Listening Between the Lines: Active and Reflective Listening in Trauma-Informed Care

Authors

Frederick Shack, LMSW^1,4
Mardoche Sidor, MD^1,2,3
Jose Cotto, LCSW^1,5
Karen Dubin, PhD, LCSW^2,4
Lesmore Willis Jr, MPA, MHA¹
Gary Jenkins, MPA¹

Affiliations

¹Urban Pathways, New York, NY
²SWEET Institute, New York, NY
³Columbia University Center for Psychoanalytic Study and Research, New York, NY
⁴Columbia University, Department of Social Work, New York, NY
⁵New York University, Department of Social Work, New York, NY

Correspondence concerning this article should be addressed to Mardoche Sidor, MD, Urban Pathways, at msidor@urbanpathways.org

Abstract

Listening is more than hearing words; rather, it is a relational act that conveys safety, dignity, and respect. For individuals with histories of trauma and homelessness, active and reflective listening form the bridge from presence to empathy within the Four-Stage Engagement Model.

This article examines the science and practice of deep listening as an intervention. Drawing on trauma-informed care, motivational interviewing, and neuroscience, we highlight how reflective listening enhances therapeutic alliance, promotes corrective emotional experience, and empowers residents to articulate their own goals. Composite case examples from Urban Pathways are demonstrating how listening between the lines, attending to tone, body language, and silences, has the potential to transform disengagement into trust and collaboration.

Keywords

Listening, Reflective Listening, Active Listening, Engagement, Trauma-Informed Care, Motivational Interviewing, Therapeutic Alliance, Supportive Housing

Introduction

Listening is often underestimated in professional training, overshadowed by diagnostic or intervention skills. Yet across psychotherapy and community mental health, the therapeutic alliance, largely built on empathic listening, is the strongest predictor of outcomes (Flückiger et al., 2018; Norcross & Wampold, 2019). For residents in supportive housing, especially those with trauma histories, being deeply listened to may be the first step toward safety and relational repair (SAMHSA, 2014). The Four-Stage Engagement Model positions listening as the second stage, bridging the nonverbal presence of sitting with the deeper empathy of corrective emotional experience.

Theoretical Framework

Listening draws from several theoretical traditions:

1. Motivational Interviewing: Reflective listening evokes intrinsic motivation and reduces resistance (Miller & Rollnick, 2013).
2. Trauma-Informed Care: Listening communicates safety and control, key trauma-informed principles (SAMHSA, 2014).
3. Neuroscience: Being heard activates neural circuits associated with reward, belonging, and self-regulation (Siegel, 2012).
4. Common Factors Research: Empathic listening is central to alliance, which predicts outcomes more than specific techniques (Wampold & Imel, 2015).

Application/Analysis

At Urban Pathways, staff are learning to apply active and reflective listening through:

• Asking open-ended questions about what matters most to the resident (“Tell me what a good day would look like for you?”).
• Using reflective statements that capture both words and emotions (“It sounds like you feel overwhelmed but hopeful about tomorrow.”).
• Affirming strengths and past successes, however small (“You’ve gotten through hard days before, now, tell me what helped then.”).
• Listening for what’s not said—changes in tone, silence, or gestures.

Composite Case Example: A resident repeatedly refused case management meetings, saying “I don’t need help.” A staff member shifted from directive approaches to reflective listening, responding: “It sounds like you’ve had experiences where people pushed you before, and you don’t want that.” This recognition led the resident to share more openly and eventually agree to collaborate on housing paperwork.

Implications

• Practice: Listening is to be recognized as an active intervention, not a passive skill.
• Training: Staff need structured opportunities to practice reflective listening, with feedback on tone and presence.
• Supervision: Supervisors can role-play listening scenarios and help staff tolerate silence and ambiguity.
• Policy: Metrics need to capture resident-reported experiences of being listened to and respected.
• Research: Studies need to investigate the specific impact of reflective listening on trust, housing stability, and recovery.

Conclusion

Listening between the lines is both science and art. In trauma-informed supportive housing, it is the thread that weaves presence into empathy, turning silence into story and disengagement into trust.

References

• Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
• Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma. Psychotherapy, 56(3), 421–430.
• (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication.
• Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). Guilford Press.
• Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.

           

This article is part of a collaboration between SWEET Institute and Urban Pathways.

Read the full scientific version HERE