ADD5106: Week 1 Discussion 1: The Role of Clinical Skills in the Assessment Process

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Basic Attending Skills Foundations of Empathic Relationships and Problem SolvingBasic Attending Skills

Foundations of Empathic Relationships and Problem Solving Sixth Edition

In this book, you will be able to learn and master the fundamental skills of listening including attending behavior, questions, encouragers, paraphrasing, reflection of feeling, and summarization through a straight forward step-by-step process. Complete a well-structured interview using only listening skills and adapted to individual and multicultural differences.

The updated sixth edition includes: b The Community Genogram — what it is, why it’s important, and how to incorporate it into the interview.

b A deeper focus on strengths, resiliency, and the positive asset search. b Neuroscience and its relationship to counseling: What you need to know about the brain to work more effectively with your client.

To compliment the 6th edition textbook, a brand new Basic Attending Skills video is available for purchase through Microtraining Associates; DVD or on-line streamed. To learn more, go to www.emicrotraining.com

Allen E. Ivey Norma Gluckstern Packard Mary Bradford Ivey

MICROTRAINING AN IMPRINT OF ALEXANDER STREET,A PROQUEST COMPANY

Sixth Edition

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Basic A ttending Skills: Foundations of Em

pathic Relationships and Problem Solving Sixth Edition

ISBN-13: 978-1-5016-2813-9

This latest revision of Basic Attending Skills simply reminds us, once again, of the power and elegance of the Microtraining Model. As a comprehensive system for teaching helping and communication skills, this Model is backed up by over 500 data-based studies, making it the most tested system available for training helpers. Teachers have lauded its simplicity and effectiveness, and students report having enjoyed the Microtraining experience immensely. Whether you are a professor of counseling, a nursing educator, a trainer of paraprofessionals, crises workers, or peer groups, this book lays out in as clear terms as possible how to teach a skill set that is absolutely foundational to effective helping.

Thomas Daniels, Ph.D. • Memorial University of Newfoundland (Grenfell Campus)

BIS_BAS_ covers.indd 1 2/17/17 2:04 PM

BASIC ATTENDING SKILLS FOUNDATIONS OF EMPATHIC RELATIONSHIPS

AND PROBLEM SOLVING

SIXTH EDITION

Allen E. Ivey

Norma Gluckstern Packard

Mary Bradford Ivey

Permission to paraphrase certain portions of this book have been granted by Charles C Thomas Publishers, Springfield, Illinois. Basic Attending Skills as well as other related videos such as neuroscience DVD’s and streaming are available from Microtraining Associates, Inc., an Imprint of Alexander Street, a ProQuest Company. www.alexanderstreet.com

Copyright © 2006, 2015, 2018 Microtraining Associates, Inc. An Imprint of Alexander Street, a ProQuest Company 3212 Duke Street, Alexandria, VA 22314 800-889-5937 or 703-212-8520 http://www.alexanderstreet.com ISBN-13: 978-1-5016-2813-9

ABOUT THE AUTHORS

Allen E. Ivey received his doctorate from Harvard University. He is Distinguished University Professor (Emeritus), University of Massachusetts, Amherst. He is the founder of Microtraining Associates, an education publishing firm, which is now an imprint of Alexander Street, a ProQuest Company. Allen is a Diplomat in Counseling Psychology and a Fellow of the American Counseling Association. He has received many awards, but is most proud of being named a Multicultural Elder at the National Multicultural Conference and Summit. Allen is author or coauthor of more than 40 books and 200 articles and chapters, translated into over 20 languages. He is the originator of the microskills model, which is funda- mental to this book.

Norma Gluckstern Packard received her doctorate from the University of Massachusetts, Amherst. While at U Mass, Norma (and Mary Bradford Ivey) were among the founding member of the Women’s Center. From Amherst, Norma, went on to teach in the psychology department at Catholic University. She left the academic world and became the first female warden at Patuxent Correctional Facility in Maryland. While there, she developed many innovative rehabilitation programs that received national accolades, and she was featured on 60 minutes. Since then, Norma has moved on to writing, consulting, and teaching online.

Mary Bradford Ivey received her doctorate from the University of Massachusetts, Amherst. A school counselor for over 20 years, Mary’s elementary school coun- seling program was named one of the ten best in the nation at the Christa McAuliffe Conference. Mary has served as visiting professor at the University of Massachusetts, Amherst, University of Hawai’i, and Flinders University, South Australia. She is the author or coauthor of 14 books, translated into multiple lan- guages, and is known for her work in promoting and explaining developmental counseling in the U.S. and abroad. She is a Nationally Certified Counselor (NCC) and a Fellow of the American Counseling Association.

The first thing I’d say... is ... ‘Listen’. It’s the second thing I’d say too, and the third, and the fourth.... And if you do people

will talk. They’ll always talk. Why? Because no one has ever listened to them before in all their lives. Perhaps

they’ve not ever even listened to themselves.

Studs Terkel, Author, Pulitzer Prize Winner

WELCOME: WHAT YOU CAN EXPECT FROM THIS BOOK

Basic Attending Skills presents the necessary and essential skills of interviewing, counseling, and psychotherapy. These same listening skills are also foundations of effective and meaningful interpersonal communication in couples and families. They are connecting glue in medical diagnosis and treatment, in skilled business management, legal work, and in all professions and settings where we find peo- ple talking to one another.

These are the original videobased communication skills that have become the international standard, based on over 500 data-based studies. You’ll find medical schools, AIDS workers in Africa, Aboriginal social workers in Australia, and those helping disaster survivors of fire, floods, war-caused displacement and trauma using listening skills as steps toward health and survival. Translated into at least 20 languages, the skills of this book have gradually entered as the standard.

But, what does this mean for you? Paradoxically, these now well-known dimen- sions of human communication are ultimately clear and easy to learn. You will grasp them and their basic essence and importance quickly. But, do not be deceived for, although easily understandable, the real test is your ability to use listening skills in the real world on a daily basis in interviewing and counseling, and in communication with others throughout the day.

And, individuals, their life experience and multicultural background differ. Do not expect your natural style of listening to be equally effective with all. Be prepared to adapt and change your mode of listening with each unique individual and with special attention to multicultural differences which include many factors such as race/ethnicity, gender, sexual orientation, ability/disability, socioeconomic back- ground, spirituality, and even region/area of a state or nation.

Thus, practice of these listening skills to full mastery is required. For example, the four major components of “attending behavior” are culturally appropriate eye con- tact, verbal following, vocal tone, and body language. These are easy to remem- ber, but far more difficult in practice if you are to consistently reach others. Most effective in the early stages is video-based practice with feedback from others on your performance. It really takes more than one try or demonstration to achieve

competence. Some fully trained professionals in psychology and psychiatry still have not mastered these basics as they move on to sophisticated theoretical sys- tems of therapy. And, without full competence in listening skills, they can be less helpful than a caring beginner.

The Microskills Hierarchy below shows you the sequence of listening skills of this book. Note the Basic Listening Sequence. These are the skills of sophisticated listening and caring: attending behavior, questioning, paraphrasing, including the encourage and restatement, reflection of feeling, and summarization. These are all essential skills of the helping relationship.

There is a second book available, Basic Influencing Skills, one which outlines the influencing skills enabling effective focusing and supportive confrontation. These two are followed by directives and assisting client decisions, feedback and self-disclosure, and reframing/interpretation. Each of the influencing skills needs to be based on effective and competent listening skills.

So, here is your chance to become an effective counselor, an effective commu- nicator, and eventually one who will make a significant difference in the lives of others.

Practice, always practice, and become a master listener. Then once you have become expert, practice even more!

— Different theories have different patterns of skill usage.

— Different situations call for different patterns of skill usage.

— Different cultural groups have different patterns of skill usage.

SKILL INTEGRATION

The Microskills Hierarchy

INFLUENCING SKILLS Directives Leading to Action:

Focusing, Empathic Confrontation, Feedback/Self-Disclosure, Reframing/Interpretation

SUPPORTIVE CONFRONTATION (Discrepancies, Incongruity)

FOCUSING THE NARRATIVE Client, Problem, Others, Family, Interviewer,

Cultural/Environmental/Contextual

REFLECTION OF FEELING

ENCOURAGE, PARAPHRASE, AND SUMMARIZATION

OPEN AND CLOSED QUESTIONS

CLIENT OBSERVATION SKILLS

ATTENDING BEHAVIOR1

Culturally appropriate eye contact, verbal tracking, body language, and vocal qualities

1. Attending behavior and client observation skills form the foundation of effective communication, but are not always the appropriate place to begin training. 2. The basic listening sequence of attending skills (open and closed questions, encouraging, paraphrasing, reflection of feeling, and summarization) is often found in effective interviewing, management, social work, physician diagnostic sessions, and many other settings.

