Mindful Listening: Learn to Communicate Without Words With Your Loved Ones

Note: This story appears in the book by Marie Marley, PhD, and Daniel C. Potts, MD, FAAN, entitled “Finding Joy in Alzheimer’s: New Hope for Caregivers.”

 “The deepest level of communication is not communication, but communion. It is wordless—My dear, we are already one.”   ~Thomas Merton

In medical school and during residency training we were taught the importance of listening. Granted, by observing some of the master clinicians who were my teachers, I came to understand what good listening skills were like, but honing them myself was a different matter altogether. That skill developed primarily from my relationships with people who have Alzheimer’s disease and other causes of dementia.

Alzheimer’s and some other dementias affect one’s ability to communicate with words. Not only can words become more difficult to think of and produce in speech, but also word meanings may be lost, causing all sorts of communication problems.

In some cases of dementia, this loss of semantics, or word meaning, may make it difficult for a person to understand and express the emotional content of words. At one time or another, most of us have had trouble recalling someone’s name. This phenomenon, as well as difficulty naming objects or parts of objects, quite commonly shows up as a symptom of Alzheimer’s disease.

The problems just described come under the term aphasia, which is the inability to understand or express language. This is one of the core characteristics of Alzheimer’s disease, and it renders communication challenging, at best.

But we communicate in ways other than through language, don’t we? In fact, at times non-verbal communication may be more expressive or truthful than verbal. This form of communication becomes especially important in persons with Alzheimer’s disease and other dementias, and in those of us who seek meaningful, joy-filled relationships with them.

We have to learn to develop the skill of non-verbal communication and to become good listeners.

I teach a course called ‘Art to Life’ at the University of Alabama Honors College. In this course (inspired by my father’s artistic gift which emerged in the throes of Alzheimer’s disease), students are paired with persons who have Alzheimer’s or another cause of dementia in a group art therapy experience. Students learn about the disease, about art and other expressive therapies and their benefits, and about person-centered caregiving and the importance of life stories in the delivery of such care.

During the semester, students learn and document the life stories of their participants. More importantly, they develop empathy for people with Alzheimer’s disease and build relationships with them.

Recently, the students and I got to practice good listening techniques, and in doing so we received a great gift.

John, a participant in his early 70s with moderately advanced Alzheimer’s disease, has fairly prominent expressive aphasia. There are long pauses when he is trying to share his thoughts.

At first, I could detect some frustration and discomfort in the students, who weren’t sure what to do when he was struggling for words. After the first art therapy session, we talked about this and discussed our strategy for handling it during the next session.

I shared with them what I had been told by several people with Alzheimer’s disease and other dementias over the years: they did not want to be interrupted and helped to complete their sentences if they were searching for words. Instead, they wanted to be given time to come up with the words themselves, and they expressed their frustration at being denied the opportunity to actually say what they meant, despite the good intentions of the ‘helpers.’

In a subsequent session, we were able to practice our skills. The art activity in which John was participating reminded him of an experience he wanted to share. As he started telling us about it, he was having a hard time coming up with the words. There were long pauses during which we all had an urge to supply words for him.

But it seemed these pauses were only awkward to us. John did not look frustrated. He continued telling his story at his own pace. The students and I had talked about mindful listening: engaging actively and non-judgmentally in the moment and the content contained therein, being completely present in mind, body and spirit, and listening for anything that was being communicated verbally or nonverbally.

So we waited for him to speak, being careful not to express anxiety or impatience in our facial expressions or other body language while maintaining intense attention to what he was telling us with his whole person. And this soon paid off.

The further John got into his story, the better he was able to verbally express himself. The students and I could see this clearly, and it was a beautiful thing to experience.

When John finished telling us his story (which happened to be about an important event in his life in which he had been able to offer assistance to others in need), he had a look of satisfaction and joy on his face. He seemed proud of himself, and we were proud of him, too.

In our later discussions about this, we realized that our mindful listening practice had given John the space and encouragement he needed to express himself, and he had been validated as a person in the process. What he had to say was important enough to wait for.

This kind of listening had required us to step out of ourselves and into his world, and we had been enriched by the experience.

Learning to be good listeners will increase our capacity to experience joy and to share it as we develop relationships with people who have Alzheimer’s disease and other causes of dementia.

ABOUT THE AUTHOR: Daniel C. Potts, MD, FAAN is a noted neurologist, author, educator, and champion of those with Alzheimer’s disease and other dementias and their caregivers. He was chosen by the American Academy of Neurology as the 2008 Donald M. Palatucci Advocate of the Year, serves as an AAN national media spokesperson for issues concerning Alzheimer’s disease and other forms of dementia, and is a faculty member at both medical schools in his home state of Alabama. Inspired by his father’s transformation from saw miller to watercolor artist in the throes of Alzheimer’s disease, Dr. Potts formed Cognitive Dynamics, a foundation dedicated to quality of life improvement through the arts. Dr. Potts has co-authored A Pocket Guide for the Alzheimer’s Care Giver with his wife, and fellow Architect of Change Ellen W. Potts, MBA; Treasure for Alzheimer’s with Richard L. Morgan, PhD; and Finding Joy in Alzheimer’s: New Hope for Caregivers with Architect of Change, Marie Marley, PhD.