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Effective listening is an essential skill that practitioners must learn. A good listener seeks to understand before being understood. It is important that you and the client agree that what you understand is a true representation of what the client was saying. Listening is very different from hearing. It can be challenging because our brains move much faster than we talk, thinking ahead and formulating diagnostic and treatment plans. Beckman and Frankel found in 1984 that in 69% of medical consultations, the patient was interrupted within 18 seconds of speaking to a doctor. When this happens, the patient loses their flow of thought, may repeat things that they have already said, and may go on to omit essential information.

Figure 2.6 Nonverbal communication: (a) smile versus (b) non‐smile.

Reflective listening returns back to the client both the words and the emotions that they themselves have conveyed. It shows that they have been heard and understood, and allows them to correct, clarify, or add additional details. It can be achieved via paraphrasing and summarizing:

1 Paraphrasing is restating the content and emotion of the client's message in your own words: “It must have been very distressing for you to see Milo paw at his face so aggressively.”

2 Summarizing presents to the client what you have understood so far: “So, Coco seems to be going off dry food, but is still keen on wet food. Her breath smells, but she seems well in herself. Is there anything else?”