BASIC LISTENING

SEQUENCE2

BASIC ATTENDING

SKILLS

FIVE STAGES OF THE INTERVIEW 1. Rapport/Structuring 2. Defining Concerns

3. Defining Goals 4. Explorations of Alternatives and Confronting Incongruity

5. Generalization and Action to Daily Life

SKILL SEQUENCING AND STRUCTURING

THE INTERVIEW

CONTENTS

Welcome What You Can Expect from This Book? ............................................. v

Chapter 1 Basic Attending Skills: An Overview .............................................. 1

Chapter 2 Attending Behavior: The Foundation of Effective Listening .......... 15

Community Genogram: A Strategy for Attending ......................... 32

Chapter 3 Questions: Open Invitation to Talk ................................................ 41

Chapter 4 Clarifying: The Encourage, Restatement, and Paraphrase .......... 60

Chapter 5 Reflection of Feelings: Emotional Regulation .............................. 75

Chapter 6 Summarization: Integrating Client Behavior, Thoughts, and Feelings ................................................................................ 99

Chapter 7 Integration of Skills: Structuring an Effective 5-Stage Interview ....................................................................... 116

Chapter 8 Teaching Helping Skills to Others .............................................. 141

Basic Attending Skills in Brief Summary Statements

#1 Attending Behavior ..................................................................................... 17

#2 Questions ................................................................................................... 43

#3 The Encourage and Restatement ............................................................... 61

#4 The Paraphrase .......................................................................................... 63

#5 Reflection of Feeling ................................................................................... 79

#6 Summarization ......................................................................................... 101

#7 The Basic Listening Sequence ................................................................. 119

#8 The Five-Stage Interview Structure .......................................................... 120

Listening is love.

Paul Tillich, Philosopher and Theologian

CHAPTER 1

BASIC ATTENDING SKILLS: AN OVERVIEW

Basic Attending Skills is designed to provide you with a fundamental understand- ing and competence in the most important skills of helping, counseling, and ther- apy. Attending and listening skills provide a means for you to make contact with your clients and to hear them accurately. These skills are basic to empathy, the ability to be sensitive to and understand the world of another human being.

Many of us are tempted to provide immediate advice and suggestions to those who come to us with a troubling concern. We give them useful suggestions, only to find ourselves disappointed and surprised when our good ideas are ignored. This book is not necessarily opposed to advice, but many people can resolve their concerns and life challenges, if we simply listen to them carefully. Advice may not be needed!

Moreover, it is important to remember that client issues are often developed over a period of time and may be more complex than we originally thought. Doesn’t it make good sense just to stop for a while and hear clients out fully before we move to suggesting what can be done?

Let’s test out the importance of listening in terms of your own life experience. Please think back on a time when someone listened to you and was truly helpful. If you can, seek to obtain an image of the helping situation and recall what you saw, heard, and felt. And, thinking back to that helpful time, reflect on what that person did to be helpful. This may help you connect personally with the value and power of really listening. Use the following lines for your recollections.

How does it feel to have someone truly listen to you?

____________________________________________________________________________________________

BASIC ATTENDING SKILLS: AN OVERVIEW

What specifically did the listener do that helped?

_____________________________________________________________________________________

The central maxim of this book and the helping process could be summarized as:

Listen, listen, listen, and then listen some more before taking action or giving advice.

If you listen to and attend to others, many times they can resolve issues on their own. This book and training program is concerned with the resilience and growth potential that is in every client, or person. Listening and enabling them to find their strengths is basic to the helping process. We now know that your relationship with a client represents 30% of factors determining a successful interview. An empathic relationship is often defined as one in which you and the client are in synchrony. You are able to “be with” the other person sensing and understanding their thoughts and feelings. But there is a difference—you are you and they are they. An empathic relationship is also called a working alliance. You and the client work together, focusing and their goals, wishes, and aspirations.

WHAT ARE THE BASIC ATTENDING SKILLS?

There are six major skill areas of listening in this book. A brief definition of each and its major function in the interview follows:

Definition and Function in the Interview

Attending Behavior Individually and culturally appropriate verbal and nonverbal behavior in the interview is central to the helping process— culturally appropriate eye contact, vocal tone, body language, and verbal following. This demonstrates that you are listening and encourages the client to talk more freely.

BASIC ATTENDING SKILLS: AN OVERVIEW

Questions/Open Invitation to Talk

Open questions often begin with what, how, or could. They help the client explore issues and talk at greater length. Closed ques- tions often begin with do, is, are and lead to focused answers, often shorter in length. While questions bring out client stories and issues in more detail, be careful. Too many of them may put off the client and make them defensive.

Clarifying —Encourage Encourages are brief responses such as head nods, “uh-huh,”

and single words or phrases. They encourage client depth explo- ration and bring clarity as to meaning. Appropriate smiling is one of the most important encourages.

—Restatement In the restatement you select several key words and repeat them back exactly. It works like an encourager, but focuses in more depth on a key issue

Paraphrase The paraphrase feeds back to the client the essence of what has been said. The paraphrase provides a check on the accuracy of your listening and may enable the client to move on to a new topic.

Reflection of Feelings, Responding to Emotions

Underneath client concerns and problems are emotions and feel- ings that need to be brought out and understood. Reflection of Feeling is concerned with identifying and feeding back to the cli- ent the underlying emotional experience. Exploration of emotion is basic to understanding a client’s deeper desires and wishes. Clarifying emotion leads to better client decision making and action. Clients often come to us using the words confused or frus- trated and clarifying mixed emotions is one of our important tasks.

Summarization This skill asks you to feed back to the client the essence of longer statements or a whole interview. Many summarizations will include descriptions of behavior, thoughts, and emotion. This skill is useful in clarifying what has happened in key interview segments and in beginning and ending the interview.

Integration of Skills —Five Stages of the Interview

You will integrate the skills above into a well-formed interview using only listening skills. Many clients find themselves able to resolve their concerns and problems by themselves if you will just listen to them fully.

BASIC ATTENDING SKILLS: AN OVERVIEW

These several skills add up to what is termed the basic listening sequence. Observation and research have revealed that not only effective counselors use these skills. The competent physician must first listen to the patient before provid- ing a diagnosis. The manager must listen to staff and learn important facts before making a critical decision.

The basic listening sequence taught in this book is critical in many different situ- ations. If you listen carefully, you will often find that clients can resolve their own issues without advice or direction from you. If your clients don’t come up with their own answers, you at least have an information base so that you can act more effectively.

Once you have studied and mastered each one of the basic listening skills above, this book provides advanced suggestions that can enable you to adapt the skills in a variety of situations. Special attention will be paid to the importance of draw- ing out client behaviors, thoughts, and feelings and, in practice sessions, applying these same skills to family therapy and to group work.

There is, of course, a second part of the microskills program called Basic Influencing Skills. There you will learn multiple possibilities leading to client growth and resilience. Among these are directives, confrontation, and refram- ing/interpretation. However, all of these skills are based on your effective listening.

As you gain experience in the interview, you will find that a positive style of inter- viewing and listening tends to be more effective than just focusing of client prob- lems and difficulties. Regardless of your work setting, you will find that if you focus on the positive, you provide your clients with a solid base on which they can then work more effectively with their most challenging issues.

THE POSITIVE ASSET SEARCH: POSITIVE PSYCHOLOGY IN ACTION

Build resilience by discovering the positive assets, strengths, and resources of each client

Beginning counselors occasionally have the tendency to become overly fasci- nated with “war stories,” the basic facts about someone else’s problems and con- cerns. It then follows that their questions, comments, and attention are given

BASIC ATTENDING SKILLS: AN OVERVIEW

primarily to negative things about the client. It is fascinating to learn the intimate facts of someone else’s life. But helping is not about prying into other people’s affairs.

If you focus on “war stories,” the client frequently jumps into your trap with glee, delighted that someone is finally listening to their problems. The naive counselor’s need to pry into another person’s life and the client’s need to share how “bad” the world is may result in a spiral that defines the situation as worse than it really is.

At the other extreme, some beginning counselors are so anxious to reassure clients that real issues are never encountered. The rescuer is perhaps even more dangerous than the prying, probing counselor. Many professional and volunteer counselors are so anxious to aid clients facing difficult issues that they gloss over and hide issues so the client “doesn’t feel bad.” Watch out for rescuing!

People talk about what other people will listen to. If a beginning counselor only lis- tens to weaknesses and problems, the client will only talk about weaknesses and problems. While airing of concerns is helpful and often necessary, it is only part of anyone’s life picture. On the other hand, if the counselor avoids hard issues, so does the client.

Positive psychology is about building resilience—the ability to bounce back from adversity with new renewed strength. It has become increasingly important as a central dimension of the field. If you seek out client strengths and help them build on these, you are taking positive psychology into action.

Four more basic maxims of the helping process:

Clients will talk about topics to which you are able and willing to listen.

Watch out for prying and don’t be a rescuer.

Discover the positive assets of each client.

Build resilience.

