Reflection: Building Trust Through Active Listening

Submitted by: J.M., Mental Health Nurse working in a community mental health team

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

I was conducting a routine follow-up appointment with a service user who had been under our care for several months following a crisis admission. During previous appointments, he had been polite but guarded, giving brief answers and appearing reluctant to engage deeply. On this particular visit, I noticed he seemed more withdrawn than usual.

Rather than following my usual structured assessment questions, I decided to take a different approach. I put my paperwork aside, made comfortable eye contact, and simply asked, "How are you really doing?" I then gave him space and time to respond without interruption.

What followed was a 45-minute conversation where he opened up about his struggles with loneliness, his fears about the future, and his difficulty trusting healthcare professionals due to past experiences. This was a breakthrough moment in our therapeutic relationship, and it came simply from giving him my full, undivided attention.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

This experience reinforced the fundamental importance of active listening in mental health nursing. I realised that whilst structured assessments and documentation are necessary, they can sometimes create barriers to genuine therapeutic engagement.

I learned that active listening involves more than just hearing words—it requires being fully present, observing non-verbal cues, and creating a safe space where service users feel heard and valued. The simple act of putting my paperwork aside sent a powerful message that he was my priority in that moment.

I also recognised that building trust takes time and cannot be rushed. My previous attempts to gather information efficiently may have inadvertently reinforced his reluctance to engage. By slowing down and prioritising the relationship over the task, I achieved far more meaningful engagement.

Following this experience, I attended a two-day workshop on therapeutic communication skills and completed reflective supervision with my clinical supervisor to explore how I could integrate this learning into my regular practice.

How did you change or improve your practice as a result?

Following this experience, I have made several changes to my practice:

• I now begin appointments with open-ended questions and allow more time for service users to respond without rushing to fill silences
• I've restructured my appointment schedule to allow 45-60 minutes for initial and review appointments, rather than the previous 30 minutes
• I consciously put paperwork aside during the initial conversation and complete documentation afterwards, ensuring the service user has my full attention
• I pay closer attention to non-verbal communication—both my own and that of service users
• I've become more comfortable with silence, recognising it as a valuable part of the therapeutic process rather than something to be filled
• I regularly seek feedback from service users about whether they feel heard and understood

These changes have significantly improved my therapeutic relationships with service users. I've noticed increased engagement, more meaningful conversations, and better outcomes. Several service users have specifically commented that they feel more comfortable opening up during our sessions.

I've also shared this learning with colleagues during team meetings, and we've collectively reflected on how we can create more space for genuine therapeutic engagement in our practice.

How is this relevant to the Code?

This reflection relates directly to several aspects of the NMC Code:

• Section 1.1: Treat people as individuals and uphold their dignity - By giving this service user my full attention and creating space for him to share his concerns, I demonstrated respect for him as an individual
• Section 2.1: Work in partnership with people to make sure you deliver care effectively - Active listening enabled genuine partnership working and collaborative care planning
• Section 3.5: Respect and uphold people's rights to privacy and confidentiality - Creating a safe, confidential space where he felt comfortable sharing sensitive information
• Section 7.1: Use terms that people in your care, colleagues and the public can understand - Adapting my communication style to meet his needs rather than following a rigid structure
• Section 8.5: Work with colleagues to preserve the safety of those receiving care - Sharing this learning with my team to improve our collective practice
• Section 9.4: Support students' and colleagues' learning to help them develop their professional competence - I've mentored junior staff on the importance of active listening in mental health nursing

Continuing Development

I plan to continue developing my therapeutic communication skills by attending advanced training in motivational interviewing and trauma-informed care. I've also committed to regular reflective supervision to ensure I maintain this person-centred approach even during busy periods.

I'm currently working with my manager to review our appointment scheduling system to ensure all staff have adequate time for meaningful therapeutic engagement with service users.

If you're preparing your revalidation portfolio and need support with your reflective accounts or confirmer discussion, book a professional confirmer session for expert, judgment-free guidance.