Reading C

Attending behavior, essential to an empathic relationship, is defined as supporting your client with individually and culturally appropriate verbal following, visuals, voice quality and body language. Listening is the central skill of attending behavior and is core to developing a relationship and making real contact with our clients.

Listening is more than hearing or seeing. You can have perfect vision and hearing, but be an ineffective listener. How can we define effective listening more precisely? The following exercise may help you to identify listening in term of clearly observable behaviors.

Exercise: The Experience of Listening

One of the best ways to identify and define listening skills is to experience the opposite – poor listening. Think of a time when someone failed to listen to you. Perhaps a family member or a friend failed to hear your concerns, a teacher or employer misunderstood your actions and treated you unfairly, or you called a computer helpline and never got someone who listened to your problem. These situations illustrate the importance of being heard and the frustration you feel when someone does not listen to you.

Please stop for just a moment and think back about what was going on when you felt that someone ignored you, distorted what you said, or just plain “didn’t listen.” How did you feel inside? What was the other person doing that showed he or she was not listening?

A more active, powerful way to define and clarify listening is to find a partner to role-play a session in which one of you plays the part of a poor listener. The poor listener should feel free to exaggerate in order to identify concrete behaviors of the ineffective counselor. The “client” ideally should continue to talk, even if the counselor appears not to listen. Then ask the “client” how he or she felt “inside” or emotionally when the counselor did not listen. Together, discuss the specific and observable behaviors that indicated lack of listening. Later, compare your thoughts with the ideas presented in this chapter.

An exaggerated role-play is often humorous. However, on reflection, your strongest memory of poor listening may be feelings of disappointment and even anger. It is the observable behaviors that affect the client immediately. Examples of poor listening and other ineffective interviewing behaviors are numerous – and instructive. If you are to be effective and competent, do the opposite of the ineffective counselor: Attend and listen!

This exercise demonstrates clearly that attending and listening behaviors make a significant difference in the session. Attending and listening are the ways in which you communicate empathy and understanding to the client. They are behavioral roots of the working alliance and a good counseling relationship.

Brain imaging has demonstrated the importance of attending in another way. When a person attends to a stimulus such as the client’s story, many areas of the brain of both counselor and client become involved (Posner, 2004). Specific areas of the brain show activity. In effect, attending and listening “light up” the brain in effective counseling and psychotherapy. Without attention, nothing will happen.

Now let us turn to further discussion of how skills and competence can “light up” a session.

Attending Behaviour: The Skills of Listening

Attending behavior will have predictable results in client conversation. When you use each of the microskills, you can anticipate how the client is likely to respond. These predictions are never 100% perfect, but research has shown that the expected responses usually occur (Ivey, Ivey & Daniels, 2014). If your first attempt at listening is not received, you can intentionally flex and change the focus of your attention or try another approach to show that you are hearing the client.

Attention is the connective force of conversations and emphatic understanding. We are deeply touched when it is present and usually know when someone is not attending to us. The way one attends deeply affects what is talked about in the session. Also, observe the client’s reactions. Learning what to do and what not to do will help determine what might be better and more effective in helping that client.

Obviously, you can’t learn all the possible qualities and skills of effective listening immediately. It is best to learn the behaviors and skills step by step. Attending and observation are the places to start. You will find that many advanced professionals, including highly paid psychiatrists and physicians need to go back and learn about listening and empathy.

Attending behavior is the first and most critical skill of listening. It is a necessary part of demystifying all counseling and psychotherapy. Sometimes listening carefully is enough to produce change.

To communicate that you are indeed listening or attending to the client, you need the following “three V’s + B”:*

1. Visual/eye contact. Look at people when you speak to them.
2. Vocal qualities. Communicate warmth and interest with your voice. Think of how many ways you can say, “I am really interested in what you have to say,” just by altering your vocal tone and speech rate. Try that now and note the importance of changes in behavior.
3. Verbal tracking. Track the client’s story. Don’t change the subject; stay with the client’s topic.
4. Body language. Be yourself – authenticity is essential to building trust. To show interest, face clients squarely, lean slightly forward with an expressive face, and use encouraging gestures. Especially critical, smile to show warmth and interest in the client.

^{* We thank Norma Gluckstern Packard for the three V’s acronym.}

Later, we will speak to individual and cultural differences in attending, but variations of three V’s + B reduce counselor talk time and provide clients with an opportunity to tell their stories with as much detail as needed. As you listen, you will be able to observe your clients’ verbal and nonverbal behavior. Note their patterns of eye contact, their changing vocal tone, their body language, and topics to which your clients attend and those that they avoid. Use your observation skills so that you can adapt your style to meet the needs of the unique person before you, who may come from a different community and cultural background than you.

These attending behavior concepts were first introduced to the helping field by Ivey, Normington, Miller, Morril, and Haase (1968). Cultural variations in microskills usage were first identified as central to the model by Allen Ivey, when he worked with native Inuits in the central Canadian Arctic. He found that sitting side by side with them was more appropriate than direct eye contact (body language and visuals vary among cultures) and that developing a solid relationship was as important as staying on the verbal topic. Nonetheless, smiling, listening, and a respectful and understanding vocal tone are behaviors that “fit” virtually all cultures and individuals. As a result, Allen became much closer to the Inuits he was teaching. In short, attending behavior and listening are essential for human communication, but we need to be prepared for and expect individual and multicultural differences.

Attending Behavior in Action: Getting Specific about Listening and Individual and Multicultural Differences in Style

Listen before you leap! A common tendency of the beginning counselor is to try to solve the client’s difficulties in the first 5 minutes. Think about it: Clients most likely developed their concerns over a period of time. It is critical that you slow down, relax, attend to client stories, and look for themes in their narratives. Use the three V’s + B – visuals, vocals, verbals, and body language – to more fully understand the client’s concerns and build rapport.

Visual/Eye Contact

Not only do you want to look at clients, but you also want to observe breaks in eye contact, both by yourself and by the client. Clients often tend to look away when thinking carefully or discussing topics that particularly distress them. You may find yourself avoiding eye contact while discussing certain topics. There are counselors who say their clients talk about “nothing but sex” and others who say their clients never bring it up. Through breaks in eye contact or visual fixation, vocal tone, and body shifts, counselors indicate to their clients whether the current discussion topic is comfortable for them.

Cultural differences in eye contact abound. Direct eye contact is considered a sign of interest in European North American middle-class culture. However, even here people often maintain more eye contact while listening and less while talking. Furthermore, if a client from any cultural group is uncomfortable talking about a topic, it is probably better to avoid too much direct eye contact.