Thus we believe a significant part of any helping interview should focus on strengths of the client to cope successfully with the world. This is true of even the most experienced professional. This means listening for positive as well as negative comments. For example:

BASIC ATTENDING SKILLS: AN OVERVIEW

Client: I really feel mixed-up and confused, nothing is going right. Society is all screwed up, the rich get richer and the poor get poorer. I worked hard, but I still got laid off.

Counselor: (accentuating the negative) The economic situation is really grim right now, you feel really hopeless. What are some of other things that bother you?

Counselor: (accentuating the positive) Losing your job at a time like this is really hard. I hear you say you did good work. Could you share some specific things that you did on your past job which you were particularly proud of that can serve as strengths for the future?

Counselor: (overly positive) Not to worry—it’s always darkest before the dawn. (Rescuing) Let me do the worrying for a while. We’ll find a way. What do you want me to do for you first?

The first response does acknowledge the feelings of desperation and hopeless- ness of the client and may well be a satisfactory response in a larger context. However, there are “would-be” counselors who only reinforce negative self-com- ments and troubles. The second response acknowledges the feelings, but also emphasizes the positive aspects of the situation, aiding the client in sorting out positive resources. The third response (reassurance) is often helpful, but can be overdone. This response fails to acknowledge the client’s hurt and the counse- lor has taken on too much responsibility for solving the client’s difficulties.

A behaviorist summarized the issue when stating that love could be defined as giving positive reinforcement to positive things about an individual. The humanist also believes in human strength and seeks to encourage self-growth from those positive assets. Different words and theories . . . but the same idea. In any ses- sion, give some attention to what’s right with the individual.

Other critical maxims for you to consider are:

Focus on the positive—search for strengths in the client and external supports in family and friends.

Use those strengths and supports— They are the building blocks for client resilience and the future.

BASIC ATTENDING SKILLS: AN OVERVIEW

THE BASICS OF A PHILOSOPHY OF HELPING

The program you are entering is highly skill oriented. We have noted that some beginning counselors get worried about what they “should” be doing when relating to a client. They get so worried about doing the “right” thing that in the process they become confused and less effective. A basic philosophy of helping can be helpful. Some key suggestions leading toward this philosophy follow.

Honor yourself!

The first step toward effective helping is respecting yourself and your capacities. If you don’t feel good about yourself, you are very unlikely to help those who come to you. You also need to focus on your strengths and build an interviewing helping style that fits you. Unless you are comfortable with yourself, you won’t be able to help others. Many beginning and experienced counselors and therapists find that they can benefit from counseling or therapy.

Each of us ultimately must define our own style of helping. When a skill or concept from this book appeals to you, go ahead and try it . . . but always be sure that it feels right to you. On the other hand, if that skill or concept doesn’t appeal to you, it is still probably a good idea to try it and check it out thoroughly. But if you find it doesn’t “fit,” it is best to acknowledge that fact and stay with a style that is more natural to you.

Another important maxim:

As a counselor, you can be most helpful if you are truly yourself. Seek to define your own style of interviewing, but always with awareness that varying clients may respond to different styles than those with which you are most comfortable.

Honor the client

Most confusion around interviewing disappears if we are willing to listen carefully and attend to the client. When you find yourself confused, lost, or wondering what to do in the interview—listen and use the attending skills of this book.

BASIC ATTENDING SKILLS: AN OVERVIEW

The major temptation in helping is to attempt to solve the problem of the client as soon as possible. The beginning counselor often barely gives the client time to get the problem out before starting to offer sympathy and solutions.

We urge you to stay away from giving early answers to those whom you would help. The use of advice, interpretation, or suggestions is for a later, more advanced, state of helping—and even then these skills should be used sparingly. Our job is to listen. Very few people in our society are effective listeners; it seems sad that we must teach people to listen, but it is a necessary skill that our culture does not emphasize.

Experienced professional counselors and therapists all-too-often are ineffective listeners. They may have become so fond of a special theory or method that they apply it to all clients, failing to see that what works with one person may not be effective with the next. And, we have seen many professionals who still have failed to master the basics of listening.

Other words for honoring the client are respect and what Carl Rogers calls unconditional positive regard. If you are meeting with a client who is different from you in terms of race, ethnicity, gender, sexual orientation, or physical/men- tal ability, can you surmount any possible bias or stereotype and work with them effectively? Perhaps more challenging for all of us in that unconditional posi- tive regard, particularly when you are talking with a client whose values and decisions are markedly different from your own. Evaluation is a dangerous and destructive word in a helping relationship. Hold your breath, listen to the sto- ries of past experiences of the client respectfully and the unconditional positive regard will develop.

Finally, honoring your client may mean that you have to be uncomfortable some- times as you adapt your personal interviewing style to the needs of the person before you. And, if you are not sufficiently comfortable with that client (or the client is not comfortable with you), it is important to refer the client carefully to someone else.

Another maxim:

Honoring and respecting your client may mean temporarily giving up your natural style and joining the client’s world.

BASIC ATTENDING SKILLS: AN OVERVIEW

Honor Multicultural Difference

Empathy asks you to listen carefully and join the client’s world. We often talk about seeing the world as various clients see it, hearing what they hear, and feel- ing what they feel. An important part of any person’s personal identity is her or his multicultural heritage. We define multiculture broadly so as to consist of at least the following dimensions:

Race/ethnicity Socioeconomic status Gender Age Sexual identity Family history Physical ability/disability Language Religious/spiritual orientation Traumatic life experiences

Each of these groups (and others) may approach the interview in a different way and may challenge your ability to be empathic and understand them. This is so, particularly, if you “haven’t been there.” For example, anyone who has experi- enced the traumatic life events of cancer, rape, or war belongs to a unique cultural group. Those who are raised in an alcoholic family have their own experiences. Your ability to gain trust with people whose life experience, skin color, or sexual orientation is different from you may be challenging at times.

How can you build trust with someone who is substantially different from you? Consider the following as a beginning toward a lifetime of learning:

Listen. Ultimately, your ability to hear client stories and understand their world will be basic, regardless of multicultural background.

Be willing to share yourself openly. At times you need more than listening to build a trusting relationship. Many have found that direct and open acknowledgement of cultural difference can facilitate trust.

Avoid stereotyping. You will find that there is extensive variation in any multicultural group. Individual White Americans and Canadians are not the same, just as all Asian-American or Asian-Canadians differ from each other. The interview and counseling are for the individual client, not for an imagined group.

Read, learn, participate. Multicultural understanding can only really develop if you commit yourself to studying and participating in the life

BASIC ATTENDING SKILLS: AN OVERVIEW

of different cultural groups. This could include attending multicultural community events, a visit to a conservative or liberal church, or visiting an open Alcoholics Anonymous meeting.

How Will You Learn Basic Attending Skills?

Even though clearly important, listening is not easy.

In one sense, the concepts in this book are simple. The listening skills presented here are seen by most readers as crystal clear. Clarity does not mean that prac- tice in these skills is not necessary. Just because you can understand the basics of attending does not mean you can use them when faced with a difficult and challenging client.

A crucial question to ask yourself is whether or not you are willing to do the work to become the most effective listener possible. Practice is essential for mastery. Providing “answers” and sympathy is easy; effective listening demands more effort.

The listening skills presented here are founded on nearly forty years of counseling and interviewing practice and over 500 research studies. The skills approach is termed “microcounseling” and breaks down the complex interview into compo- nent parts and teaches them one-at-a-time. The advantage of this process is that you can readily master specific concepts and methods that will make a difference in the lives of those with whom you work.

The microcounseling training system, as you will encounter it here, consists of the following steps:

1. Introduction/Warm-up. You will receive a brief introduction to a basic skill of interviewing. Learning objectives will be established.

2. Reading about the skill. A brief summary describes the key components of the interviewing skill you are about to learn.

3. Viewing a model of the skill in action. Seeing a person perform a helping skill can bring reading and theory into real life. Video models provide one way to see a skill in action. Live demonstrations by experts is another way. Seeing is believing.

BASIC ATTENDING SKILLS: AN OVERVIEW

4. Practicing. Even more important than watching others is you taking time to practice the skills to full competence. Specific suggestions and feedback sheets are provided to facilitate your learning the skills at a full mastery level. With some more complex skills, several practice sessions may be needed.

5. Generalizing and moving the concepts into action. Specific suggestions for taking the concepts of the training session to your home setting are included with each skill. If you don’t take learning home, it soon will be lost.

The first three steps focus on you learning the skill and should lead you to an understanding of why the skill is important and what it can do for you and your client. The last two steps, however, are the critical ones. There are many peo- ple who can develop an intellectual understanding of the helping process—but understanding is not competence in the interview.

The competent, effective interviewer practices the skills to a level of mastery and is able to take the ideas of the skill “home” to his or her daily life and work setting.

ETHICAL ISSUES AS YOU PRACTICE SKILLS

Practice is central to mastery of the skills in this book, but when you practice you are working with real people. This is not a book on ethics, but we’d like to intro- duce some key issues.

Competence. You are a beginning interviewer. In these early stages do not attempt to do therapy and seek to keep your practice interviews to topics around which both you and the volunteer client are comfortable. Be ready to refer your volunteer to a more experienced counselor. Always seek supervision and consul- tation on these issues with your teacher or workshop leader.

