbal cues to signal the exchange uh so if i've known you for a lot of years i know from watching your 5:32 body language when it's your turn to talk when you want it to be your turn to talk right so so in in 5:39 therapy yeah one of the things that i'm aware of is that when the client speaks 5:48 there are a lot of times when i have they say something and it triggers a 5:53 response and and i hold on to the response until i find yeah as long as it remains 5:59 relevant i mean then the client could take a shift and then it's not but but so do you think that that's okay is it 6:05 okay for a therapist to be listening to the dialogue that the 6:10 client is reporting to come up with a response and to hang 6:16 on to that and then deliver it or do you think that you should listen to the whole message before you even attempt to 6:22 try and formulate a reaction so the article that's going to accompany this 6:27 conversation says you there's no such thing really as multitasking and you shouldn't multitask 6:33 but what i used to try to train people who wanted to be therapists to understand 6:38 is that you have to listen on two or three channels at the same time i listen to your words i listen to 6:46 your nonverbals i listen to the patterns of our conversations over time and i retain those in my awareness 6:53 and so if something is off it it's like an alarm going off and i 6:59 notice it and at some point when you stop talking i'm going to say mike something seems to be off 7:05 and i'm not sure what it is can you help me and you'll say oh no no i'm fine there's nothing wrong okay i just i need 7:11 to check because it's really important for me to hear you accurately that's what you pay me for and that's what we're here to do 7:18 but i have to think about the patterns of i know about which i know how you live your life 7:25 i have to think about the themes that you repeatedly talk to me about what's going on and you'll have today's focus 7:32 you have the crisis of the moment or you'll be focused on something that's really important to you 7:38 but it's one-dimensional and there are other dimensions of you that i need to listen to and check in with 7:45 it's almost like talking to a multiple as if we were all multiples so i think part of being a good 7:51 clinician is developing that awareness that sort of percolates in the 7:57 background of your of your consciousness and will knock on the door and say hey women ask him about this 8:02 so i listen to your conversation and i give you feedback and i check to say am i so this week you're just really 8:08 focused on this my am i getting that right and that's how we teach couples when we do couples therapy you listen what they 8:15 say then you repeat it and you say here's what i heard you say verbally hear the feelings i got from you when 8:22 you said it did i hear you accurately and until the partner says yes you have 8:28 to just keep you say well repeat it again and you ask them to tell it again then you say okay this is what i heard 8:33 you say these are the feelings i got from you as you were saying it am i hearing you accurately so you teach 8:38 people to do that but for a therapist you have to go a deeper level you have to listen 8:44 sort of with your background training uh saying wait a minute there's a red flag 8:49 come back to that and so as you said sometimes you wait you bring it up later 8:54 and sometimes you have to interrupt and say well hold on something's going on so you do think that there are times in 9:00 therapy where it is appropriate to interrupt the client to stop their flow their free flow of information and then 9:07 say hey i need to check in and and see if this is something that i heard accurately right yeah and uh 9:14 my best story about listening is 9:21 so when when my kids were little and i used to watch a lot of football what i would tell people is if my kids walk 9:28 into the room and they say hey dad i can hear them 9:33 but to actually listen to them i have to turn the football game off and 9:38 i actually have to look at them right and so people 9:44 get caught up in the jargon about hearing listening and i don't i don't care what you call it but what 9:51 what it requires is a focus on that individual and a focus on the individual 9:58 not just from the listeners perspective right like i'm watching the football game i'm saying yes go ahead child talk 10:06 to me that's not good enough you have to make the receiver the person who is speaking 10:13 you have to make them believe and feel like your focus is on 10:20 them which is easier to do in therapy because obviously you're sitting in a room with somebody and 10:25 hopefully you're only paying attention to that individual but that doesn't mean that they feel it and so 10:33 you as a clinician your job is to make sure that their experience is that they are 10:40 speaking and you are listening to them and the way that you do that is by what you aptly said is by the attending and 10:47 the way you make sure that they feel attended to is that you check in with them so you're rephrasing things that 