Research indicates that some traditional African Americans in the United States may have reverse patterns; that is, they may look more when talking and slightly less when listening. Among some traditional Native American and Latin groups, eye contact by the young is a sign of disrespect. Imagine the problems this may cause the teacher or counselor who says to a youth, “Look at me!” when this directly contradicts the individual’s basic cultural values. Some cultural groups (for instance, certain traditional Native American, Inuit, and Aboriginal Australian groups) generally avoid eye contact, especially when talking about serious subjects. This is a sign of respect.

Persons with disabilities represent a cultural group that receives insufficient attention. They also represent the diversity that you will encounter in every session. Eye contact with persons with disabilities may vary, and we need to be careful not to label or counsel them in one way. Emphatic understanding and effective listening require that we recognize uniqueness in each person. For example, in working with those who are blind, you can observe their behavior, but they cannot see you. However, your vocal tone communicates an immense amount of information. They often get much more from your vocal tone, speech hesitations, and conversational style than sighted clients. Working with deaf clients, on the other hand, makes your body language more important. If they can read lips, speak clearly and look at them directly. If they have a sign language interpreter available, then look at the client, not at the interpreter.

We suggest that those of you who do not face these challenges think of yourself as a member of the temporarily able culture. Age and life experience will bring most of you some variation of ability challenges. For older individuals, the issues discussed here may become the norm rather than the exception. Approach all clients with humility and respect.

Vocal Qualities: Tone and Speech Rate

Your voice is an instrument that communicates much of the feeling you have about yourself or about the client and what the client is talking about. Changes in pitch volume, and speech rate, as well as breaks and hesitations, convey the same things as the nature of your eye contact. Throat clearing on your part or the client’s may indicate the words are not coming easily. If clients are stressed, you’ll observe that in their vocal tone as well as body movements. If the topic is uncomfortable for you or you pick up on the client’s stress, your vocal tone or speech rate may change. Keep in mind that different people are likely to respond to your voice differently. Think of the radio and television voices that you like and dislike.

Verbal underlining is another useful concept. As you consider the way you tell a story, you may find yourself giving louder volume and increased vocal emphasis to certain words and short phrases. Clients do the same. The key words a person underlines by means of volume and emphasis are often concepts of particular importance. At the same time, expect some especially significant things to be said more softly. When talking about critical issues, especially those that are difficult to talk about, expect a lower speech volume. In these cases, seeking to match your vocal tone with the client’s is usually appropriate.

Accent is a particularly good example of how people react differently to the same voice. What are your reactions to the following accents: Australian, BBC English, Canadian, French, Pakistani, New England, Southern United States? Obviously, we need to avoid stereotyping people because their accents are different from ours.

Verbal Tracking: Following the Client or Changing the Topic

Verbal tracking is staying with your client’s topic to encourage full elaboration of the narrative. Just as people make sudden shifts in nonverbal communication, they change topics when they aren’t comfortable. In middle-class U.S. communication, direct tracking is appropriate, but in some Asian cultures such direct verbal follow-up may be considered rude and intrusive.

Verbal tracking is especially helpful to both the beginning counselor and the experienced therapist who is lost or puzzled about what to say next in response to a client. Relax, you don’t need to introduce a new topic. Ask a question or make a brief comment regarding whatever the client has said in the immediate or near past. Build on the client’s topics, and you will come to know the client very well over time.

The Central Role of Selective Attention

The normal human brain is wired to attend to stimuli in a way that focuses on coping with the environment and what is near at hand. Selective attention is central to counseling and psychotherapy. Clients tend to talk about what counselors are willing to hear. In any session, your client will present multiple possibilities for discussion. Even though the topic is career choice, a sidetrack into family issues and personal relationships may be necessary before returning to the purpose of the counseling sessions. On the other hand, some counselors may not be interested in career work; their career clients may end up talking about themselves and their personal history and end up in long-term therapy. How you selectively attend may determine the length of the session and whether or not the client returns.

Observe the selective attention patterns of your clients. What do they focus on? What topics do they seem to avoid?

A famous training film (Shostrum, 1966) shows three eminent counselors (Albert, Ellis, Fritz Perls, and Carl Rogers) all counseling the same client, Gloria. Gloria changes the way she talks and responds very differently as she works with each counselor. Research on verbal behavior in the film revealed that Gloria tended to match the language of the three different counselors (Meara, Pepinsky, Shannon, & Murray, 1981; Meara, Shannon, & Pepinsky, 1979). Each expert indicated, by his nonverbal and verbal behavior, what he wanted Gloria to talk about!

Should clients match your language and chosen topic for discussion, or should you, the counselor, learn to match your language and style to that of the client? Most likely, both approaches are relevant, but in the beginning, you want to draw out client stories from their own language perspective, not yours. What do you consider most central and meaningful in the session? Are there topics with which you are less comfortable? Some counselors are excellent at helping clients talk about vocational issues but shy away from interpersonal conflict and sexuality. Others may find their clients constantly talking about interpersonal issues, excluding critical practical issues such as getting a job.

The multiple topics the client presented were chemistry, dealing with her wheelchair, the bookstore being out of books, the failure of the college to provide direct access, the car breaking down, missing school, friendship issues and finally, that indication of depression, “Some days it just doesn’t seem worth the effort.”

Often the last thing a client says in a list of concerns needs to be a focus of the discussion, either now or later. In this case, we’d suggest keeping awareness of possible depression in mind and reflecting the main theme of the client’s story. We recommend in these situations that you respond by helping the client decide where to start. “You must feel like you’re being hit from all directions. What would you like to talk about first?” Angelina has a lot to talk about, but we can only talk about one thing at a time. At a later point in the session, return to the issues she mentioned at the beginning so that she knows you have heard her fully. It can be helpful to list the topics with Angelina and write a contract for how each will be addressed in future sessions, all the time observing signs of depression, which may require referral or longer-term counseling.

Some counselors consistently listen attentively to only a few key topics while ignoring other possibilities. Be alert to your own potential patterning of responses. Try to ensure that no issues get lost, but avoid confusion by not seeking to solve everything at once.

The Value of Redirecting Attention

There are times when it may be inappropriate to attend to the here and now of client statements. For example, a client may talk insistently about the same topic over and over again. In such cases, intentional nonattending may be useful. Through failure to maintain eye contact, subtle shifts in body posture, vocal tone, and deliberate jumps to more positive topics, you can facilitate redirecting the session to other areas. Instead of actively changing the topic, you may want to ask for details from the repeating story. Remember that if clients have been traumatized (hospital, breakup of a long-term relationship, accident, burglary), they may need to tell their story several times.

A depressed client may want to give the most complete description of how and why the world is wrong and continue on with more negatives in their lives. We need to hear that client’s story, but we also need to selectively attend and not pay attention to only the negative. Clients grow from strengths. Redirect the conversation, and when you observe a strength, a wellness habit (running, music), or a resource outside the individual that might be helpful, focus on that positive asset.

The most skilled counselors and psychotherapists use attending skills to open and close client talk, thus making the most effective use of limited time in the session.

