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Levels of Listening

What it Means to Listen

Stephen Covey, author of the popular book “The 7 Habits of Highly Effective People”, famously once said “Most people do not listen with the intent to understand, they listen with the intent to reply”.

As healthcare professionals, it is our job to listen. But do we really do it effectively? We have all come across the concept of active listening, but do we truly listen in order to understand our patients and support those we work with? Let us begin with examples of how not to listen.

How Not to Listen

The Great Pretender! All the outward signs are there, nodding, making eye contact, but their mind is somewhere else.

The Gate Crasher! Will not allow the speaker to finish, always butting in with little concern for the speaker.

The Clever Bunny! Not interested in the underlying emotion, the logical listener is always trying to interpret what the speaker is saying.

The Egotist! When the speaker says frankly anything, the egotist steels the focus. Favourite lines are, “Oh that's nothing, I remember when I was…”

The Quibbler! Listens only long enough to use your words against you. They are argumentative and want to prove you wrong.

The Instructor! Giving advice is useful but at times this interferes with good listening and does not allow the speaker to articulate thoughts.

Sharmer’s Four Levels of Listening

Modern society encourages the promotion of self and the need to cater for our own desires first. This contrasts with listening; listening is all about others. We use it to connect on different levels and ultimately fulfil the needs of others. Otto Sharmer created a model of listening that consists of four levels. Which level do you operate at?

Level 1: Downloading

“Yeah, I know that already!”

This occurs when listening to information that is already largely known. Individuals will listen to confirm what they already know or support their current opinion. Everything is projected onto their prior perceptions of the situation and reflects past experiences rather than the present information. Often their minds are seen to be elsewhere.

Level 2: Factual

“Ooo, look at that!”

This involves listening with an open mind without presumptions or prior judgements. Individuals are attentive to new ideas and may change their existing opinions if the information supplements or differs from what they already know. However, listeners may focus on searching for facts at the expense of interpreting the human being at the other end.

Level 3: Providing Empathy

“Oh, yes, I know how you feel.”

Listening with empathy requires emotional intelligence. Empathetic listeners are able to connect with the speaker and see the world, situation, subject or opinion, as they do, through their eyes. It helps the speaker feel understood and provides the listener with alternative perspectives which can help sculp and define their decision making. The listener is non-judgemental.

Level 4: Acting Generatively

“..I am connected to something larger than myself”

The final level of listening results from connection to the core ideas of the conversation and the implications they have for the future. Listeners are open and willing to change as they act to incorporate new ideas and bring about the best possible future(s) for themselves and others. This shift of knowledge occurs as listeners see the potential in others/situations and recognise the underlying processes which drive them.

Other Levels of Listening

Sharmer is not the only individual who has attempted to define the different levels of listening. In fact, you will be able to find multiple different theories across the web. Below is compilation of alternative theories to the four levels of listening described above.

Internal Listening

Listening to your inner voice.

Focused Listening

Listening intently to another person.

Global Listening

Listening to others while taking into account the context of their surroundings.

Listening to Speak

The listener is concerned mostly with thinking about the next thing they want to say.

Listening to Hear

The listener is actively and completely paying attention to what the other is saying. They are not distracted by thinking of what to say next.

Listening to Understand

The listener is paying to what is being said, as well as the underlying feelings and thoughts behind the words. Often, the true message is not conveyed with words alone.

Methods for Improving your Listening

Sharmer provides a fantastic goal for the listener you should aspire to become. Here are some simple tricks and tools you can employ in order to maximise your ability to reach the higher levels of listening.

  1. Create a safe environment, both physically and verbally, in which the conversation can take place in.
  2. Clear away all distractions and ensure you are fully focused on the speaker.
  3. Build the speaker’s self-esteem and encourage them to speak all of their thoughts. Be genuinely interested, treat the speaker as an expert and discuss with enthusiasm.
  4. Make no assumptions when listening or speaking. Ask questions if any doubts to prevent misunderstandings.
  5. Monitor non-verbal communication given by both the speaker and you as the listener. Do they align with the verbal message?
  6. Collaborate and make suggestions from a position of trust and aligned objectives. Gently encourage the speaker to express the fullness of what they want to say. Be careful not tell them what to do.
  7. Ask explorative questions to promote discovery and insight for both parties. Probe their understanding and feelings toward the given subject. Help see the situation from a new perspective.
  8. Focus on creating a connection with the speaker. Empathise with them.
  9. Acknowledge feelings and emotions. Note how the speaker feels towards about the topic and be aware of what makes you defensive.
  10. Focus on the speaker. Put your thoughts and feelings aside, quieten your internal voice and place yourself alongside the speaker. Suspend your judgement.
  11. Understand what is being communicated between the lines. Listen to the essence of what is being said. Note the tone and vigour of the language. Ask questions.
  12. Restate exactly what has been said. Ask for clarification if not understood.
  13. Paraphrase the essence of what has been said. Leave opportunities for speaker to correct you.
  14. Interpret the meaning, beliefs, values and assumptions behind the words and relay this to the speaker.

Active Listening

This is a topic we are all familiar with. It is widely taught at medical school, as well as impressed on us by our teachers from a young age! This section serves as a reminder of what active listening entails. Be warned, displaying the features of active listening does not mean you are truly listening. Don’t become the great pretender!

Body Language

These are physical cues that suggest an individual is listening. Most of the time they act unconsciously, but they are just as important as the words that are being said. They include:

  • Acknowledgements
    • Nod occasionally, smile. This shows the listener is paying attention or agrees with the message.
  • Maintain eye contact
    • This can be intimidating so use in moderation.
  • Open posture
    • Face the speaker, lean towards them, open arms, shoulders back, upright and relaxed posture.
  • Mirroring
    • Automatically reflect or mirror any facial expressions used by the speaker. Be careful, conscious mimicking can be a sign of inattention.

Verbal Language

  • Acknowledgements
    • ‘Uh hu’, ‘very good, ‘yes’. Use with caution or elaborate your meaning.
  • Responding Appropriately
    • Be honest and open in your responses.
  • Remember
    • Recall and relay core ideas and concepts from previous discussions.
  • Reflect
    • Paraphrase what has been said, ask questions to clarify certain points and periodically summarise key points.
  • Minimise Interruptions
    • Listen without interrupting the flow of the speaker.