Recording and Informed Consent. When you work with a volunteer practice client, it is very helpful if you can record the session. Volunteers need to know that this is a practice interview. Obtain permission before you record a session or write a transcript of what has been recorded. If you are relaxed about this request, they will be as well. Clients should be informed that you will turn off recording equipment at any point if they are uncomfortable. You may even wish to develop

BASIC ATTENDING SKILLS: AN OVERVIEW

a written consent form, as this practice is becoming more common in counseling and therapy in general.

Confidentiality. As this is practice, you obviously do not have legal confidentiality. But, even so, it is vital that you keep the information learned in the interview to yourself and only share it with classmates or teachers if you have the consent of the volunteer. If the volunteer should indicate that he or she may do harm to self or others or otherwise engage in illegal acts, it is your duty to break confidentiality and seek consultation with your supervisor.

For further study of ethical issues, we recommend Issues & Ethics in the Helping Professions by G. Corey, M. Corey, & P. Callanan (San Francisco: Cengage 2014) or a succinct summary will be found in A. Ivey, M. Ivey, & C. Zalaquett Intentional Interviewing and Counseling, (San Francisco: Cengage 2018).

MICROCOUNSELING: A BRIEF SUMMARY OF KEY THEORETICAL CONCEPTS

We are often asked if microcounseling is a theory and mode of helping in itself or if it is merely a set of practical skills. We believe that the concepts presented here are both theoretically significant and practical. Microcounseling was first devel- oped as a set of skills, which could be used in conjunction with other theories. This belief is still primary—regardless of the theory you select, you will find that the listening skills here are invaluable in being an effective counselor or therapist.

However, microcounseling can be viewed as a theory and method of helping in itself. Defining theory can be said to rest on three key questions:

1. Does the system organize knowledge about helping in a fashion so that it can be used in many different settings and situations?

The microskills presented here are used in many settings ranging from coun- seling and therapy to medical training to business management education. All these fields need effective listening. The concepts have been translated into at least twenty languages and have been used effectively in Japan, Germany, and North America with a range wide of populations. The microskills system has proven effective in workshops with multicultural groups of many types in the United States and Canada, through managers in Sweden, teachers and nurses in

BASIC ATTENDING SKILLS: AN OVERVIEW

Japan, Inuit and Dene social workers in the Central Arctic, and AIDS and refugee counseling in Africa.

2. Does the system contain a basic set of assumptions that can analyze, pre- dict, or explain what happens in the helping process?

You will find, if you use certain helping skills in the interview, that you can predict what clients may be expected to say in return. You will also find that following the recommended five-stage interviewing sequence will often result in clients gener- ating new perceptions of themselves and others.

3. Does the system explain what happens in the practice of interviewing, counseling, and therapy?

Microcounseling theoretical goals have traditionally been modest. Nonetheless, the framework explains some of the basics of effective helping. Whether you prac- tice listening as a counselor, social worker, pastoral counselor, financial adviser, or as a child advocate in court, the listening skills presented here remain central.

Put most concisely, clients often come to us with tight and narrow ways of think- ing about their problems. If we listen to them effectively, they will likely loosen the old and ineffective ways of thinking—they will generate new ways of perceiving themselves, their situations, and others.

The acts of attending and listening are very powerful. Through your careful listen- ing, the client will come to find new perspectives and ways of being in the world. The generation of new perspectives and ways of thinking is at the heart of Basic Attending Skills. This is a simple, but profound, part of any comprehensive theory of helping.

Listening lights up the brain.

But attending behavior needs to be varied to meet

individual and cultural styles.

CHAPTER 2

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

But what is listening? We all know what it is when it happens, but defining the term precisely is another matter. The central goal of this first session in micro- training is to help you identify specifically what listening is and to consider the many implications of this definition.

The exercises and readings in this chapter will help you to:

1. Understand the importance of effective listening.

2. Define four central dimensions of attending behavior and identify some crit- ical individual and cultural differences underlying effective attending.

3. Understand the critical concept of selective attention. Clients will tend to talk about topics to which you are willing to listen.

4. Demonstrate attending behavior yourself in a practice individual interview. You are also encouraged to practice these concepts in a group session.

5. Use attending behavior in your daily life and also consider how you might teach the skill to others.

WHAT LISTENING IS NOT!

One effective way to discover the nature of listening is through examining what it is not. Find another person and go through the following exercise or watch the behavior of another pair demonstrating poor listening skills.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Record your observations of what effective interviewing is not. After you make your list, check to see if your list consists of observable behavior, something that you can see or hear (e.g., the counselor may appear anxious—true, but what do you see that makes you think he/she is anxious? Wringing the hands, sitting tensely, stammering?). What do you hear?

Take time to reflect on your observations of specific observable behaviors that represent ineffective listening.

After obtaining reactions from the volunteer and any other observers that watched, you may want to add to the above list. As a final step, look over the list and note the things that you think are most important. Underline those you would stress if you were teaching basic helping skills. In the following reading, you’ll see what research and practice have found to be most basic. However, it is also important

Person 1: Interviewer The task is to do the worst job of listening possible. It helps to exaggerate. You may also want to think of an individual who talked to you in real life and did a very poor job of hearing what you had to say.

Person 2: The client Regardless of how poorly the interviewer behaves, your task is to keep talking.

Suggested topics for the brief two-minute role-play

A job interview, a discussion of a family conflict, choice of school courses, or a topic of mutual interest.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

to remember your own list for it is uniquely yours and provides some important clues for your own approach to analyzing and teaching the interview.

The following Basic Skill description lays a foundation for becoming a counselor. The behaviors described are bedrocks for effective listening. Without the following skills, even the most brilliant counselor may fail.

ATTENDING BEHAVIOR: BASIC SKILL #1

The most basic skill of helping is listening to those you seek to help. But what is listening? We use the term “attending behavior” to remind us that listening con- sists of specific and observable dimensions. Attending behavior is a basic, rather simple skill—but with many, many profound implications.

As you look at these four dimensions, how are you on eye contact, body lan- guage, vocal tone, and verbal following? At the same time, use attending con- cepts to observe your client’s behavior. Thus attending behavior has a double meaning—listen to the client, but simultaneously observe the client’s personal communication style, particularly changes and variations. Observation of nonver- bal behavior is a special part of effective listening.

Four key dimensions comprise attending behavior:

1. Eye contact. If you are going to talk to someone, look at him or her. No need to stare, just be aware that you are talking to another person. You’ll also want to notice eye contact breaks. When you look away you are sometimes telling the person you are working with that you aren’t really attending (but don’t stare—some natural breaks do occur). Later on, you’ll start noticing that eye contact breaks on the part of others gives you clues as to where that person “is at.” More on that later.

2. Attentive body language. We usually think that counseling is a verbal rela- tionship. In truth, some estimates say that 85% of our communication is nonverbal. Think for a minute—how does your body communicate that it is listening? Find your own natural listening style and check with others to see how it “comes across.” The basic attentive listening posture in our culture is a slight forward trunk lean with a relaxed easy posture. But find your own style—if you are not true to yourself, you won’t appear attentive to your client.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Later on you’ll want to start looking for small signs of tension at key times in the interview (facial expression such as frowns, tense mouth or chin, clenched fists, and marked shifts in body posture) in both yourself and the client. Note when the client relaxes and smiles. But for now, simply assume a relaxed body position and communicate that you are involved. Your awareness of body language will naturally increase throughout this training series.

3. Vocal style. Changes in speech rate, volume, and tone often communicate the emotional tone underneath the words. Speech hesitations or stammers often occur at tension points. The music of emotion and feeling is often most apparent through the voice.

4. Verbal following. A frequent basic question of beginning counselors is “What do I say?” We say, relax—it doesn’t help to be nervous. When in doubt as to what to say, take whatever the client has said and respond to it in a natural way. Direct whatever you may say to what the client has just said or perhaps said earlier in your session. The counselor seldom needs to introduce a new topic. Watch for client shifts and changes in topic. These can be subtle and take you and the client off track.

Your prime task is simply to stay with what has already been said. In sum- mary, don’t topic jump!

Cultural differences. It is critical that you remember that the attending behav- ior of different cultural and ethnic groups varies in style. Eye contact among some Southwest traditional Native Americans may represent a hostile act, whereas more acculturated individuals will maintain direct contact—NEVER STEREOTYPE verbal or nonverbal behavior. The physical distance between two speakers may vary from culture to culture. As one example, people from the Middle East may be expected to stand more closely together than middle-class people in the U.S. who may be seen by them as standoffish and cold. The stand- ard vocal tone of American English may be slow and boring to some Latina/o peoples. Attending behavior appears to be a universal cultural phenomenon. However, attending skills manifest themselves differently among different people.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

The following list summarizes only some key differences in listening skills among different groups. And, as you read the following, recall that individual differences within a group vary extensively. Avoid stereotyping your client.