The Usefulness of Silence

Sometimes the most useful things you can do as a helper is to support your client silently. As a counselor, particularly as a beginner, you may find it hard to sit and wait for clients to think through what they want to say. Your client may be in tears, and you may want to give immediate support. However, sometimes the best support may be simply being with the person and not saying a word. Consider offering a tissue, as even this small gesture shows without asking or being offered. Of course, don’t follow the silence too long, search for a natural break, and attend appropriately.

There is much more happening in the brain than just silence. It turns out that the auditory cortex remains active when you are attending or listening to silence. Your brain remains highly sensitive, as shown on an fMRI. Similarly, there is evidence that the brain’s visual areas activate before the individual is consciously aware of seeing an object or person (Somers, 2006).

For a beginning counselor, silence can be frightening. After all, doesn’t counseling mean talking about issues and solving problems verbally? When you feel uncomfortable with silence, look at your client. If the client appears comfortable, draw from her or his body language and join in the silence. If the client seems disquieted by the silence, rely on your attending skills. Ask a question or make a comment about something relevant mentioned earlier in the session.

Talk Time

Finally, remember the obvious: Clients can’t talk while you do. Review your sessions for talk time. Who talks more, you or your client? With most adult clients, the percentage of client talk time should generally be more than that of the counselor. With less verbal clients or young children, the counselor may need to talk slightly more or tell stories to help the client talk. A 7-year-old child dealing with parental divorce may not say a word about the divorce initially. But when you read a children’s book on feelings about divorce, he or she may start to ask questions and talk more freely.

Body Language: Attentive and Authentic

The anthropologist Edward Hall once examined film clips of Southwestern Native Americans and European North Americans and found more than 20 different variations in the way they walked. Just as cultural differences in eye contact exist, body language patterns also differ. Box 3.1 demonstrates the impact of our attending behavior on people from different cultures.

A comfortable conversational distance for many North Americans is slightly more than arm’s length, and the English prefer even greater distances. Many Latin people prefer half that distance, and some people from the Middle East may talk practically eyeball to eyeball. As a result, the slightly forward lean we recommend for attending is not appropriate all the time.

What determines a comfortable interpersonal distance is influenced by multiple factors. Hargie, Dickson, and Tourish (2004, p.45) point out the following:

• Gender: Women tend to feel more comfortable with closer distances than men.
• Personality: Introverts need more distance than extraverts.
• Age: Children and the young tend to adopt closer distances.
• Topic of conversation: Difficult topics such as sexual worries or personal misbehavior may lead a person to more distance.
• Personal relationships: Harmonious friends or couples tend to be close. When disagreements occur, observe how harmony disappears. (This is also a clue when you find a client suddenly crossing the arms, looking away, or fidgeting.)
• Ability: Each person is unique. We cannot place people with physical disability in any one group. Consider the differences among the following: a person who uses a wheelchair, an individual with cerebral palsy, one who has Parkinson’s disease, one who has lost a limb, or a client who is physically disfigured by a serious burn. They all may have the common problem of lack of societal understanding and support, but you must work with each individual from her or his own perspective. Their body language and speaking style will vary. Ensure that your working space makes any necessary physical accommodations, and attend to each client respectfully as a complete person.

A person may move forward when interested and away when bored or frightened. As you talk, notice people’s movements in relation to you. How do you affect them? Note your own behaviour patterns in the session. When do you markedly change body posture? A natural, authentic, relaxed body style is likely to be most effective, but be prepared to adapt and be flexible according to the individual client.

Your authentic personhood is a vital presence in the helping relationship. Whether you use visuals, vocal qualities, verbal tracking, or attentive body language, be a real person in a real relationship. Practice the skills, be aware, and be respectful of individual and cultural differences.

The following session example illustrates the importance both of empathic attending skills and of using these skills with awareness of cultural and gender differences.

Azara, a 45-year-old Puerto Rican manager, was not promoted, although she thinks her work is of high quality. She is weary of being passed over and seeing less competent individuals take the position she feels she deserves.

The first session segment is a negative example, designed to be particularly ineffective so that it provides a sharp contrast with the more positive effort that follows. In both examples, the counselor, Allen, has the task of developing a relationship and drawing out the client’s story. Note how disruptive visual contact, vocal qualities, verbal tracking, and body language can lead to a poor session.

Allen does not seem to listen to Azara. Furthermore, he confronts her inappropriately, and it is very unlikely that she will return for another session. Her European American male counselor just doesn’t “get it.” But let’s give Allen another chance. What differences do you note in this second session?

Even in this brief period of time, Allen has conveyed to Azara a genuine warmth and readiness to hear her story. The session continues with Allen discussing with Azara information about the structure of the sessions. Allen also spends time discussing cultural concerns with her, ensuring that she feels comfortable with Allen and that he understands some aspects of her culture. The session resumes with Azara describing the problem she is facing at work. Notice the difference in information gathered between the positive and negative examples.

The session continues from here, with Allen and Azara exploring her strengths.

Here we see a much stronger focus on Azara as a person with individual needs and feelings. A relationship has been established, and it is now possible to discuss multicultural issues as appropriate to the moment. Through attending and listening, we see her story and concerns more fully. A positive asset search for strengths has been initiated.

Observation is the act of watching carefully and intentionally with the purpose of understanding behavior. In spite of what some professionals believe, mastering this skill is not easy.

What can you learn by observing, and why is it important? Through observation you get to know the client and what is conveyed by his or her verbal and nonverbal behavior. Client intentions, needs, meanings, and underlying emotions are often conveyed through nonverbals. Some authorities say that 85% or more of communication is nonverbal. How something is said can sometimes overrule the actual words used by you or your client. A keen observer discovers the many ways clients express their needs, emotions, and motivations.

Observation gives you key information to foster the relationship and facilitate empathic understanding of the client. Observation gives you information about when and what kind of intervention is needed and how the client responds to it. It also indicates what in the environment needs to change to facilitate the client development and progress.

We suggest that you take time out and try the following exercise, as it will help you understand the challenges of effective observation in real life. Please stop for a moment and – before reading any further – view at least one of the following short videos:

These videos are both fun and interesting; most important, they illustrate that we can miss quite a bit in the process of observing.

These videos really show us what Yogi Berra is talking about. They are often used in neuroscience demonstrations because of their close relationship with attentional issues (Shabris & Simon, 2009). If we are carefully attending to a single event or client topic, we can easily fail to notice something that is even more important and miss critical nonverbal issues. Our attentional system, even the most vital and effective, can sometimes fool us. This can be an element in false memories, as well. The client might remember a negative event, but fail to recall that someone saved him or her at the last moment.

Observation can enable you to learn as much about yourself and your counselling skills as you do about your clients. By turning observation inward, you can tune into your own reactions and examine what lies within. This process of self-awareness may lead to growth and change. Whether the focus is on the client or on you, observation provides you with a compass to guide you through the session.