10:54 they say you're asking them for clarification and those should always be obviously open-ended questions so when 11:00 we do therapy we talk about open-ended enclosed ending questions and since you're the person that taught me that i 11:08 what's the difference between an open ended and a closed-ended question 11:13 well a close-ended question is one that has a definitive answer are you warm yes 11:18 no yeah and that's the end of the thing an open-ended question is one that invites 11:24 you to speculate and continue wherever it is you need to go there's nothing i want to bring up too 11:30 though about clinical skills that is a question for therapists to be able to answer and 11:36 that is there two elements one is things going on your own life i had a friend that died recently i'm 11:43 grieving the loss of that friend i come to work today and you start talking about somebody dying and it triggers all 11:50 kinds of things in me am i listening to me or am i listening to you and if i if i have a headache 11:58 today uh my stomach hurts uh from whatever reason my friend's death or the grieving that i'm doing or 12:04 physically i have a head cold it's a pollen season in st louis 12:11 do i need to take the day off because can i responsibly listen to you and take your money 12:17 if i'm not able to attend so that's one thing the other thing is as i've gotten older 12:23 my hearing is diminished i can't discriminate your voice out of background noises if i'm watching the tv 12:29 show and you say something to me i would literally have to turn the tv show off i 12:34 do now in order to listen to you my wife and i are learning this as an ongoing 12:40 thing we've been together for 35 years and i'm used to hearing her and talk to me in the background and track 12:45 something else because i was able to do that no i'm not and and i asked her to repeat 12:50 things uh because she speaks softly and she gets frustrated with all those three or four repetitions i'm not getting and 12:56 and i watch her get frustrated and i apologize i'm really sorry you know i'm 13:01 just struggling to hear as a clinician do i bring that to work for me to do it 13:08 that's actually something that i've never considered before but as a super relevant point 13:15 uh yeah if if you are having difficulty and obviously 13:22 i guess what my recommendation would be that if you're having that experience the first thing you do is go see a 13:28 doctor go see an audiologist and see if there's something that can help you be able to hear 13:33 better but yeah if you're really really i remember um do you remember when um 13:40 uh russ limbaugh died rush limbaugh died 13:46 okay it wasn't significant in my car yeah right rush limbaugh is a conservative talk show guy tony snow who 13:53 worked in the white house for a long time took his place and the reason that i remember this is because originally 14:00 and and not when rush limbaugh died but he stopped doing his show this was before he passed away uh but he stopped 14:06 doing his show and the reason was because he couldn't hear and when that happened i actually 14:13 thought that i was losing my hearing like it was happening at the same time tony snow took over brush limbaugh's 14:20 show rush limbaugh was talking about he couldn't hear and it wasn't because you know i was 14:25 simpatico with rush limbaugh i went to the doctor and i said hey what's going on i'm having problems hearing people 14:31 and that's my whole livelihood i can't i could work blind i could work paralyzed 14:36 i can't work deaf and the doctor uh did a cursory examination and said 14:42 michael you're getting older and the allergies that you have that didn't bother you when you were younger now are 14:49 having an effect on you and he prescribed me a decongestant and i was fine 14:55 so the first thing to do is go to the doctor and get it checked out because maybe something is going on which again 15:00 clinically is the thing we recommend to clients all the time they can complain about things and and they're struggling with things and you say let's get a 15:07 physical checkup and refer them out to a physician if that solves the problem they don't need to come and pay you money right 15:13 well or yes but i'm thinking more in terms of the clinician yeah taking their own 15:18 advice and going and getting it checked out okay let's take our break and when we come back i'm going to ask you a question 15:24 hey everybody dr michael mahoney here from psych with mike and i couldn't be more excited to talk to you about 15:30 athletic greens which is a new sponsor we have here on the show i started taking athletic greens 15:36 watching some youtube videos and doing my own research i wanted to add something to my 15:42 daily workout program to give me some energy and to support gut health and 15:47 that was the one thing that kept coming up again and again with athletic greens is the guy who started the company did a 15:54 bunch of research because he was having some gut health issues that he couldn't get any resolution for he developed 16:01 