Eye Contact Traditional African-Americans, Latina/o, and Native Americans may avoid eye contact as a sign of respect. With Latina/o’s, direct sustained eye contact can represent a challenge to authority. A bowed head may be a sign of respect from Native Americans.

Body Language African-Americans may have public behavior that seems emo- tionally intense and demonstrative to European Americans. A slap on the back may be insulting to an Asian-American or Latina/o.

Vocal Style Latina/o’s often begin meetings with lengthy greetings and pleasant talk before getting down to key issues. Family is often an important beginning discussion topic. European Americans tend to value quiet, controlled vocal style that other groups may see as manipulative and/or cold.

Verbal following More traditional Asian-Americans may prefer a more indirect and subtle communication and consider the African-American or European American styles too direct and confrontational. Personal questions may be especially offensive to Native Americans, and also other minorities who may have learned to distrust authorities (socioeconomic, educational, ability/dis- ability, sexual orientation, etc.)

Individual differences. Similarly, individuals vary in their attending patterns. A depressed client will have difficulty in maintaining eye contact with you at all and likely have one topic—how bad things are. A client talking about an embarrassing or difficult issue may avoid eye contact and topic jump. When one combines indi- vidual and cultural variation, it is obvious that this most basic skill of listening can become very complex. Observation skills will help you maintain alertness.

Thus it is suggested that not only do you demonstrate attending behavior your- self, but that you also observe the attending patterns of others. You may find

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

that what seems to be rude or distant behavior is simply culturally appropriate patterns on the part of the other person and your own style may be interpreted by the client as even more rude. And, as your observation skills increase, you will note vast individual differences in patterns of attention on the part of your clients, regardless of culture. Attending behavior provides a framework for observing your own behavior and the behavior of your clients.

Summary. In briefer form, your goal in interviewing is to be a good listener through the use of specific, observable behaviors that are culturally appropriate:

1. Use varied eye contact to communicate with the client. Be aware that differ- ent cultural groups may have varying patterns of eye contact.

2. Maintain an attentive body posture using a natural relaxed posture and gestures. Use your body to communicate your involvement. Smiling vali- dates the client and adds warmth to the session.

3. Use a natural vocal tone. Your voice communicates your emotions.

4. Stay on the topic. Don’t topic jump or interrupt. Simply note what the client has said and take your cues from him/her. There is no need to go into your own head to think of what to say. The client has already told you.

If you get confused and can’t think of anything to say, simply hesitate a moment and think back to something said earlier that interested you. Make a comment or ask a question about that topic. You are still attending! This simple point is a life- saver for both beginning counselors and highly experienced professionals.

WHERE DO YOU FOCUS YOUR ATTENTION?

The purpose here is to summarize some further implications of attending behav- ior with special reference to individual counselor “style.” The essential point of this manual is summarized below:

Clients talk about what counselors listen to. At first glance attending skills impress the beginner as “nondirective” in nature. Attending skills lead as much as they follow.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

For example, a client may say “I’m doing really poor work in school this past month. I’m really stressed right now. Plus things are going bad at home—Mom and Dad are talking divorce.”

Before going further, what would you say to the client?

Compare your responses with the five following possibilities below which all attend to the client in some way:

1. “In what subjects are you having the most problems?”

2. “You’re really stressed right now.”

3. “Sounds like right now you’re really concerned about what your parents fighting means for you?”

4. “What specifically is going on at home?”

5. “What type of work does your Dad do?”

The response selected by the counselor often says more about the counselor than it does about the client. Notice what topics you selectively attend to. What topics turn you on, turn you off? What do you zero in on? What do you avoid?

In the example above, the first response above focuses on schoolwork, the next two on the feelings of the client in the interview, the last two on the family context. All of the responses are attending and potentially helpful, but each response focuses on client issues from a different vantage point.

It is important to note the topics to which you attend and those that you tend to ignore. In the example above, schoolwork, the client’s personal feelings, and the family context are all important. Nonetheless, most experts believe it is most important to focus on the feelings and thoughts of the client sitting there in front of you (#2 and #3 above). Was your first focus on the client, the school problem, the family, or some other issue?

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

The three aspects of attending behavior provide you with important cues indi- cating what your “style” is. For example, where do you break eye contact? Do you unconsciously avert your eyes when someone talks about religion, thereby indicating this is a topic you don’t care to hear about? Do your eyes brighten when the client talks about sex and you find that all your clients are talking about this area? Or, is that a topic your clients seem to avoid. All of us have certain areas and topics where we are more skilled than others—watch for them. Careful examination of video will reveal clear points where you reinforce certain client comments and extinguish others.

Similarly, note your pattern of body language in relation to specific topics. When do you sit forward, move back, tighten a fist, or relax? What does your body language communicate to your client? You’ll find your body often mirrors that of your client if you are truly listening. This is termed “movement synchrony” and is a variable which can only really be studied by looking at video of the interaction.

The examples above illustrate the importance of selective attention in verbal follow- ing. Once again, clients talk about topics to which you are willing and able to listen.

Constantly monitor your patterns of selective attention both verbally and nonver- bally. It will give you a clue as to your natural “style.” Finally, note your “percent of talk-time.” Some counselors talk too much. Attending is about listening. Do you give your client enough “air-time” on topics of interest to her or him? Audio or vid- eorecord a practice session and note how much you talk and how much the client talks in a session. Use your watch or a stop watch and check it out.

USING ATTENDING BEHAVIOR SKILLS WITH FAMILIES AND GROUPS

Increasingly, you will be called on to work with groups and families. Attending behavior skills are just as important in these settings as with an individual. Most counselors learn individual interviewing first. Individual work focuses on the sin- gle client. Frequently beginning family and group workers focus solely on individ- uals and their problems, ignoring the potential power of the group.

In a meeting, observation of attending behavior of participants is both fascinating and important. Note who gets the most eye contact and attention from the leader.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Who is the first to respond to a question? Who talks after whom? Where are people sitting? (The power position is often at the end of the table opposite the leader or sitting to the right.) Note the distinction between positive supports and putdowns. And, perhaps most useful and fascinating is observing topic jumps. One useful strategy, whether a business, church, or school meeting is to ask one member to sit out, become a process observer and at the end of the meeting share what they have discovered. With an open group, this information makes a positive difference.

As you work with the skills in this book, pause frequently to recall that the same skills are useful in family and group work. Following are some important issues in using attending beyond individual interviewing.

Do you balance your attending? Do you look at all group and family members or are there some few individuals who have the vast majority of your atten- tion? Many counselors who move from individual work to family work falter when they give one or two people their primary attention. Some counselors give more attention to women in families, others to men. Some totally ignore children in family groups.

What are the attending behavior patterns in the group or family? Certain members of the family or group are sought for leadership, particularly on certain topics. You will find that people who tend to have alliances in the family or group have similar patterns of body posture and may mirror one another. Those who are in conflict in the group will tend to avert eye contact and show signs of bodily tension.

Constantly practice your observations of nonverbal behavior. You will discover that family and group members respond differently to you personally. These data can be a clue to your own effectiveness and may even give you information as to culturally appropriate behavior if the group or family comes from a different back- ground than you. Also, be aware of your behavior—the group is!

Are there multicultural issues in the group? Again, recall that multicultural issues are critical in the helping process. You will want to learn specifics of the cultural group with which you are working. Not only is it possible that their patterns of eye contact and body language are different from your own, but who talks after whom can be important. In some cultures, the father is expected to speak for the family as a whole while with others the situation may be very different.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Working in a multicultural setting such as Canada or the U.S. provides counselors with the opportunity for a lifetime of learning about differences in attending styles. Group work with those from the Canadian Atlantic Provinces, California, and the Southern States varies. Men and women’s groups have different styles, just as African-American, Latino, and White groups will vary.

Can you attend to the family or group as a whole? Essentially, learn to focus your attention on the entire “family” or “group.” Deliberately use statements that contain the words “family” and “group”—“This group/family seems to feel anxious about meeting together.” “The group/family seems to be good at supporting each other.”

One general rule for family and group work is that one-third of the time should be spent on the total process of the group (with a focus on the words “family” and “group”); one-third of the time should be spent on individuals in the group and their behavior, thoughts, and feelings; and one-third of the time on the group’s special topic or problem.

Thus, if you are working with a group of teens that come from alcoholic families, you will want to balance your attention to the three topics. Equal time and atten- tion can be given to the general problem of alcoholism and the family, the individ- ual problems of the teens, and to the group process itself.

CLASSIFYING ATTENDING AND NONATTENDING STATEMENTS

Imagine that you are working with a client who makes the following statements. Which of the following are attending and which are nonattending? (See end of the chapter for answers.)

1. Client: I just had a nasty argument with my roommate. She’s such a mess and leaves stuff all over the place. But, this last time, she went too far.