Keep Watch on the Counselling Session

If you use observation skills as defined here, you can anticipate how the client is likely to respond.

What should you observe about client behavior in the here and now of the session? From your own life experience, you are already aware of many things that are important for a counselor or psychotherapist to notice. Brainstorm from what you already know and make a list.

But there are two people in the relationship. What about you? How are you affecting the client verbally and nonverbally? Looking at your way of being can be as critical as observing the client. Start by taking a brief inventory of your own nonverbal style. You might begin by thinking back to your natural style of attending (see Chapter 1, Your Natural Helping Style: An Important Audio or Video Exercise), but expand those self-observations. Better yet, make a video of you talking with someone on a topic of interest to you both, and then a topic that is less interesting or even boring. What is your interpersonal style, and how might it affect your relationship with others and in the session?

Observe the Attending Patterns of Clients

An ideal place to start practicing your observation skills is by noticing your own and your client’s style of attending.

Observe Nonverbal Behavior

Clients may break eye contact, shift bodily movement, and change vocal qualities as their comfort level changes when they talk about various topics. You may observe clients crossing their arms or legs when they want to close off a topic, using rapid alterations of eye contact during periods of confusion, or exhibiting increased stammering or speech hesitations when topics are difficult. Jiggling legs, complete body shifts, or suddenly closing one’s arms most often indicates discomfort. Hand and arm gestures may give you an indication of how the client is organizing things.

Random, discrepant gestures may indicate confusion. A person seeking to control or organize things may move hands and arms in straight lines and point fingers authoritatively. Smooth, flowing gestures, particularly those in harmony with the gestures of others, such as family members, friends, or the counselor, may suggest openness. If you watch yourself carefully on tape, you, as counselor, will exhibit many of these same behaviors.

However, be careful of identifying specific meanings with both nonverbal and verbal behavior because of individual and/or multicultural differences. For example, Siegel’s statements about anger might be compared to what occurs in sexual attraction, that instant awareness of someone who really draws your attention. Here we often have involvement indicating desire – pupil dilation, widened eyes, perhaps even a glazed over look or slight blinding, indicating excitement. Pupil dilation usually means involvement and interest, whereas contracting may mean disdain or disgust, and even be part of anger at times.

Nonverbal behavior may be an indication not only of feeling toward another person or situation, but also of immediate reactions to you as a person, including transference behavior indicating how the client is seeing you.

Observe Verbal Behavior

Language is basic to counseling and psychotherapy, and ways to consider verbal behavior range from detailed linguistic examination to the differing language systems of varying counseling and therapy theories. This chapter will consider four dimensions useful for direct verbal observation in the session: patterns of selective attention, client key words, abstract and concrete conversation, and “I” statements and “other” statements.

Observe Conflict, Incongruities, and Discrepancies

Whether you are helping clients work through problems, deal with issues, encounter challenges or manage concerns, you will be facilitating the resolution of discrepancies, incongruity, and conflict in their lives. Out of your awareness of verbal and nonverbal behavior will come an increased ability to notice conflict of many types. Stress comes from internal and external conflict. Examples of internal conflict and discrepancies include indecision, guilt, depression, and anxiety. Problems with interpersonal relations, cultural oppression, and work are three examples of external conflict. Of course, many of your clients will be dealing with both types of conflict.

Careful observation of multiple types of discrepancies give you a deeper understanding of where clients “really are” in terms of their issues. Conflict is literally the “stuff” of counseling and is often where you can help clients the most.

Individual and Multicultural Variations in Verbal and Nonverbal Behavior

As you engage in observation, recall that each culture has a different style of nonverbal communication. For example, in Turkey, “yes” is indicated by moving the head forward and “no” by raising the eyebrows. For a brief but helpful summary of such cultural differences visit “The Importance of Nonverbal Communication” at http://www.expats-moving-and-relocation-guide.com/nonverbal-communication.html.

As another example, researchers have compared the touching behavior of different cultural groups. One study, which counted the average number of times friends touched each other in an hour while talking in a coffee shop, found that English friends did not touch each other at all, French friends touched 110 times, and Puerto Rican friends touched 180 times (cited in Asbell & Wynn, 1991). Croce (2003) cites a parallel study in which students at the University of Florida, Gainesville, touched twice, compared with 120 instances of touching in San Juan, Puerto Rico.

Smiling is a sign of warmth in most cultures, but in some situations in Japan, smiling may indicate discomfort. And, in all cultures, there can be a difference between a genuine smile and one that seeks to cover up real feelings. Eye contact may be inappropriate for the traditional Navajo, but highly appropriate and expected for a Navajo official who interacts commonly with White Arizona government staff. Similar issues with Native people can arise in other countries such as Australia, Canada, and New Zealand. In Nigeria, direct eye contact can be seen as intrusive, so looking at the shoulder is more appropriate.

Be careful not to assign your own ideas about what is “standard” and appropriate nonverbal communication. All helping professionals need to continue a lifetime study of nonverbal communication patterns and their variations. In counseling sessions, you will find that observing changes in nonverbal behavior may be as important as, or more important than, finding specific meanings in verbal communication style.

Skilled attending behavior is the foundation of the microskills hierarchy; questioning provides a useful framework for focusing the session. Questions help a session begin and move along smoothly. They assist in pinpointing and clarifying issues, open up new areas for discussion and aid in client’s self-exploration.

Questions are an essential component in many theories and styles of helping, particularly cognitive behavioral therapy (CBT), brief counseling, and much of career decision making. The employment counselor facilitating a job search, the social worker conducting an assessment interview, and the high school guidance counselor helping a student work on college admissions all need to use questions. Moreover, the diagnostic process, while not counseling, uses many questions.

Types of Questions

This chapter focuses on two key styles of questioning: open and closed questions.

Open questions

Open questions are those that can’t be answered in a few words. They tend to facilitate deeper exploration of client issues. They encourage others to talk and provide you with maximum information. Typically,open questions begin with what, how, why, or could. For example, “Could you tell me what brings you here today?”

Closed questions

Closed questions enable you to obtain specifics and can usually be answered in very few words. They may provide useful information, but the burden of guiding the talk remains on the counselor. Closed questions often begin with is, are, or do. For example, “Are you living with your family?”

If you use open questions effectively, the client may talk more freely and openly. Closed questions elicit shorter responses and may provide you with specific information. Following are some of the results you can anticipate when using questions.

Questioning Questions

Some theorists and practitioners are concerned about the use of questions and believe that they are best studied and learned after expertise is developed in the reflective listening skills of Chapters 6 and 7. They point out that once questions are presented to those beginning counseling, the listening skills of paraphrasing, reflecting feelings, and summarizing may receive insufficient attention. Certainly, excessive use of questions takes the focus from the client and can give too much power to the counselor. Your central task in this chapter is to find an appropriate balance in using questions with clients.

