Bani Aadam, Abner Weng Cheong Poon, Elizabeth Fernandez
9 min
Listening is fundamental to mental health, yet it is frequently treated as an axiomatic or secondary skill in clinical training. This study explored how twenty-four mental health practitioners (including social workers, nurses, psychiatrists, and psychologists) in Sydney, Australia, conceptualize and perform listening in their daily work. By using semi-structured interviews and template thematic analysis, the researchers sought to uncover whether listening is merely a technical communication tool or a deeper moral practice.
The study identified four primary listening modalities employed by clinicians: 'just' listening (being present), active listening (demonstrating engagement), reflective listening (verifying meaning), and instrumental listening (gathering data for diagnostics or administration). While practitioners were often familiar with 'active' and 'reflective' listening through formal training, they reported using other modes intuitively without formal guidance. The findings reveal that practitioners often struggle to balance the pressure of 'listening to assess'—driven by administrative requirements and diagnostic checklists—with the more relational goal of 'listening to learn.'
The researchers argue that current communication-based definitions of listening are insufficient because they ignore the power dynamics, cultural contexts, and institutional pressures inherent in mental health care. They propose that 'virtuous listening'—grounded in virtue ethics—allows practitioners to move beyond procedural compliance. By cultivating moral dispositions like humility, compassion, and phronesis (practical wisdom), practitioners can better navigate the ethical tensions of their roles, ensuring that service users are treated as active meaning-makers rather than passive subjects of clinical intervention.
This paper underscores a significant gap in professional training, where listening is often marginalized. By framing listening as an ethically loaded, context-dependent activity, the authors suggest that mental health curricula must move toward a 'multimodal' approach. This shift could help practitioners prevent epistemic injustice—where a service user's perspective is unfairly dismissed—and ultimately build stronger, more empathetic therapeutic alliances.
Abstract Listening is central to mental health practice. However, there is limited empirical research that informs our understanding of what listening is and how listening practices are performed. This study aimed to unpack how practitioners’ listening practices were actually conceptualized, understood, and deployed. Twenty-four mental health practitioners working in community and inpatient settings from Sydney Local Health District were recruited using purposive sampling. A semi-structured interview guide was utilized to explore listening practices. Interviews were recorded and transcribed using Microsoft Teams. Template thematic analysis was employed to analyse data. Two topic summaries emerged: understanding and practicing listening. Themes developed comprise how competencies in cultural adaptation and epistemic justice, as well as more direct ways of working by listening to learn, applying a multi-modal listening approach, and integrating virtue ethics into listening practices, can enable better listening practices. Listening is defined as a cognitive, action-orientated, and relational skill. However, this understanding is limited and excludes listening as a situated activity shaped by broader structures. Listening to learn, a multimodal approach to listening and virtue ethics may safeguard the integrity of the therapeutic relationship, enable practitioners to meet the ends of their profession, and achieve better outcomes.
Alex: What did practitioners mean by listening, before the authors added their broader interpretation?
Sam: They described processing and understanding information, building relationships, and responding through action. They also saw listening as a skill that could improve through practice. Some called it basic or taken for granted, while recognizing how much work it involved.
Alex: The action component sounds consequential. If someone feels unheard, does that necessarily mean the practitioner missed their words?
Sam: Not in these accounts. Practitioners described situations where a service user said they hadn't listened because no response followed. A response might mean reviewing a discharge plan or following up an enquiry. It could also be a bodily gesture showing genuine attention.
Alex: But requiring an action could make listening into another problem-solving exercise. Did anyone defend simply being present?
Sam: Yes, and that's a central tension. The authors call that mode “just listening”: giving someone space without immediately offering advice. One social worker described feeling they had done little beyond sitting with someone, while that person left feeling valued. Other practitioners worried that listening alone couldn't meet their responsibilities.
Alex: So the accounts don't support a universal rule that listening must lead to a solution. Sometimes being heard is what the person wants.
Sam: That's the distinction the authors draw. They then describe active listening, meaning verbal and bodily responses that show engagement. It was the most frequently named approach, and practitioners linked that familiarity to their training.
Alex: Showing engagement doesn't guarantee understanding, though. Did practitioners recognize that gap?
Sam: Some described active listening as too superficial for certain situations, especially higher-stakes encounters. Reflective listening addresses understanding more directly: you reflect someone's meaning back and check it. Practitioners described paraphrasing what they heard, then discovering that the person meant something different.
Alex: That example makes the method concrete. The interview reveals a practice, but also why the practitioner thinks it matters: their first interpretation can be wrong.
Sam: It also shows why the categories overlap. Participants sometimes treated active and reflective listening as inseparable. Reflecting someone's words can both demonstrate attention and test understanding. The authors aren't describing neatly isolated techniques.
Alex: Where does assessment fit? Clinicians still need information for diagnosis and documentation.
Sam: The authors call that instrumental listening: listening to meet diagnostic or organizational purposes. A social worker described listening for particular things during a mental state examination. A nurse described selectively hearing information that confirmed an assessment. Their concern was that predetermined ends could exclude other meanings.
Alex: Does the paper argue that assessment itself is the problem, or that assessment can dominate the encounter?
Sam: The concern is domination, not that every assessment should disappear. The authors contrast listening to assess with listening to learn. The latter seeks someone's meaning, strengths, and wider context. They propose a multimodal approach: deliberately choosing and combining listening modes to suit the situation.
Alex: Practitioners were already combining them informally. What would making that explicit add?
Sam: The proposed benefit is better judgment about when each mode fits. Training had emphasized active listening, while practitioners struggled to name other approaches they used. The authors recommend teaching a fuller repertoire, including its purposes and limitations. That recommendation wasn't tested as a training intervention.
Alex: We started with culture and power. How do those change the choice of listening mode?
Sam: The authors warn that culturally narrow listening can mistake difference for resistance or disengagement. Silence, for example, might be misread as a lack of engagement. They argue that family, community, and cultural context may need to be central to understanding someone's distress.
Alex: And power changes whether the person's account is treated as knowledge, rather than just material for an assessment.
Sam: That's their concern about testimonial injustice: giving someone's account less credibility than it deserves. They ask whether service users are treated as people who make meaning from experience, or merely sources of information. Listening therefore involves decisions about whose knowledge counts.
Alex: That sounds larger than a communication skill. What do the authors propose beyond learning more techniques?
Sam: Virtue ethics, an approach focused on cultivated character and practical judgment. They argue that a duty to listen doesn't specify whether you listen with humility, compassion, or sensitivity. Those qualities could help practitioners respond well under time pressure, heavy caseloads, and competing obligations.
Alex: Could that put responsibility on individual clinicians for conditions they don't control?
Sam: The authors acknowledge structural constraints, but didn't directly examine the broader political and economic forces shaping care. Their proposal concerns judgment within those conditions. It isn't evidence that individual virtues can remove organizational pressures.
Alex: How much confidence should listeners place in the central findings?
Sam: The interviews provide detailed evidence about how this group described listening. But there were no service-user interviews, direct observations, or outcome comparisons. The sample also came from one health district. I'd treat it as a useful account of practices and tensions, not proof that the proposed approaches improve care.
Alex: Who should read the full document, and where would you send them first?
Sam: Mental health and social work researchers, educators, and practitioners. Start with the findings on common listening approaches, especially the tension between just listening and instrumental listening. Then read “Listening to learn,” “Incorporating virtue ethics,” and the limitations. Keep the distinction clear between what participants reported and what the authors propose.
Alex: And what should someone outside those fields remember?
Sam: Listening well isn't only hearing someone's words. It's allowing their meaning to challenge what you expected to hear.
Alex: Thanks for listening.