____ a. Counselor: You say she went too far . . . what happened?

____ b. Counselor: I think I can help you learn to get along.

2. Client: I’m not doing well in biology and I want to drop the course, but they say it’s required for nursing. I’m really doing badly.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

____ a. Counselor: Biology is required for nursing. Could you tell me more about the difficulties you are having with the course and about your feelings about being a nurse?

____ b. Counselor: I can help you change majors without much problem.

3. Client: My parents are giving me a bad time about my friends. They say that they are into drugs and they really aren’t. We do have fun, but nothing serious.

____ a. Counselor: It sounds to me as if you may not be giving them or me a straight story.

____ b. Counselor: You are twenty-one. You can make your own decisions.

4. Client: My boss is difficult. He grabbed at me yesterday. I pushed him off, but I really need this job as it pays pretty well and keeps me in school. How can I handle this?

____ a. Counselor: Quit the job.

____ b. Counselor: Tell me a bit more about the situation. How are you handling things thus far? (However, recognize sexual harassment for what it is. While we need to listen first, naming the problem as oppression in the form of sexism, racism, heterosexism, ageism, or disability prejudice and injustice is part of this response later.)

5. Client: I’m feeling really sad lately. I can’t sleep and even sometimes I cry for no reason at all. Things just aren’t right.

____ a. Counselor: I hear you feel sad and that things aren’t right for you. Tell me more.

____ b. Counselor: I’ll refer you to a physician and see if some drugs can help.

PRACTICING ATTENDING BEHAVIOR

You have now seen negative examples of attending behavior and read about the possibilities inherent in the concepts. Hopefully, you will have had the opportunity

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

to view a live demonstration or video of the skill in action. But what is most impor- tant is your ability to engage in attending skills. The following is suggested to practice attending behavior.

1. Develop a working group. You can’t practice attending behavior alone. The most effective group size is three or four. However, two people can be suf- ficient for practice.

2. Assign roles for the first practice session. The following are listed in order of critical importance:

a. Counselor: This individual practices attending behavior in a short role-play.

b. Client: This person discusses real or role-played concerns. The observer also provides feedback after the role-play.

c. Observer/operator. This person operates the video or audio equipment and provides verbal and written feedback to the counselor. If no equip- ment is available, the emphasis is solely on observation. Consider using a cell phone or iPad as an alternative—the sound and quality is constantly improving.

d. Second observer. This individual provides written feedback to the counselor and ideally concentrates observations on nonverbal dimen- sions which may be missed by others. This is especially important if no video is available.

3. Determine topic for role-play. The volunteer client decides what he or she would like to talk about in the brief role-play. While any topic may be suit- able, we suggest that you use past and present vocational interests and jobs. The task of the counselor is to enable the client to talk freely. As you gain more experience with the skills, select increasingly challenging topics. Attitudes to or experiences with alcohol and drugs is a very useful area that virtually all counselors will encounter.

4. Watch time carefully and provide feedback. The role-play should be approx- imately 3–4 minutes in length and video or audio-recorded. If not recorded, the observers become especially important to provide feedback. Use the

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

feedback sheets provided and give specific information to the client. Do not be judgmental (e.g., “That was a great job!”). Rather, attempt to be specific and concrete (e.g., “You maintained eye contact and the client responded with a gradually relaxing body posture and vocal tone.”).

5. Rotate roles so that every person has an opportunity to serve as counselor and client. Again, remember to divide time for practice equally.

GROUP/FAMILY PRACTICE IN ATTENDING BEHAVIOR

Basic Attending Skills does not claim to make you an expert group or family inter- viewer or counselor. However, whether you are a beginner or even an advanced expert, some time spent deliberately working with the skills of this book can make you more effective with groups and families.

1. Develop a working group. For practice, a working group of four is recom- mended, a facilitator and three group members.

2. If possible, assign two additional roles for the practice session.

a. Observer/operator. This person operates the video or audio equipment (or smart phone/iPad, etc.) and provides verbal and written feedback to the group. If no equipment is available, the emphasis is solely on observation.

b. Second observer. This individual provides written feedback to the counselor and ideally concentrates observations on nonverbal dimen- sions that may be missed by others.

3. Determine topic for role-play. The family may wish to develop a joint positive story from their past or their community. A useful and stimulating topic for the group can be taken from the alcohol and drug area—a working topic might be “the meaning of alcohol,” but the specific topic should be decided on by the group and its leader.

4. Planning. Divide the time between the topic (alcohol suggested in this case), the individuals in the group (their feelings and attitudes toward alco- hol), and the group itself (how the group interacts as a whole). For this first practice exercise, follow time guidelines carefully. In the beginnings of

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

family and group work, you will find that a firm structure is useful and helps make the group or family sense themselves as a “group” rather than just a collection of individuals.

5. Watch time carefully and provide feedback. The role-play group session should be approximately 30 minutes in length and video or audio-recorded. If not recorded, the observers become especially important to provide feed- back. Complete the feedback sheets provided and give specific information to the client.

ATTENDING BEHAVIOR FEEDBACK SHEET

(Feel free to photocopy this for your practice sessions)

1. Attending Behavior Counts

As you view an interview live or on video, count the several attending behaviors. In this first exercise, look for problems in attending. Search for strengths and pos- itives in the effective sessions.

Attending Dimension

Ineffective Demonstration

Effective Demonstration

What was done right in the effective session? Remember, we build

resilience on strengths

Inappropriate eye contact breaks

Distracting body movements

Vocal style distractions

Topic jumps

Total nonattending behaviors

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

2. Percent of talk time. Use a stopwatch to record talk-time. What percent of the conversation did the counselor talk? _________

3. Subjective Attending Observations Patterns of eye contact. Appropriate, inappropriate, staring, avoiding? On

what topics did the person break eye contact?

______________________________________________________________

Physical attention. What do you see in terms of body movement, trunk lean, and hand or leg movements? Did you see any specific movements (e.g. physical withdrawal or moving forward) in relation to client’s statements?

______________________________________________________________

Vocal tone/speech hesitations. General comments on vocal tone. Did you note any specific changes in vocal tone as the counselor responded to the client? At what points did speech hesitations appear?

______________________________________________________________

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Topic jumps/verbal following. Was the counselor able to stay on the topic and not give advice or suggestions? How many topic jumps occurred? Who initiated topic jump changes?

______________________________________________________________

Selective Attention. Are there certain topics toward which the counse- lor seems to demonstrate more extensive attending behavior? Are there places where the counselor seems to lessen attending behavior and avoid a topic?

______________________________________________________________

4. What were the strengths? What did the counselor do right? What do you notice as particular individual strengths in the interview?

______________________________________________________________

You won’t know the power of community until you are part of one.

–Anonymous

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

THE COMMUNITY GENOGRAM—A PRACTICE STRATEGY FOR ATTENDING1

“It takes a community to raise a child.” This well-known African proverb underlies the community genogram. Our original community is where we learn the culture which will remain with us through our lifetime. Communities consist of our family and perhaps extended family, friends and neighbors, schools, work settings, the physical geography of the community territory, church or spiritual connections, and other unique factors. Our personal experiences with community are as unique as our fingerprints.

But, why are we presenting the community genogram at this early point in this book? First, it provides a way for you and the client to learn more immediately that we can most effectively approach problems and difficul- ties if we focus on positive, strength-based factors. Secondly, we can learn the background of our clients and see them holistically through develop- mental experiences implicit and explicit in the community.

Equally important, a community genogram inevitably provides data that would be otherwise missed. And, for your practice session with each skill, talking through the community genogram will give you topics for the conversation that is counseling and psychotherapy. The community gen- ogram is also a way to discover the important groups (church, school, peer groups, neighborhood, etc.) that influence a person. You will not only know the problems a client faces, but you will have a solid knowledge of strengths and what he or she can do rather than can’t do.

The specific steps toward developing a community genogram are pre- sented below. We suggest that you first develop your own community genogram and then later use this strategy with your client or share your genogram with a classmate. As you work with the strategy, note that the visual style of the genogram can be changed to meet specific needs and

1 © Allen Ivey, 8877 Bloomfield Blvd., Sarasota, FL. 34238. Permission to copy granted.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

experiences. To realize the potential of the Community Genogram, it is essential that you actually engage in the process of the Practice Exercise.

Drawing a Community Genogram

Rather than fixing on a single visual framework for a community genogram, we suggest that you work with each client to develop their own model, their own way of presenting their background. Many clients like to draw literal maps of their communities with pictures of family, school, church, and other key influencers drawn in. One useful visual model is that of the star with interacting influences. Others prefer abstract circles and squares drawn with lines of connection. Here are two example approaches.

Community Genogram of client Dominiqua.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Alex, 13 years old

Foster mom

Biological mom

Mrs. Lawrence, my counselor

School

Baseball

Debriefing the community genogram has three major goals: 1) to gen- erate a narrative or story of the client in community and cultural context; 2) to help the client (or you in this case) generate an understanding of how we all develop in community—we are people in relationship; and 3) to use the images and accompanying stories as sources of strength and lasting resources. Clients may be tempted to first focus on the negative as they develop their awareness and stories of how they developed and live in a community setting. While you will need to attend to potential negative stories, we urge you to focus first on positive strengths.