People often respond to this exercise by describing situations in which they were put on the spot or grilled by someone. They may associate questions with anger and guilt. Many of us have had negative experiences with questions. Furthermore, questions may be used to direct and control client talk. School discipline and legal disputes typically use questions to control the person being interviewed. If your objective is to enable clients to find their own way, questions may inhibit your reaching that goal, particularly if they are used ineffectively. For these reasons, some helping authorities – particularly those who are humanistically oriented – object to questions.

Additionally, in many non-Western cultures, questions are inappropriate and may be considered offensive or overly intrusive. Nevertheless, questions remain a fact of life in our culture. We encounter them everywhere. The physician or nurse, the salesperson, the government official, and many others find questioning clients basic to their profession. Most counseling theories espouse using questions extensively. Cognitive-behavioral therapy and brief counseling, for example, use many questions. The issue then, is how to question wisely and intentionally.

The goal of this section is to explore some aspects of questions and, eventually, to determine their place in your communication skills repertoire. Used carefully, questioning is a valuable skill.

Sometimes Questions are Essential: “What Else?”

Clients do not always spontaneously provide you with all necessary information, and sometimes the only way to get at missing data is by asking questions. For example, the client may talk about being depressed and unable to act. As a helper, you could listen to the story carefully but still miss underlying issues relating to the client’s depression. The open question “What is happening in your life right now or with your family?” might bring out information about an impending separation or divorce, a lost job, or some other issue underlying the concern. What you first interpreted as a classical clinical depression becomes modified by what is occurring in the client’s life, and treatment takes a different direction.

An incident in Allen’s life illustrates the importance of questions. His father became blind after open heart surgery. Was that a result of the surgery? No, it was because the physicians failed to ask the basic open question “Is anything else happening physically or emotionally in your life at this time?” If that question had been asked, the physicians would have discovered that Allen’s father had developed severe and unusual headaches the week before surgery was scheduled, and they could have diagnosed an eye infection that was easily treatable with medication.

In counseling, a client may speak of tension, anxiety, and sleeplessness. You listen carefully and believe the problem can be resolved by helping the client relax and plan changes in her work schedule. However, you ask the client, “What else is going on in your life?” Having developed trust in you because of your careful listening and interest, the client finally opens up and shares a story of sexual harassment. At this point, the goals of the session change.

Useful questions from the helper that can provide more complete data include the following:

• What else is going on in your life?
• Looking back at what we’ve been talking about, what else might be added? You may even have thought about something and not said it.
• Could you tell me a bit about whatever occurs to you at this moment? (This question often provides surprising and helpful new information.)
• What else might a friend or family member add to what you’ve said? From a _____ perspective (insert ethnicity, race, sexual preference, religious, or other dimension), how could your situation be viewed? (These questions change the focus and help clients see their issues in a broader, network-based context of friends, family, and culture.)
• Have we missed anything?

Empathy and Concreteness

To be empathic with a client requires that you understand specifically what the client is saying to you. Concreteness is valuable in empathic understanding. Seek specifics rather than vague generalities. As counselors, we are most often interested in specific feelings, specific thoughts, and specific examples of actions. One of the most useful of all open questions here is “Could you give me a specific example of…?” Concreteness helps the session come alive and clarifies what the client is saying. Likewise, communication from the counselor – the directive, the feedback skill, and interpretation – needs to be concrete and understandable to the client.

Virtually all of us have experienced conflict on the job: angry, difficult customers, insensitive supervisors, lazy colleagues, or challenges from those whom we may supervise. In the following set of transcripts, we see an employee assistance counselor, Jamila, meeting with Kelly, a junior manager who has a conflict with Peter.

Closed Question Example

The first session illustrates how closed questions can bring out specific facts but can sometimes end in leading the client, even to the point of putting the counselor’s ideas into the client’s mind.

Closed questions can overwhelm clients and can be used as evidence to force them to agree with the counselor’s ideas. While the session above seems extreme, encounters like this are common in daily life and even occur in counseling and psychotherapy sessions. There is a power differential between clients and counselors. It is possible that a counselor who fails to listen can impose inappropriate decisions on a client.

Open Question Example

The session is for the client, not the counselor. Using open questions, Jamila learns Kelly’s story rather than the one she imposed with closed questions in the first example. Again, this interview is in the employee assistance office.

In this excerpt, we see that Kelly has been given more talk time and room to explore what is happening. The questions focused on specific examples to clarify what is happening. We also see that question stems such as why, how, and could have some predictability in expected client responses. The positive asset search is a particularly relevant part of successful questioning. Issues are best resolved by emphasizing strengths.

You are very likely to work with clients who have similar interpersonal issues wherever you may practice. The previous case examples focus on the single skill of questioning as a way to bring out client stories. Questioning is an extremely helpful skill, but do not forget the dangers of using too many questions.

Questions can be facilitative, or they can be so intrusive that clients want to say nothing. Use the ideas presented here to help you define your own questioning techniques and strategies and how questioning fits with your natural counseling style.

Questions Can Help Begin the Session

With verbal clients and a comfortable relationship, the open question facilitates free discussion and leaves plenty of room to talk. Here are some examples:

• “What would you like to talk about today?”
• “Could you tell me what prompted you to see me?”
• “How have things been since we last talked together?”
• “The last time we talked, you planned to talk with your partner about your sexual difficulties. How did it go this week?”

The first three open questions provide room for the client to talk about virtually anything. The last question is open, but provides some focus for the session, building on material from the preceding week. These types of questions will work well for a highly verbal client. However, such open questions may be more than a nontalkative client can handle. It may be best to start the session with more informal conversation – focusing on the weather, a positive part of last week’s session, or on a current event of interest to the client. You can turn to the issues for this session as the client becomes more comfortable.

The First Word of Open Questions may Determine Client Response

Question stems often, but not always, result in anticipated outcomes. Use the following guidelines and you’ll be surprised how effective these simple questions can be in gathering information.

What questions most often lead to facts.

• “What happened?”
• “What are you going to do?”

How questions may lead to an exploration of process or feeling and emotion.

• “How could that be explained?”
• “How do you feel about that?”

Why questions can lead to a discussion of reason. Use why questions with care. While understanding reasons may have value, a discussion of reasons can also lead to sidetracks. In addition, many clients may not respond well because they associated why with a past experience of being grilled.

• “Why is that meaningful to you?”
• “Why do you think that happened?”

Could, can, or would questions are considered maximally open and also contain some advantages of closed questions. Clients are free to say, “No, I don’t want to talk about that.” Could questions suggest less counselor control.

• “Could you tell me more about your situation?”
• “Would you give me a specific example?”
• “Can you tell me what you’d like to talk about today?”

Give it a try and you’ll be surprised to see how effective these simple guidelines can be.

