The Art of Listening: Unlocking Deeper Understanding in Speech-Language Therapy

In nearly 25 years of clinical practice as a speech-language therapist, listening is the most important skill I’ve had to learn and cultivate on an ongoing basis. Listening skills may appear to be an obvious prerequisite for any therapist, or perhaps it’s an assumed quality that therapists possess, but what does it really mean for a therapist to demonstrate traits of an effective listener?

I have learned most about the art of listening through my involvement and work in the stuttering community. Meeting and working with people who stutter has opened my eyes to the vital need for communicative environments where listening is prioritized and valued.

In the therapy world, whether we call it reflective listening, empathic listening, or active listening, this kind of listening means we seek to listen with understanding, that is, understanding what the speaker is truly feeling and experiencing (Rogers & Roethlisberger, 1952).

The late Carl Rogers (1952) calls this “understanding with a person, not about her.” He defines it as “seeing the expressed idea and attitude from the other person’s point of view, sensing how it feels to the person, achieving his or her frame of reference about the subject being discussed” and being “willing to enter his private world and see the way life appears to him, without any attempt to make evaluative judgments” (Rogers & Roethlisberger, 1952).

Each time a client shares their story, it’s a privilege to be invited into their world—to see life through their eyes. This deep listening—understanding WITH a person rather than merely about them, and without judgment—is transformative in therapy. When we as therapists engage in this way, we create a safe space that encourages our clients to open up further. They begin to share more deeply, express themselves more freely, and experience a genuine sense of being heard, perhaps for the first time.

Rogers also asserts that if we can listen with understanding and “catch the essence” of a person’s hatreds and fears, we will be “better able to help them alter those hatreds and fears and establish realistic and harmonious relationships with the people and situations that roused such emotions” (Rogers & Roethlisberger, 1952). This concept is so applicable to the stuttering experience, so let’s examine further.

Learning from the lived experiences of people who stutter (Tichenor & Yaruss, 2019), we know that stutterers often grapple with complex emotions. These can range from anxiety and frustration stemming from challenging speaking situations to guilt and shame due to societal stigma and unrealistic fluency demands. Many also experience fear and isolation, feeling alone and disconnected from others due to their stutter. In the face of profound and deeply rooted emotions, speech-language therapists have a unique opportunity. By listening with empathy and understanding, we can guide individuals who stutter to explore and reframe their relationships with the people and situations that evoke such intense emotional responses.

Itzchakov and Kluger (2018) highlight Rogers’ theory that “when speakers feel that listeners are being empathetic, attentive, and non-judgmental, they relax and share their inner feelings and thoughts without worrying about what listeners will think of them. This safe state enables speakers to delve deeper into their consciousness and discover new insights about themselves—even those that may challenge previously held beliefs and perceptions.”

Reflecting on this concept, again I consider the experiences of our clients who stutter. They often find themselves in communicative spaces that feel unsafe, where listeners are not empathetic, attentive, or non-judgmental, and are thus hindered in their ability to communicate freely. By contrast, therapists who engage in the art of listening can go against the grain by creating safe communicative spaces that open the door to self-reflection and growth.

We must beware, however, of potential barriers to listening that might keep us from unlocking deeper understanding in our interactions and sessions with clients. Four main barriers warrant our attention:

1. Not being present. In an age of constant distractibility and frequent competition for our attention, being present with someone often requires intentionality, even in a therapeutic environment. To this end, we must seek to understand what optimizes our abilities to focus and attend, also realizing that being quiet does not necessarily mean being present. For some, this might mean learning to listen to hear and understand rather than listening to respond in an interaction. For others, it might mean consciously removing visual, auditory, or sensory distractors within the therapy environment. Ultimately, the goal is being fully present and engaged, which enables deeper connections.
2. Our tendency to impose solutions. Therapists who assume they have all the answers risk overlooking tailored solutions that best suit their individual clients. Itzchakov and Kluger (2018) suggest that “the role of the listener is to help the speaker draw up a solution themselves.” A good listener may be able to help elicit solutions with open-ended questions such as, “I wonder what might happen if…” Or “If X happened, what would be different?” Or “What would you be doing differently if…?” By asking thoughtful questions, rather than being the solution generator, the listener may lead the speaker to reflect and dive deeper into their thoughts and experiences (Itzchakov & Kluger, 2018), thus drawing on their own resources to generate possible solutions.
3. Failing to listen for the unspoken or the unnoticed. Sometimes listening is hearing what isn’t said, or it may be hearing what is said in passing or dismissively when that statement might point to small positive changes or hints of progress. Manning and DiLollo (2018) describe this as helping our clients identify alternative ways of interpreting their experiences by listening for cues to moments that have potentially been overlooked, ignored, or dismissed that speak a different story than the story they have habitually told themselves (or the stories imposed by others). Manning and DiLollo (2018) further assert that “dominant narratives can be limiting, thereby preventing people from enacting their own ‘preferred identities’ or narratives that lead them to more fulfilling and functional lives.” As we demonstrate interest in more details of our clients’ stories, we can encourage clients who stutter to consider alternative stories and perspectives by asking open-ended questions such as, “Tell me more about this. I am really interested in what you did to get through it successfully.” Or “How did you manage to do that?” Or “I wonder if there might be another explanation (for this positive outcome).” Or “Can you think of any other times that this has happened—maybe even just small examples?” (Manning & DiLollo, 2018). Change often happens in the small moments and as alternative narratives are recognized and embraced.
4. Holding to dogma. Dogma in therapy means that therapists may hold unquestioning beliefs or unchallengeable convictions about a particular treatment approach or program or certain therapeutic strategies and techniques, even if that means holding on to outdated beliefs. In this way, they become “treatment-directed” rather than client-directed, where the nature and needs of the client should be primary (Manning & DiLollo, 2018). Manning and DiLollo (2018) point to Cooper and Cooper’s writings suggesting that therapists should be “‘devoid of dogma’ and have the ability to adapt the therapeutic approach to the client’s uniqueness and needs.” This means we are listening attentively to the client’s concerns and worries, learning about their experiences, values, and hopes, and gaining a clear understanding of their needs, desires, and goals—in other words, truly hearing and seeing the client. Being devoid of dogma also means that therapists view both stuttering and stuttering treatment holistically, being attentive and attuned to the whole person and the entire stuttering experience (Tichenor et al., 2022). Additionally, holistic treatment means we walk alongside our clients with a willingness to take risks and explore fresh ideas and opportunities, particularly when the process of change is slow or difficult (Manning & DiLollo, 2018).

The art of listening in speech-language therapy, especially for those who stutter, is paramount. It transforms therapy rooms into places where individuals who stutter can safely explore their experiences and challenges and reshape their relationship with stuttering. As therapists refine their listening skills, they not only improve clinical outcomes but also model the patience and acceptance that clients may struggle to find in their daily lives. As we continue serving people who stutter and their families, may we learn and practice listening with understanding, that our clients may truly feel heard!