Listening First Aid
By Steve Adelman, MD
In the past two days, I have had the privilege of participating in two large support sessions for volunteers who witnessed the horrors at the Boston Marathon finish line. The sessions were organized by the Boston Athletic Association, in conjunction with the Massachusetts Department of Public Health.
The purpose of these events was to give stressed and traumatized volunteers an opportunity to come together, share their experiences, and to commence the process of regaining a sense of emotional well-being after having served a sudden and unexpected tour of duty in an urban war zone.
Sunday’s session took place at the Boston Sheraton on Boylston Street, not far from the finish line. Monday’s session took place at the offices of the Massachusetts Medical Society and Physician Health Services, in Waltham.
Many affected volunteers at each session expressed feelings that they wish they had done more. Virtually everybody at the scene was thrust into a chaotic and unpredictable situation, one that nobody anticipated. In the minutes after the blasts, most everyone at the scene of carnage experienced serious challenges to their sense of being competent and effective.
Although the results speak for themselves – many, many lives and limbs were saved by a superlative team effort – the members of the team are all feeling pretty bad. It’s as if they were saying, “I have no idea how our team won on Monday, because I certainly could have played better.”
Many of the survivors described awkward conversations in the community and the workplace: “People call me a hero, but I don’t feel like a hero.” It’s very difficult to feel incompetent and to be told that you are a hero.
Several survivors have learned that people out there “just don’t know what to say.” After the manhunt ended on Friday, a common comment they heard was, “You must feel better now.” But they didn’t feel better – many of them felt worse.
Question: How do we talk to people who have recently endured extreme trauma?
Answer: Very little – better to listen than to talk.
Listen very carefully, and try to put yourself in their shoes. Ask open-ended questions and respect their answers and wishes. Follow the lead of the person you are listening to. Here are a few questions and comments to consider utilizing if you undertake a conversation with a traumatized person:
- Do you feel like talking?
- What would you like to talk about?
- Tell me more.
- What was that like?
Don’t assume that you know how the other person feels, and don’t assume that their experience of the trauma is what you imagine it to be. By asking gentle, empathic questions, you can help the trauma survivor to unburden himself or herself, but only if he or she wants to.
As an empathic listener, your job is to follow the other person’s lead, never to take the lead. If the survivor you are with prefers to remain silent, that’s okay. Just let them know that you’re ready to listen if they ever feel like talking.
Gregorio Billikopf Encina of the University of California Berkeley has referred to this form of “empathic listening” as “listening first aid.”
Now that the acute trauma of the Marathon explosions is beginning to subside, let’s approach our conversations with the survivors – in our communities and throughout the health care system – in a low-key, respectful, and empathic way. By applying “Listening First Aid,” we can promote healing by helping them to feel understood, by trying, as best we can, to see the fractured world through their eyes.
Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.