Open Questions Help Clients Elaborate and Enrich their Story

A beginning counselor often asks one or two questions and then wonders what to do next. Even more experienced therapists can find themselves hard-pressed to know what to do next. To help the session start again and keep it moving, ask an open question on a topic the client presented earlier in the session.

• “Could you tell me more about that?”
• “How did you feel when that happened?”
• “Given what you’ve said, what would be your ideal solution to the problem?”
• “What might we have missed so far?”
• “What else comes to your mind?”

Questions Can Reveal Concrete Specifics from the Client’s World

The model question “Could you give me a specific example?” is one of the most useful open questions available. Many clients tend to talk in vague generalizations; specific, concrete examples enrich the session and provide data for understanding action. Suppose for example, that a client says, “Ricardo makes me so mad!” Some open questions that aim for concreteness and specifics might be:

• “Could you give me a specific example of what Ricardo does?”
• “What does Ricardo do, specifically, that brings out your anger?”
• “What do you mean by ‘makes me mad’?”
• “Could you specify what you do before and after Ricardo makes you mad?”

Closed questions can bring out specifics as well, but even well-directed closed questions may take the initiative away from the client. However, at the discretion of the counselor, closed questions may prove invaluable:

• “Did Ricardo show his anger by striking you?”
• “Does Ricardo tease you often?”
• “Is Ricardo on drugs?”

Questions like these may encourage clients to say out loud what they have only hinted at before.

PART V:

Jennifer: (enters the room and starts talking immediately) I really need to talk to you. I don’t know where to start. This term things were going pretty well, but I just got my last exam back and it was a disaster, maybe because I haven’t studied much lately. I’ve been sort of going out with a guy for the last month – we were hooking up, but that’s over as of last night… (pause) But what really bothers me is that my Mom and Dad called last Monday and they are going to separate. I know that they have fought a lot, but I never thought it would come to this. I’m thinking of going home, but I’m afraid to…

Jennifer continues for another three minutes in much the same vein, repeating herself somewhat, and seems close to tears. At times the data are coming so fast that it is hard to follow her. Finally she stops and looks at you expectantly.

What might be going through your mind about Jennifer at this moment? What would you say and do to help her feel that you understand her and empathize? Given our commitment to emphasizing strengths and positive assets, do you have any ideas on when and how to talk about something other than problems? Compare your thoughts with ours below.

When working with Jennifer, a useful first step would be to say, “I hear that you’re really hurting right now,” and then to summarize the essence of Jennifer’s several issues and say them back to her. As part of this initial response, use a checkout (e.g. “Have I heard you correctly?”) to see how accurate your listening was. The checkout (sometimes called a perception check) lets you confirm the accuracy of your summary. You could follow this by asking her, “You’ve talked about many things. Where would you like to start today?”

Choosing to focus first on the precipitating crisis is another possible strategy. We could start with the breakup or, more likely, Jennifer’s parents’ separation, as the latter seems to be what bothers her the most, but she needs to tell us what is most important to her. Then, we can restate, paraphrase, and summarize some of her key ideas. Doing this is likely to help her focus on one key issue before turning to the others. The other concerns, particularly the breakup, could relate to the parental separation. Once a direction is found, other issues can be discussed later.

We need to keep in mind Jennifer’s potential strengths and resources. Obviously, at the moment she doesn’t feel that she has any. But, if you listen carefully, fairly soon you will find a list of strengths. There is a clue in her first words, “things were going pretty well.” At an appropriate point, paraphrasing back those key words may open the way for learning resources and strengths. Here you may find a number of friends, a previously solid academic record, and before the separation, a good relationship with her parents. All these can be summarized as positive assets that can be used to help her deal with the immediate and longer-term issues that she currently faces.

Listening is an active process. You do not just sit and listen to a story. Whether using attending skills or the skills presented in this chapter, you are actively involved in the session. If you use encouraging, paraphrasing, or summarizing skills as defined here, you can anticipate how clients will respond.

Active listening demands that you participate fully by helping the client clarify, enlarge, and enrich the story. It requires that you be able to hear small changes in thoughts, feelings, and behaviors. It asks that you walk in the other person’s shoes. Active listening demands serious attention to empathy – truly being with and understanding the client as fully as possible.

Encouraging, paraphrasing, and summarizing are basic to empathic understanding and enable you to communicate to clients that they have been heard. In these accurate listening skills, you do not mix your own ideas with what clients have been saying. You say back to the clients what you have heard, using their key words. You help clients by distilling, shortening, and clarifying what has been said.

Encouragers are a variety of verbal and nonverbal means that the counselor or therapist can use to prompt the clients to continue talking. They include head nods, open-handed gestures, phrases such as “uh-huh”, and the simple repetition of key words that the client has uttered. Restatements are extended encouragers, the repetition of two or more words exactly as used by the client. In addition, appropriate smiling and interpersonal warmth are major encouragers that help clients feel comfortable and keep talking in the session.

Paraphrasing, sometimes called reflection of content, feeds back to the client the essence of what has just been said. The listener shortens and clarifies the client’s comments. Paraphrasing is not parroting; it is using some of your own words plus the exact main words of the client.

Summarizations are similar to paraphrases but are used to clarify and distill what the client has said over a longer time span. Summarizations may be used to begin or end a session, to move to a new topic, or to clarify complex issues. Most important, summarizing helps both the client and you organize thinking about what is happening in the session.

Necessary in counseling and psychotherapy is a nonjudgmental attitude in which you simply hear and accept what the client is saying. All your behavior can unintentionally convey judgmental and negative attitudes. A real challenge is to listen nonjudgmentally when you have inner feelings discrepant from those of the client. Recall that your client is often able to catch small facial expressions that reveal your judgments. How can you deal with this? Basically, focus your attention fully on the client in the here and now; try to enter that person’s world as he or she sees it. Later, you can separate yourself from this world and more ably help your client.

Encouraging

Encouragers include head nods, open gestures, and positive facial expressions that encourage the client to keep talking. Minimal verbal utterances such as “ummm” and “uh-huh” have the same effect. Silence, accompanied by appropriate nonverbal communication, can be another type of encourager. All of these encouragers have minimum effect on the direction of client talk; clients are simply encouraged to keep talking. Restatements, repetition of clients’ key words, or brief statements are encouragers that more directly influence what clients talk about.

Let’s imagine that Jennifer, the client with multiple issues presented at the beginning of this chapter, focuses on her parents separating as the major immediate issue.

I feel like my life is falling apart. I’ve always been close to both my folks and since they told me that they were breaking up, nothing has been right. When I sit down to study, I can’t concentrate. And my roommate says that I get angry too easily. I guess everything upsets me. I was doing OK in my classes until this came along. I’m hurting so much for my Mom.