1. Consider a large piece of paper or posterboard as representing community culture. Usually, it is best to select the community in which you primarily were raised, but any other community, past or present may be used. Place yourself or the client in that community, either at the center or other appropriate place. Represent yourself or the client by a circle, a star, or other significant symbol.

2. Place your own or the client’s family or families on the paper, again represented by the symbol that is most relevant for you. The family can be nuclear or extended or both.

3. Place important and most influential groups on the community gen- ogram, again representing them by circles or other visual symbols.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

4. School, family, neighborhood, and spiritual groups are most often selected. For teens, the peer group is often particularly important. For adults, work groups and other special groups tend to become more central.

5. Connect the groups to the focus individual, perhaps drawing more heavy lines to indicate the most influential groups, broken lines for disrupted relationships.

Debriefing the Community Genogram by Searching for Stories of Strengths and Resources.

While you undoubtedly recognize that many individual difficulties and problems arise in a family, community, and cultural context, the commu- nity genogram focuses on strengths.

The community genogram provides a frame of reference to help the client see self-in-context. Ask the client to generate narratives of key stories from the community where he or she grew up. The emphasis is on positive stories from the community and positive images. The community genogram is kept and posted during the entire counseling series of practice sessions or interviews.

1. Ask the client to provide stories on the family and community images. The client may want to start with a negative story or image. Please do not work with the negative until positive strengths are solidly in mind.

2. Develop at least two positive stories from different parts of the community genogram. Consider searching for images and sto- ries of older family members, cultural heroes, and spiritual experiences.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

3. When the client face stress, one or more positive stories can be drawn on—the client is not alone, their strengths and resources remain with them in the here and now. For example, if the client’s grandfather was supportive and loving with them as a child, ask them to think of a specific single time and image that stands out. This story image can be used to help cope with daily issues—the client is not alone, the strength and resource stays with them. In addition, many clients experience emotions and feelings in their body. Many will speak of strength in their arms, a feeling of warmth in the stom- ach, or a comforting smile. These physical body resources from the past can be drawn on at times of present stress, just as the positive stories need to be recalled.

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

DO-USE-TEACH CONTRACT

DO: The First Dimension

You first had an opportunity to understand the concept of attending behavior through reading. You then experienced the ideas of attending behavior first hand through practice. This is the do portion of the Do-Use-Teach Contract. If you can demonstrate attending behavior in the practice session, you have achieved the first dimension of competence in attending.

USE: Taking the Concepts to the Real World

Now is the time to decide what these concepts mean to you and how they can be used in your own life space. We know from past experience and extensive research that the concepts are important and make a significant difference in the interview. But, can you take these ideas and use them beyond reading and the classroom or workshop session? What we’d like you to do now is think about how you might use the concepts of attending behavior outside the interview.

Ways that people have used attending behavior in their own lives include:

A beginning counselor tried attending in an interview when she didn’t know what to do. She simply asked a question about something the client just said.

A shy person who couldn’t talk to anyone tried attending and found it pro- vided an opening wedge in conversation.

A man in trouble with his boss tried deliberate attending and discovered he was missing some crucial messages.

At the family dinner table, a husband and wife found they weren’t listening to their children and then used attending to open up the family interaction.

A depressed individual found that going out and deliberately attending to someone else helped him become less depressed. (We have found that teaching attending skills is particularly useful in work with clients who show slight, moderate, or at times even severe depression.)

A student deliberately attended to her teacher in class and to her surprise found the teacher talking to her and no one else!

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

Personal experience with using attending is crucial. Our helping skills should not be used just in the interview; they have meaning in our daily lives as well.

What do you want to do to test out the value of attending in your own life? Write a specific plan and outline in detail how you will make the concepts relevant to you.

My plan to use attending behavior in my own life is _______________________

__________________________________________________________________

Talk with someone about your plan to use attending. Is it specific enough? Will it work? Can you arrange a time to get together with this individual to report how your contract worked out?

TEACH: Helping Others Grow

Next we would like you to think about someone or some group with whom you might like to test your understanding and facility with attending behavior by teach- ing them what you have learned in this chapter.

Teaching someone else about attending behavior has taken many forms:

Using this same workshop format to teach teachers, parents, peer facilita- tors, hot-line operators, etc., these listening skills that you have learned.

Labeling listening skills in your own way. After all, you don’t have to use the terms eye contact, body language, and verbal following. Some might prefer very different use of words.

If you are helping someone in a counseling session, try teaching these basic skills. Teaching attending is especially helpful to depressed individuals or those with weak social and interpersonal skills. When clients attend to some- one else, they are not attending to their own difficulties.

Teaching your clients listening skills can be very helpful. For some clients, learn- ing how to listen may be more important than traditional counseling. To whom and

ATTENDING BEHAVIOR: THE FOUNDATION OF EFFECTIVE LISTENING

when would you like to teach attending behavior? And how would you do it? Write a contract with someone in the group to actually set up a teaching plan.

My teaching plan is:

__________________________________________________________________

DO—USE—TEACH

You don’t know what you are doing until you can teach it to someone else.

Answers to Classification Items on Pages 24–25

1. A is attending 2. A is attending 3. A is attending 4. B is attending 5. A is attending

Note that in most of the examples above, the error of the counselor who failed to attend was that her or his response tried to solve the problem much too early. In attending, we really want to draw out issues and concerns in more detail before moving to problem solving.

An open invitation to talk is a gift to the client.

But, sometimes that gift of questioning becomes “grilling” and may be intrusive.

How are you going to find a balance?

CHAPTER 3

QUESTIONS: OPEN INVITATION TO TALK

Questions help an interview move along. They open new areas for discussion, they assist in pinpointing issues, and they can be used to facilitate client self- exploration. In recent years, questioning approaches to counseling and therapy have gained increased favor. Many cognitive behavioral counselors or family ther- apists, for example, may use as much as fifty percent questioning in their ses- sions. At the same time, it must be remembered that a few practitioners, primarily from a humanistic orientation, have suggested that the counselor should never ask questions. One of your central tasks in this session will be to define where you stand on the use of questions.

The exercises and readings in this chapter will help you to:

1. Develop awareness of both strengths and weaknesses of questioning skills. You will be asked to generate your own position on the use of questions in the interview.

2. Define the difference between open and closed questions.

3. Identify how different questions stems (“Could,” “What,” “How,” and “Why”) tend to lead to varying types of client talk.

4. Demonstrate the skills of question-asking in a practice interview. You are also encouraged to test these skills in practice with couples, groups, and family.

5. Use questioning skills in your daily life, and consider how you might teach the skills to others, including your clients.

WHAT ARE YOUR FEELINGS AND EXPERIENCES WITH QUESTIONS?

In North American society, questions come endlessly. Children ask us questions almost as their first sentences, teachers question us in school, our employers question our performance and skills, and in the evening we watch television entertainers use questions to bring out their guests. Clearly, questions are an important part of our culture.

QUESTIONS: OPEN INVITATION TO TALK

Questions also indicate that a person is interested in you and what you have to say. Good questions help people explore themselves and their feelings more deeply.

Yet, questions have varying impact on different people. Some feel put “on the spot” or “grilled” when someone asks them questions. If you have not established a solid base of trust with another person or a client, questions used too early can interfere with the development of rapport. If you are working with a client who is culturally different from you, it may be helpful to save questions until some trust is established.

Take some time to think about your positive and negative experiences with ques- tions below. Has your personal experience with questions been mainly positive or negative?

My personal experience with questions has been:

Positives:

Negatives:

The position taken in this book is that questions are a helpful and necessary part of most interviews, but that we all must be aware of their limitations. Skilled question asking can result in clients learning how to question and examine themselves. Let us now consider more information about the critical skills of questioning.

QUESTIONS: OPEN INVITATION TO TALK

QUESTIONS: OPEN INVITATION TO TALK: BASIC SKILL #2

The client comes into an interview with a concern or problem. The initial task of the interviewer is to stay out of the client’s way so as to find out how the client sees the situation and defines the issues. Most useful in this process is the tech- nique of providing limited structure through the use of an open invitation to talk. Compare the following examples focused on interpersonal relationships:

Open: Could you tell me about your relationship? How are you feeling toward her/him? What are some things you like about her/him?

Closed: How long have you been together? Do you argue a lot? Does he/ she understand you?

The open questions provide room for the client to express what is going on with- out the imposed categories of the counselor. An open comment allows the client an opportunity to explore self and situation.

Closed questions, on the other hand, too often emphasize factual content as opposed to feelings. While they can help to learn specifics around client issues and even sometimes enable the client to elaborate in important new ways, they may shut off client talk and if used too much, and you find yourself searching for the next thing to say. They may demonstrate a lack of interest in what the client has to say, and they frequently attack or put the client in his/her place. Closed questions can often be answered in a few words or with a yes or no. However, they can still be useful at times to fill in details.

