How to Listen to Your Clients to Improve Your Practice

Written By Bailee Adler

“You can lead a horse to water, but you can’t make them drink.” That adage has never rung more true to me than when I was practicing as an occupational therapist. 

I spent 90% of my effort motivating my clients. That clinical expertise I'd spent so much time and money getting? I only used that about 10% of the time. I was so frustrated. It led to me feeling burned out and powerless to help my clients who didn’t seem to want to help themselves. This frustration started to damage my ability to feel empathetic towards my clients. My effectiveness as a therapist suffered.  

I don’t think I’m alone in this struggle. Healthcare practitioners encounter diverse patient populations, but we all find a similar theme...

There are many patients and clients who aren’t motivated to make the changes necessary to get better. 

If you’re like I was, it’s easy to write this off as “well that’s their problem– I’ve done all I can do and they are choosing to not listen”... 

But this begs the question... "did you listen?"

Full transparency- most of the time I was a really terrible listener as a clinician. I did my chart review. As much as I’d tell myself I didn’t, I already had biases and assumptions made based on a patient’s chart before I even met them. Ignorant to how I was sabotaging my ability to really listen to them when they came in for their evaluation. 

I genuinely longed to help all my patients, whether they were 8 years old or 80. I couldn’t understand why someone would show up to seek the knowledge of a specialized healthcare professional just to blatantly ignore all the education and advice given. I was the most fired up when this happened with the parents of my pediatric patients. 

It took me a whole lot of frustration and self-victimization before coming around to the understanding that…

…my clients were only going to listen to me as well as I listened to them.

The missing piece was not their “lack of motivation”, it was my ability to not only listen, but to listen really well.  

I thought I was listening. I took diligent notes in evaluation. I asked parents and caregivers how things were going at home. Offered relevant information and solutions that I had learned about. I shared resources for their specific problem areas and explained them at length. I collaborated on therapy goals with them and gave education on the importance of home exercise programs and good sleep hygiene. All the things a holistic OT encompassing the whole person should do right?

Kind of. 

I was making the assumption that if my patients and their families simply had the right information and the right plan they would see tremendous progress. I was dishing out my treatment plan and approach with the best of intentions, but I had already missed the mark. 

I was listening to what they trained me to hear instead of listening to everything my clients had to say.

Six Active Listening Tips For Therapists

In school they taught us how to “listen actively”. Look at the speaker, nod, repeat back what you’re hearing, etc.

I was doing this. All the while coming up with solutions, explanations, and a host of other things instead of actually listening to my patient.

When you are the expert in your field, patients come to you for help. It’s easy to fall into the trap that you should be the one dominating the conversations during appointments as you guide and educate. This is how our billing process gears us to think as well. As an OT, PT or SLP– we can’t bill ethically for a session of just listening to our client. 

But you know who you’re treating - that specific patient- and you know who is the expert in them? They are.

If you’re ever going to get to a place where you can integrate your expertise into their lifestyle to impact meaningful change... you need to let them teach you about themselves. 

I know I certainly have a looooong way to grow in the areas of intentional listening and humility. Here are a few things I’ve learned about how to listen to your patients well.

  1. Talk to Your Client Wayyyy Less. 

Research shows that within 1 hour of a conversation, the listener has forgotten 50% of the information, and within 24 hours they have forgotten 70%. Share only prioritized information you want the parent or caregiver to learn and apply after that particular session. Forget any fluff or extra notes you have. Allow the parent or caregiver to do the talking as they process. Give them the space to work through how it will look for them and their child at home by staying silent. If you don’t jump in right away to respond, the parent will have more time to gather their thoughts and share more with you about their questions, hesitations, or other context you may need to improve their child’s treatment plan.

2. Keep in mind that there are 3 different types of conversations: emotional, social, and practical. Listen to the one your client is having.

When you are visiting with a parent, it is so important to identify the kind of conversation you are having. Is the parent wanting to vent (emotional), are they discussing what they did over the weekend (social), or are they asking you about their child’s progress (practical)? 

From my experience, most parents begin an interaction with a therapist with an emotional or social type of conversation. Given the nature of being a service provider to the child and educator to the parent, the type of conversation you’re aiming to have is going to likely be practical.

If you launch into the practical conversation while they are trying to communicate differently than you, you’ll both be missing each other.

If they are having an emotional conversation, acknowledge that emotion you are hearing, ask questions about their feelings, and tie in their emotions to your goals. For example, here is a response that missed the mark:

Parent: “We have just been so busy with all the running around we forgot to do our exercises this week.”

Therapist: “Yeah I totally get it. That’s okay. How about you try to do them right before bed this week?!”

In this example the therapist met the parent with a practical solution after the parent shared their emotional start to the conversation. Let’s run it again.

Parent: “We have just been so busy with all the running around we forgot to do our exercises this week.”

Therapist: “You have so much going on and I’m hearing that you’re feeling stressed and maxed-out. I totally get it. But imagine how you’ll feel when your child can do (insert activity) independently!? What type of schedule for a home exercise program would work best for you guys so that we can make that happen?”

In this example, the therapist followed the parent’s lead and continued an emotional conversation and then invited them to collaborate on a solution with emotional motivation in a practical conversation.

Bestselling author Charles Duhigg suggests that after you identify the type of conversation you’re having, you should then explicitly state what your goal is for the conversation and ask the parent what theirs is.

For example:

"My goal today is for you to leave here feeling confident about how to help your child do these 2 exercises and understand why we are doing them. "

Then explore both of your feelings around those goals, ask the parent how they feel about what’s happening as well as any objections or questions they may have.  

3. When people feel heard, they are more apt to like you. If they like you, they are more apt to follow your advice. 

It may feel uncomfortable, but make sure you are allowing a pause before you respond in conversation with a parent. This actually increases their perception that you are actually listening to them. Then respond with something thoughtful that acknowledges what they said to confirm their perception. 

4. Talk about yourself as little as possible. 

You are not learning more about your client or their family if you are talking about yourself. Resist the temptation to reciprocate their weekend story with yours unless they ask you directly. Instead, ask thoughtful open-ended questions. There is an endless amount of information you can learn about your client and their family that is going to help you be a better therapist for them.

5. Create an environment where they feel comfortable sharing. 

Provide a private space. Give their child something to do while you step away with them to speak at the end of the session. Turn off any electronic distractions and give them your undivided attention.  

6. Don’t fear the deep end. 

Studies show that most people are not excited about having deep, emotional, and meaningful conversations, but are usually happy they did. They usually find that it went much better than they had thought it would.

Parents of children who need your services are likely struggling because their child is. They could be feeling grief, frustration, shame, self-blame, helplessness, overwhelm, insecurity, guilt or even defensiveness because of whatever challenges their child is facing. So don’t be afraid to really dive in with your client’s family and talk about things that may feel uncomfortable at first. Both of you will likely be glad you did. 

Listening well, reflecting and meeting patients where they are is going to help you see results with your clients much faster than fire-hosing them with information, techniques, and new strategies.

Practice intentional, selfless listening professionally and personally to see how much people open up to you. You’re about to learn a lot.

I’d love to listen to you about your business and how you want it to grow. Book a 15 minute call with me to have a conversation about your goals. 


Book a 15 Minute Call
Bailee Adler
Next

“Is It Important for My Therapy Clinic to Have an Online Presence?”