Jennifer still has a lot going on in her life. Eventually, we will want to focus on some of her strengths, but at the moment, she clearly needs to vent and explore her thoughts and feelings around her parents in more depth. There are several key words and ideas in this statement, and the repetition of any of them is likely to lead Jennifer to expand on current issues. As counselors, we tend to recommend repeating the exact key words: “You’re hurting.” This provides an opening for her to discuss her feelings or thoughts about Mom, herself, and if she chooses, even other issues.

“You’re hurting for your Mom” would focus more narrowly, but likely would be another good choice. “Falling apart,” “close to your folks,” “can’t concentrate,” and “you get angry easily” are other possibilities. All of these will help Jennifer to continue to talk, but do lead in varying directions.

Key word encouragers contain one, two, or three words; restatements are longer. Both focus on staying very close to the client’s language, most typically changing only “I” to “you.” (Jennifer: “I’m hurting so much for my Mom.” Counselor: “You’re hurting.”)

It may be helpful if you reread the paragraphs above, saying aloud the suggested encouragers and restatements. Use different vocal tones and note how your verbal style can facilitate others’ talking or stop them cold.

All types of encouragers facilitate client talk unless they are overused or used badly. Excessive head nodding or gestures and too much parroting can be annoying and frustrating to the client. From the observation of many counselors, we know that using too many encouragers can seem wooden and unexpressive. However, too few encouragers may suggest to clients that you are not interested or involved. Well-placed encouragers help to maintain flow and continually communicate that the client is being listened to.

Paraphrasing (Reflection of Content)

At first glance, paraphrasing appears to be a simple skill, only slightly more complex than encouraging. However, if you can give an accurate paraphrase to a client, you are likely to be rewarded with a “That’s right” or “Yes…,” and the client will go on to explore the issue in more depth. The goal of paraphrasing is facilitating client exploration and clarification of issues. The tone of your voice and your body language while paraphrasing will indicate whether you are interested in listening or wish for the client to move on.

Accurate paraphrasing can help clients complete their story. A client who has been through a trauma may need to tell the story several times. Our goal is not to stop this talk, but paraphrasing can help work through the trauma because each time you repeat what the client has said, the client’s story has been told again and heard. Friends who have been through a difficult hospital operation need to tell their story several times. Rather than becoming bored and saying “I’ve heard that before,” give full attention and say back or paraphrase what you have heard.

How do you paraphrase? Client observation skills are essential in accurate paraphrasing. You need to hear the client’s key words and use them in your paraphrase much as the client does. Other aspects of the paraphrase may be in your own words, but the main ideas and concepts should reflect the client’s view of the world, not yours!

An accurate paraphrase, then, usually consists of four dimensions:

• A sentence stem, sometimes using the client’s name. Names help personalize the session. Examples would be “Damaris, I hear you saying…,” “Luciano, it sounds like….,” and “Looks like the situation is…” A stem is not always necessary and, if overused, can make your comments seem like parroting. Clients have been known to say in frustration, “That’s what I just said; why do you ask?”
• The key words used by the client to describe the situation or person. Again, drawing on client observation skills, the effort is to include key words and main ideas that come from the client. This repetition can be confused with the encouraging restatement. A restatement, however, is almost entirely in the client’s own words and covers only a limited amount of material.
• The essence of what the client has said in briefer and clearer form. Here the counselor’s skill, in transforming the client’s sometimes confused statements into succinct, meaningful, and clarifying statements is most valuable to smoothing the counseling process. The counselor has the difficult task of keeping true to the client’s ideas but not repeating them exactly.
• A checkout for accuracy. The checkout is a brief question at the end of the paraphrase, asking the client for feedback on whether the paraphrase (or summary or other microskill) was relatively correct and useful. Some examples of the checkouts are “Am I hearing you correctly?” “Is that close?” “Have I got it right?” It is also possible to paraphrase with an implied checkout by raising your voice at the end of the sentence as if the paraphrase were a question.

Here is a client statement followed by sample key word encouragers, restatements, and a paraphrase:

I’m really concerned about my wife. She has this feeling that she has to get out of the house, see the world, and get a job. I’m the breadwinner, and I think I have a good income. The children view Yolanda as a perfect mother, and I do too. But last night, we really saw the problem differently and had a terrible argument.

• Key word encouragers: “Breadwinner?” “Terrible argument?” “Perfect mother?”
• Restatement encouragers: “You’re really concerned about your wife.” “You see yourself as the breadwinner.” “You had a terrible argument.”
• Paraphrase: “You’re concerned about your picture-perfect wife who wants to work even though you have a good income, and you’ve had a terrible argument. Is that how you see it?”

The key word encourager operates like selective attention. Note that the encouragers above lead the client in very different directions for what is appropriate conversation. “Breadwinner” leads to talk about the job and possibly responsibility. “Terrible argument” may result in the details of the argument, while “perfect mother” leads to his wife’s behavior.

As this example shows, the key word encourager, the restatement, and the paraphrase are all different points on a continuum. In each case, the emphasis is on hearing the client and feeding back what has been said. Both short paraphrases and longer key word encouragers will resemble restatements. A long paraphrase is close to a summary. All can be helpful in a session; or they can be overdone.

Summarizing

Summarizing encompasses a longer period of conversation; at times, it may cover an entire session or even issues discussed by the client over several meetings. In summarizing, the counselor attends to verbal and nonverbal comments from the client over a period of time and then selectively attends to key concepts and dimensions, restating them for the client as accurately as possible. Facts, thoughts, and emotions are included in the summary. A check-out at the end for accuracy is an effective part of the summarization. Following are some examples of summarizations.

To begin a session: Let’s see, last time we talked about your angry feelings toward your mother-in-law, and we discussed the argument you had with her around the time the new baby arrived. You saw yourself as terribly anxious at the time and perhaps even out of control. Since then, you haven’t gotten along too well. We also discussed your homework as developing ideas of what to do next. How did that go?

Midway in the session: So far, I’ve seen that the ideas you came up with didn’t work too well. You felt a bit guilty and worried thinking you were getting too manipulative, and another argument almost started. “Almost” is better than a “blow up.” Yet one idea did work. You were able to talk with her about her garden, and it was the first time you had been able to talk about anything without an argument. You visualize the possibility of following up with new ideas next week. Is that about it so far?

At the end of the session: In this session, we’ve reviewed your feelings toward your mother-in-law in more detail. Some of the following things seem to stand out: First, our plan didn’t work completely, but you were able to talk about one thing without yelling. As we talked, we identified some behaviors on your part that could be changed. They include better eye contact, relaxing more, and changing the topic when you start to see yourself getting angry. I also liked your idea at the end of talking with her about the fact that you really want to forgive and be forgiven so that you two can relate better. Does that sum it up? Well, we have some specifics for next week. Let’s see how it goes.