athletic greens and it's just exploded from there so it's 75 superfoods 16:07 vitamins minerals probiotics whole food sources that's all in one daily scoop 16:14 you put it in eight or twelve ounces of water you shake it up and you drink it the taste is very very drinkable i 16:21 actually enjoy it and i have been using it and my energy levels have just been through the roof i 16:28 really like athletic greens because of some of the sustainability things that they do so they buy carbon 16:35 credits and you know to help protect the rain forest which is something that i really like 16:41 but if you order athletic greens in your subscription you're going to also get a 16:47 year's supply of their vitamin d supplementation and five free travel 16:52 packs and that vitamin d is so important during those winter months when we're 16:58 not getting enough sunlight we've talked about how that decreases your mood and 17:03 increases depression and that can be a real deal changer so you go to 17:08 athleticgreens.com emerging that's athleticgreens.com 17:15 e-m-e-r-g-i-n-g that's the psych with mike promo and 17:20 you're going to get that additional vitamin d support for a year and five 17:25 free travel packs so take control of your own health today and as always if 17:31 it's friday it's psych with mike okay we're back and so you know then if 17:39 the therapist goes to the doctor they get it checked out and the doctor says well you 17:46 know it's just a natural form of aging and you are losing your hearing 17:53 what would you say to a therapist what would a therapist in that situation do so again at the end of the day 18:00 are you ethically functional to do your job but there are things that you can do 18:06 for instance if you traditionally have low grade background music playing in your sessions turn the music off 18:13 if you're set 10 12 feet away move four to six feet away 18:20 and then make sure you're looking at them make sure you're physically looking at them i've had clients throughout my 18:26 career that come in and at some point they'll interrupt themselves and say stop looking at me because i i look at 18:32 them and i pay attention i'm watching their body language i'm watching their facial expressions but more than their face because their body will tell you 18:38 more right their breathing will tell you they're fidgeting their knee bump their hand movements their stereotypical 18:45 pattern movements whatever they're telling you something and you're listening to hear what it is that it's 18:50 saying right and i've always been a big believer that nonverbal behavior is much more relevant 18:56 in psychotherapy than the verbal message uh you know even if that isn't true 19:02 accurate yeah and gives you more information i think because there's more of it i mean people don't recognize that 19:09 only 15 percent at most of the communication that we have as human beings is that verbal spoken message 19:16 everything else is all nonverbal information and so the overwhelming 19:21 majority of information that we get from other people is non-verbal which we just 19:27 did recently did a show on you know talking over screens and what is the 19:33 impact that that's going to have on how we communicate because i'm very very 19:38 concerned about that and in that show i was much more dark and negative than you were and you 19:44 were talking about all of the good things that the evolution of technology has brought 19:51 us and i just see it as a real negative because i see people changing the ways that they interact and 20:00 filling in the pieces of missing information with assumptions which i 20:05 think is just a very dark road 20:14 i think assumptive communication is a topic for another day because it's an 20:21 incredibly important topic when you talk about learning how to communicate with people because most of us do that and again it goes back and 20:28 who was it albert morabian and ken cooper did a study and they said when you break down 20:34 a non-mediated conversation mediated conversations something uses a piece of technology like 20:40 writing on a page a phone 20:46 walkie-talkie something like that there's a device or an intermediary between you and the 20:52 recipient of the message non-mediated face-to-face conversation you hear me 20:57 you see me so if you break down those communication components they said only seven percent 21:05 was the words themselves and the rest of it is tone facial 21:10 expression volume right whatever so i 21:16 it's important that even as we move in some ways to 21:23 uh teletherapy zoom 21:28 whatever we have to factor that into our understanding of 21:34 and and evaluation of how do i know what i'm hearing i don't know what i'm seeing 21:40 are you suicidal would i know that would i recognize that how what if i'm in another state i'm in missouri you're in 21:46 colorado you call me sam the press and i know you live in the bump still colorado 21:52 do i have the police department's phone number can i send somebody over to to check on you uh do i have responsibility 22:00 legally can i