How Reflective Listening Can Go Awry

Good listening skills are essential for clinicians, but are you overusing them? Learn how
and why to deepen therapeutic conversations and improve your effectiveness.

It seems obvious that one of the basic skills psychotherapists must have is an ability to listen to
their clients. However, this skill can be overused or misused in ways that are counterproductive
in psychotherapy. By over-relying on reflective listening therapists may be missing opportunities
to deepen the therapeutic experience and make it more effective — or may even be causing
harm.

Many clients who were in therapy previously with another clinician tell me they quit that therapist
“because all they did was listen.” One study finds that 91% patients want therapy to address
deep-rooted problems. Clinicians who merely listen and don’t engage in deeper inquiry or
interventions may lose clients or fail to provide progress on client-centered goals. Clients then
terminate therapy early with a misunderstanding of what therapy could be and they may never
return.

Good therapists should do more than just passively listen. They should constantly listen to make
sense of a client’s words and behaviors so this information is then used to conceptualize
interventions. A person talking about their “problems” is also modeling how they think, feel and
behave with others and the world. Said another way, if a client is constantly reciting problems,
that is the clinical problem to be addressed. A clinician must look past the recitation of content
and complaints to identify patterns and then directly engage to help the client recognize and
make meaning of those patterns.

Consider that the word “intervention,” which clinicians use to indicate therapeutic treatments, is
based on the word “intervene” — literally to “come between so as to prevent or alter a result or
course of events.”

Beyond Reflective Listening

One simplistic therapy tool is reflective listening, sometimes labeled mirroring. This repeating
back what a person says is often a crutch for junior therapists, but should not be overused.
Passive listening keeps the conversation superficial, especially with clients who feel most
comfortable offering up intellectualized content. Engaging in this way with someone dependent
on intellectualizing will only reinforce use of these habits outside of therapy as well.

There are certain times when reflective listening can be effective. Perhaps a client says
something in an off-hand manner, but I want to repeat the comment to make it more meaningful.
I do this by slowing my pace, emphasizing certain words, and using body language and facial
expressions. I might roll forward in my chair, lean in and with a very deliberate pace and tone
say: “So… if I understand you correctly… you’re saying that your boyfriend won’t let you go to
the store without him?” I refer to this as “letting the words hang in the air” so the client really
hears what she just said. It is done with a clinical intention to slow the client down and focus
their attention. A therapist over-reliant on passive listening who lets statements like this client’s
stand without addressing them can cause harm by failing to highlight dysfunctional or abusive
patterns in relationships.

Similarly, reflective listening that merely repeats a client’s negative self-talk reinforces unhelpful
cognitions, such as in this example:

Client: “I was really angry when my boyfriend didn’t text me back immediately, even
though I knew he was busy at work. And then I just knew it meant he didn’t love me.”

Therapist: “You were angry with Jake because he didn’t text you back when he was at
work and then you thought he didn’t love you.”

This interaction merely reinforces the client’s anxious attachment behaviors and feelings. It also
validates her negative self-image as unlovable, a significant clinical failure, since shame is a
trans-diagnostic emotion that results in anxiety, depression, and personality disorders. In
shame-informed therapy therapists listen carefully for opportunities, such as this one, to address
low self-worth. If a client makes a self-derogatory comment the therapist can use the technique
described above to call attention to the way the person is talking about and relating to
themselves.

Inquire About Family and Attachment History

All clients are impacted by developmental experiences and can benefit from an investigation of
family attachment or relational patterns. Many are reluctant to bring up these histories without
direct inquiry by a clinician because of their fears of criticizing a parent.

Clinicians usually must bring up the topic of family of origin attachment patterns in session after
session for a client to fully and completely understand and process the learned relational
patterns. Some people are hesitant to admit that parents are flawed and will reflexively protect
their view of parents as perfect. Changing this pattern by taking parents off a pedestal can help
heal patterns of self-blame and low self-worth. Clinicians should listen carefully for openings,
because clients are often unconsciously protecting parents with their description of them: “Dad
yelled sometimes, but it wasn’t every day” or “Mom spent a lot of time focusing on herself and
her appearance.” Comments like these should give a therapist an opening to inquire gently, but
persistently, about a client’s real life experience with a father who probably yelled much more
than was originally reported or a mother who was likely narcissistic and self-focused. Merely
reflecting what a client says fails to get the client to reflect deeply on the impact of emotionally
neglectful or harmful parenting on their upbringing.

Don’t be Afraid of Accountability

Buddhists have a phrase that challenges the Rogerian idea of unconditional positive regard:
“idiot compassion.” This describes a kind of unwise empathy that never challenges someone’s
stories or threatens to hurt their feelings. Theologian Henri Nouwen said it this way: “Receptivity
without confrontation leads to a bland neutrality that serves nobody.”

Many clients come to therapy subconsciously hoping to be held accountable for their behaviors
so that they can learn and grow. Yet too many clinicians are afraid to hold clients accountable
for fear of offending them and perhaps causing the client to leave therapy. If handled correctly
accountability may be the very thing that makes therapy successful. Of course, building the
relationship is an essential first step so the client trusts that when you speak directly you are
doing so with care.

Consider the impact of passive listening on this conversation:

Client: “I just can’t seem to get motivated to help clean the house and it’s making my
partner upset.”

Therapist: “It must be so hard to lack motivation and have it affect your partner.”

This reflective listening merely validates and cements the client’s behaviors as acceptable and
can even turn them into ways to seek pity and attention. Stopping the conversation and
intervening to explore the deeper reasons for the lack of motivation can lead to a client’s
awareness of their shame avoidance and lack of accountability.

Therapists should have an awareness of typical responses to shame, embarrassment and guilt,
especially avoidance. Watch for shame-based body language (downcast eyes or avoiding eye
contact, hesitant speaking style, slumped posture, awkwardness, etc). Clients may completely
avoid a subject or quickly change the subject if they do mention it. Therapists should go beyond
listening to gently inquire about what the client is experiencing in that moment when they
mention that subject.

Therapists should be aware of their own shame issues and how they impact therapy. If you are
uncomfortable handling accountability, then you may unthinkingly shield clients from this
experience.

As with many interventions, clinical judgment is necessary to know when to use passive
listening and acceptance and when to intervene more actively, perhaps even by very directly
holding a client accountable.