Reflection of feelings involves observing emotions, naming them, and repeating them back to the client. Paraphrasing and reflection of feelings are closely related and will often be found together in the same statement, but paraphrasing feeds back key thoughts what the client has just expressed. The important distinction is between the emphasis on content (paraphrase) and emotion (reflection of feelings). Note the content and the feelings expressed by a client names Thomas:

Thomas: My dad drank a lot when I was growing up, but it didn’t bother me so much until now. (pause) But I was just home and it really hurts to see what Dad’s starting to do my Mum – she’s awful quiet, you know. (Looks down with brows furrowed and tense) Why she takes so much, I don’t figure out. (Looks at you with a puzzled expression) But like, I was saying, Mum and I were sitting there one night drinking tea and he came in, stumbled over the doorstep, and then he got angry. He started to hit my mother, and I moved in and stopped him. I almost hit him myself, I was so angry. (Anger flashes in his eyes.) I worry about Mum. (A slight tinge of fear seems to mix with the anger in his eyes, and you notice that his body is tensing.)

To clarify the distinction, write a paraphrase of Thomas’s comments above with an emphasis on content; then write a reflection of feeling, focusing on emotion. You have not yet been asked to write a reflection of feeling, so use your intuitions and note the main feeling words of the client. Two possible sentence stems are provided for your consideration.

Paraphrase: Thomas, I hear you saying…

Reflection of feeling: Thomas, I sense that you are feeling…

You may want to compare your response with our thoughts, presented in the following introductory section.

Carl Rogers is the theorist/practitioner/ author who has made us fully aware of the importance of listening. We can thank him for our current use of the term “reflection of feeling.” Becoming a Person (Rogers, 1961) is the book that brought listening, particularly reflection of feeling, to center stage.

The definition of reflection of feeling is presented in the following. If you use this listening skill as defined here, you may anticipate specific results.

Comparing Paraphrasing and Reflection of Feeling

Paraphrasing client statements focuses on the content and clarifies what has been communicated. In the case of Thomas, the content includes the father’s drinking history, Mum being quiet and taking it, and of course, the specific situation when the client was last home. The paraphrase will indicate to the client that you have heard what has been said and encourage the client to move further into the discussion.

Paraphrase: Thomas, your father has been drinking a long time and your Mum takes a lot. But now he’s started to be violent and you’ve been tempted to hit him yourself. Have I heard you right?

Reflection of feelings: Thomas, you feel real hurt, anger, and worry because of what happened. The most basic reflections of feeling would be “It really hurt,” “You felt angry,” and “You are worried.”

The first task in eliciting and reflecting feelings is to recognize the key emotional words used by the client. You can know with some certainty that the client has these feelings as they have been made explicit. At another level, reflections may help the client explore deeper unsaid things. For example, “I hear a lot of caring and that you are anxious to help resolve the situation.”

The Techniques of Reflecting Feelings

Somewhat like the paraphrase, reflection of feelings involves a typical set of verbal responses that can be used in a variety of ways. Keep in mind that we will often be using the words feelings and emotion interchangeably. The classic reflection of feelings consists of the following elements:

Sentence stem. Choose a sentence stem such as “I hear you are feeling…,” “Sounds like you feel…,” “I sense you are feeling…” Unfortunately, these sentence stems have been used so often they can sound like comical stereotypes. As you practice, you will want to vary sentence stems and sometimes omit them completely. Using the client’s name and the pronoun you helps soften and personalize the sentence stem.

Feeling label. Add an emotional word or feeling label to the stem (“Jonathan, you seem to feel bad about…,” “Looks like you’re happy,” “Sounds like you’re discouraged today; you look like you feel really down”). For mixed feelings, more than one emotional word may be used (“Maya, you appear both glad and sad…”).

Context or brief paraphrase. You may add a brief paraphrase to broaden the reflection of feelings. The words about, when, and because are only three of many that add context to a reflection of feelings (“Jonathan, you seem to feel bad about all the things that have happened in the past two weeks,” “Maya, you appear both glad and sad because you’re leaving home”).

Tense and immediacy. Reflections in the present tense (“Right now, you are angry”) tend to be more useful than those in the past (“You felt angry then”). Some clients have difficulty with the present tense and talking in the “here and now.” Occasionally, a “there and then” review of past feelings can be helpful and feel safer for the client.

Checkout. Check to see whether your reflection of feelings is accurate. This is especially helpful if the feeling is unspoken (“You feel angry today – am I hearing you correctly?”). But there are also many unspoken feelings expressed in client statements – and the client may or may not be fully aware of them. These unspoken or implicit feelings are often, but not always, expressed nonverbally. For example, Thomas looked down with brows furrowed and body tense (an indication of likely tension and confusion); anger and fear flashed in his eyes as he was talking about hitting, and fear in his eyes was mixed with the anger. Note that the client says that his father’s drinking didn’t bother him until recently. But this seems unlikely, and it may be useful at a later point to explore his family life while he was growing up. Is the client denying underlying long-term deep emotions about family drinking? At this point, however, the main issue is drawing out the story and noting the client’s emotions associated with the story. As you move beyond crisis, what does all this mean to the client?

Feelings are also layered, like an onion. Clients may talk about emotional tones such as feeling confused, lost, or frustrated; or they may be direct and forthright with a single clear emotion. However, further listening and reflection often reveals underlying complex and sometimes conflicting emotions. For example, clients may say that they are frustrated in their relationships with a partner. Reflecting that frustration may lead to discussion in which the client talks about caring for the partner. And in the middle of all this, the hurt will likely remain important.

While we believe that focusing first on the potential violence is critical, combining the paraphrase with feelings by repeating the client’s stated key feeling words is likely also appropriate. For example, “You’re really hurting with it all right now,” “You’re angry because your Dad hit your Mum,” “You’re worried that your Dad’s drinking is getting worse.” Combining the feeling with the paraphrase acknowledges the client’s emotions and may encourage a fuller telling of the story.

Right now, Thomas, you’re hurting about the situation. I also see some anger. Is that right? (Uses a key word that reflects the underlying emotion.)

Stopping your Dad from hitting your Mum brought out a lot of emotion – I see some anger, perhaps even a little fear about what’s going on. Am I close to what you’re feeling? (The focus here is on unspoken emotions, seen more nonverbally than verbally. The checkout is particularly necessary here to make sure that you are really with the client.)

Thomas, I hear that your Dad has been drinking for many years. (Paraphrase) And I hear many different feelings – anger, sadness, confusion – and I also hear that you care a lot both for your Mum and Dad. Am I close to what you are feeling? (This is a broader reflection of feeling that summarizes several emotions and feelings and encourages the client to think more broadly.)

Later in the session, after the story is told more completely through your listening and reflecting, you can help the client sort through the many and often conflicting emotions, set goals, and develop an action plan, all of which will help him move to useful and constructive action for his Mum and the family as a whole.