be sued have i done my job there are all kinds of questions right right so the first 22:08 really big factor that is about listening we've already talked about which is 22:13 focus you have to pay attention to the other person in a way that that person recognizes that you are attending to 22:20 them and we've talked about some of the ways that you do that then the second big thing for me is empathy that that a person has to 22:28 experience an empathic connection and i think that this is really 22:36 the difference between therapy that's going to work for you as a client in therapy that may not is the 22:43 and some people don't want that if you know if they feel that empathic connection they may go find a different 22:48 therapist because that may be scary so i have two reactions now one is a lot 22:53 of times people find a different therapist for different issues so they may be comfortable talking to you about 22:58 their marital problems but they won't talk to somebody else about their child abuse uh and that's fine i mean you should go 23:05 where you feel hurt um but so the safe holding environment 23:10 is that term that i use for the reflection of empathic listening if you feel like i 23:18 really see you i really get you and that i not approve of everything about you but i accept you 23:24 as you are then that is the safe holding environment it's my job as a therapist to create that experience for you with 23:31 my training with my personality with my expectations with my attending and listening 23:37 and so the creation of that unconditional positive regard 23:45 universal acceptance however you want to phrase that you believe that that is how 23:51 the client feels empathically connected to them so i think you may have to make 23:56 the distinction uncond carl rogers term unconditional positive regard doesn't mean approval right doesn't mean 24:03 that i accept or agree with your value judgments or your behavior but it means 24:08 that i globally accept you as worthy of right acceptance and my attention right 24:13 so somehow i have to communicate that even if i then have to say you have to stop hitting your child 24:18 that's not going to go nothing's ever going to get better it's only going to get worse so if we want to make progress here 24:26 that's a behavior that you have to recognize you can no longer do right if i have to say that to you and not in 24:32 terms of of me condemning you you're a bad parent you're an abusive parent although i may have to warn you i'm a 24:38 mandated reporter if you tell me this i may have to call it in but what i am trying to say is i 24:45 recognize that you are struggling with this and i still accept you as a person who's 24:50 trying to make their way with failings but part of what i believe is you can 24:55 change right this is a piece that must change how can we find a way that you 25:02 can attempt to change this piece and still be okay with who you are 25:07 and i i think that that for me when i'm was listening to you speaking there it really 25:15 drew to mind your joke about when people say are you a christian therapist and you say yeah i 25:21 work with christians and and i think that that's really relevant that you know sometimes 25:28 you have to get out of a specific comfort zone if you're just looking for confirmation bias you're not really 25:34 looking for therapy if you know you're struggling with an unwanted pregnancy and you're going to somebody who 25:41 thinks like you i'm not saying that's wrong i'm saying that that shouldn't be 25:47 the reason why you decide to go see that person 25:52 absolutely and that's still talking about clinical issues uh it's more likely to be a problem if 25:59 you are an agenda therapist if i've got an agenda to prohibit abortions or to 26:04 promote abortions that i'm listening for an angle that i can pull you in the 26:10 direction that i want you to go that's not therapy that's right so if you're if you are listening for the 26:17 opportunities to confirm the therapist i'm talking about to confirm your 26:22 beliefs and your worldview that's not listening i used to work with a partner 26:28 that was a very strong religious orientation really active in his church and 26:33 a part-time minister and so on and he would talk in our conferences 26:39 because we do supervision with each other uh he would talk about getting into 26:44 these debates with people and bringing out his bible and reading quotations that seemed relevant to him to whatever 26:49 they were presenting and i kept telling them that that's not your job you're not here to proselytize 26:54 you're not here to convince or persuade to your religious perspective you're here to hear what the client needs to 27:01 heard and help them find a way forward that works for them not for you right right 27:06 and so and this is a little bit tangential off topic but you know so do you ever see 27:13 that as being therapeutically valid let's break out the bible and see what the bible has to say i think it's a 27:19 reasonable thing to do if you have a client with a religious orientation that's struggling with something 27:25 my church condemns this behavior i've done this behavior and and the bible 27:31 says blah blah blah well let's see if the bible says that tell me how you understand this phrase what were you quoting what's it coming 27:38 from oh it's a king james version it's a first corinthians or donald trump would 27:43 say two corinthians uh and he said well what does your church say about that 27:49 and how do you understand what they mean and have you spoken to someone within 27:54 the hierarchy to explain your confusions or your turmoil 28:00 how do you so so again i'm not proselytizing my perspective i am saying 28:06 use your own experience use your own education your own background your own connections to 28:12 find a way to process what you're struggling with that can lead you to peace it can lead you to 28:19 change if change is necessary acceptance if it's not so 28:26 who when would the therapist make that decision that okay this is the time to 28:31 bring so let me start differently so i kind of think of that 28:37 in a similar way as i think of the big book when i'm dealing with people who are substance abusers there are times 28:43 when people want to talk about you know what's written in the literature of the recovery community and i don't typically 28:52 do that but there are times where i say okay this person is making a relevant 28:58 request about understanding or trying to process something and we'll look in the 29:03 big book and read what the big book is you're more comfortable with the big book and your experiences with it 29:10 i would be less comfortable i mean from my background my training my education my life i would be less comfortable 29:17 explaining to somebody something from the bible i would recommend that they go 29:22 to their minister or someone that their minister would recommend for 29:27 interpretation where i use it clinically is more when somebody says 29:32 i've sinned yeah and i can't be forgiven i've done this horrible thing and i said what does your church teach you about 29:38 forgiveness what does your church or your religion teach you about forgiveness can can we find documentation can we find quotations can 29:45 we find something but how do you understand what that means and they'll say well typically they'll say well god 29:52 forgives all sinners who come to him all right so why aren't you included you know what is it about you that's so 29:58 bad and so ugly and so unacceptable that even god would reject you you know isn't that an arrogance on your part in that 30:04 conceit on your part what does your church say how do you find comfort i mean so grieving yeah 30:11 let's talk about the grief less feel the grief but self-punishment 30:16 uh self-entrapment and you know i can't change now i have to carry this and i'm i'm stained and i'm unacceptable 30:24 that's going to get in the way of you living your life can we find a way to put it down 30:30 so kind of just to to wrap this up if you had to 30:39 give somebody doing therapy a a primer on 30:46 good listening how would you define that for somebody doing therapy don't get in 30:52 the way pay attention read the non-verbals check for accuracy 30:57 get feedback and i would say make sure 31:02 that whatever you're doing the attention that you are paying 31:08 to the client is focused on them and what their needs are and not focused 31:16 on you like you're not dropping pearls of wisdom you're not yeah but also like so i taught in a 31:22 graduate program for 35 years and the classes were at night they were from 5 30 to 9 30 at night people that 31:29 came to those classes had worked a full day i remember regularly they would 7 30 8 o'clock start saying 31:36 can we go home i'm tired this is boring you know or they'd start playing especially when computers became 31:42 pervasive they'd be checking their email or checking the bank ballgame score stuff like that and i would tell them 31:47 this is a training opportunity your job is to park your stuff and pay 31:53 attention to mine and if you can't do it in this class how are you going to do it in an office with somebody right so you 31:58 need to look at your own behavior you need to learn your own self-control you need to learn how to pay attention on 32:04 demand because you're on the clock exactly somebody's paying you money right and so you can't just do it when 32:09 you feel like right right you got to learn the skill that's right so hopefully that was beneficial for 32:16 somebody out there and you can always get a hold of us at psychwithmike.com we would really appreciate if as many 32:23 people as well i'm just not even going to say that i'm just going to say go to youtube 32:29 and find psych with mike on youtube go to apple podcast and find psych with mike on apple podcast and subscribe to 32:36 the show and leave a comment on the apple podcast those are things that really really help us out as always the 32:44 music that appears in psych with mike is written and performed by mr benjamin the clue and if it's friday it's cyclic 32:51 [Music]