Questions generally should be designed to help the client explore issues, rather than to merely provide information for the interviewer. If you rely on closed ques- tions to structure the interview, you will find yourself forced to concentrate so hard on thinking up the next question that you may fail to hear what the client had to say.

Open invitations to talk are extremely useful in a number of different situations. The following are some examples:

1. They help begin an interview. (Could you tell me what you’d like to talk about today? How have things been since the last time we talked together?)

QUESTIONS: OPEN INVITATION TO TALK

2. They help get the interviewee to elaborate on a point. (“Tell me more” or “Please continue” will often produce the same result and you don’t need to use a question at all.)

3. They help elicit examples of specific behavior so that the counselor is bet- ter able to understand what the client is describing. (Will you give me a specific example? What do you do when you get “depressed?” How do you behave? What do you mean when you say your father is hard to get along with?)

4. They help focus the client’s attention on feelings. (What are you feeling as you’re telling me this? How did you feel then?)

5. Questions may help you find client thinking patterns that are not immedi- ately obvious. (What were you thinking when you said that to your boss? What thoughts were in your mind while you did that? What were you saying to yourself when the boss spoke to you and you stayed silent?)

Go through the examples above again, and change them to closed questions. This exercise will help you note distinctions and differences between open and closed questions.

VARYING QUESTIONING CAN HELP CLIENTS EXPLORE ISSUES

During your next practice session, it will help if you explore various types of questions. Try asking a variety of open and closed questions. We would espe- cially like you to try questions beginning with “how,” “what,” and “could” which most in the field believe give more room for client exploration than “why.” For example, consider the different possibilities if you are asking a client about his or her job:

Could you tell me how things are going at work?

What are some of the things that trouble you about your job?

How do you feel about your boss?

Why do you think the boss treats you this way?

QUESTIONS: OPEN INVITATION TO TALK

Or consider a marital counseling session:

“Could you share an example of a typical argument?”

“What did you do when he/she struck you?”

“How did you feel when he/she cried?”

“Why are you staying in the relationship?”

Could questions tend to be maximally open and pass on control to the client (“Could you tell me more?” “Could you give me an example?”). Research reveals that could questions put focus on the client in a comfortable way and seem to establish trust. Technically, could questions can be answered with a “yes” or “no,” but relatively few clients stop there. Could questions seem to empower the client to answer questions as he or she wishes.

You may note that questions beginning with “could” might be interpreted as closed. A client may respond to this question with a simple “no” and say nothing more to this question. However, in North American culture, the “could” question tends to function most often as an open invitation to talk. “Could” questions have the special advantage of giving the control even more to the client as the word “could” implies that the client can decide whether or not to respond at all.

What questions often lead the client to talk about facts and specifics about a situ- ation or event. Facts provide the foundation so that you know more precisely what occurred for your client. (“What happened?”)

How questions most often lead to client talk about process and sequence or emo- tions (“How did that happen?” “How do you feel about that?”). Emotions are the motor of behavior and clients can get into their issues much more deeply when we help them explore their feelings.

Why questions typically ask clients to search for reasons underlying their behavior, thoughts, or emotions. Why questions and their search for reasons may put people on the spot. They are sometimes difficult to answer for we don’t always know why others or we do things. What, how, and could questions provide more room, and providing space for growth is one basic dimension of being an effective counselor.

You will find that clients hesitate longer if you ask them “why.” Researchers sug- gest that “why” leads to an internal search. At the same time, you will find many

QUESTIONS: OPEN INVITATION TO TALK

effective counselors using why questions. Many clients gain benefit from under- standing the reasons underlying their actions. Again you will have to make your own personal decisions whether or not you choose to use why questions.

A balance of open and closed questions is suggested in the early phases of an interview. Further, the open question “could” often provides the best overview of the situation. Later in the interview, you will often find clients talking in relatively vague terms about a problem (“I don’t get along with my lover/boss/ etc.”). An open question seeking specifics (“Could you give me a specific example?”) often proves to be extremely effective in defining the problem more clearly.

The multicultural dimension and establishing a relationship. As noted earlier, peo- ple who are culturally different from you may be put-off by too early use of ques- tions. Self-disclosure on your part before questioning may be helpful in situations where cultures differ. With some reticent clients, some personal sharing helps gen- erate more openness. Frank discussion of cultural differences may be useful. For example, “I’m White (or other background) and you are from a Mexican background (or other background). How does it feel to work with someone different from you?” “I’d appreciate your letting me know if you feel uncomfortable working with me at anytime. And let me know if I miss something.” And, it is often helpful to say, “Do you have any questions for me? What might you like to know about me?” This provides the client with an opportunity to ask some critical questions and illustrates your own openness. Differences in race/ethnicity, gender, sexual orientation, and other issues are sometimes best discussed before the session gets fully underway.

LESS VERBAL CLIENTS AND OPEN AND CLOSED QUESTIONS

Generally, open questions are much preferred to closed questions in the inter- view. Yet, it must be recognized that open questions require a verbal client who is willing to share information, thoughts, and feelings with you. Following are some suggestions that may facilitate clients talking more freely with you.

Build trust at the client’s pace. A central issue with hesitant clients is trust. If the client is required to meet with you or is culturally different from you, he or she may be less willing to talk. At this time, your own natural openness and social skills are particularly important. Trust building and rapport need to come first. With some clients, trust building may take a full session or more. Extensive questioning too early can make trust building slow with some clients.

QUESTIONS: OPEN INVITATION TO TALK

Accept some randomness. Your less verbal client is not likely to give you a clear linear story of the problem. If he or she lacks trust or is highly emotionally involved in the concern, it may take some time for you to get an accurate understanding. You may need to use a careful balance of closed and open questions to draw out the story and get “bits and pieces” before you can put a coherent story together. Regardless of what you do, keep your language as simple, straightforward, and concrete as possible.

Search for concrete specifics. Counselors and therapists talk about the “abstrac- tion ladder.” If you or the client moves “too high” on the abstraction ladder, things won’t make sense to anyone. This is especially so with less verbal or emotion- ally distraught clients. Constantly seek to find concrete examples and stories. Avoid searching for general themes and patterns. The open question, “Could you give me a concrete, specific example?” is a particularly effective general con- crete question. Abstractions and repeating patterns of behavior, while important, should wait until the basic facts, feelings, and thoughts have been discovered.

Seek short, concrete answers. After some trust is generated, you might begin by saying, “The teacher said you and she had an argument.” Then try asking the concrete open question, “What did your teacher say (or do)?” If you focus on concrete events and avoid evaluation and opinion in a nonjudgmental fashion, your chances for helping the client talk will be greatly expanded. You’d like to know what happened specifically, what each person said and did, and perhaps the accompanying emotions. Example concrete questions focusing on narrow specifics include:

What happened first? What happened next? What was the result? (This helps you draw out the linear sequence of the story.)

What did the other person say? What did he/she do? What did you say/do? (Focuses on observable concrete actions.)

What happened after? What did you do after? What did he/she do after? (Sometimes less verbal clients are so focused on the event that they don’t yet realize it is over. This helps them see the end and the consequences of the situation.)

What did you feel/think just before it happened? During? After? What do you think the other person felt?

QUESTIONS: OPEN INVITATION TO TALK

Note that each of the questions above requires relatively short answers. These are open questions that are more focused in orientation and can be balanced with some closed questions. Do not expect your less verbal client to give you full answers to these questions. You may need to ask closed questions to fill out detail and obtain specific information. (“Did he say anything?” “Where was she?” “Is your family angry?” “Did they say ‘yes’ or ‘no’?”)

The leading closed question is dangerous. In the examples above, you can see that a long series of closed questions can bring out the story, but it may be the cli- ent’s limited responses to your questions rather than what the client really thought or felt.

Working with children. Children, in particular, may require considerable help from you before they are willing to share at all. With children, it really helps if you are naturally a warm, talkative person who likes and accepts children. Thus, it helps to begin sessions with children sharing something fun and interesting. Games, clay, and other toys in the counseling room are useful when dealing with children. You will find that children generally like to do something with their hands while they talk to you—drawing a picture during your conversation often is useful to them and to you. And, the drawings are often revealing as to what is going on in the child’s life.

Summary. Your ultimate goal is to draw out: 1) the general picture of what hap- pened (“could?”); 2) key facts of the situation (“what?”); 3) emotions (“how?”); and 4) where appropriate, draw out the reasons for the situation via the why question. But do not expect this information to come in sequential order as above. If you have patience and use attending skills well, you will eventually be able to bring out their full story. Clarifying skills (minimal encourages and paraphrases), reflec- tion of feeling, and summarization, discussed in later chapters, will help you and the client organize the story more fully.

PRACTICE IN RECOGNIZING OPEN AND CLOSED QUESTIONS

The example interview below illustrates the varying types of questions. As you read the segment, classify each question as open or closed. Also circle the key words that indicate the type of question (for example, “Do,” “Is,” “What,” “Why”). The following is a segment of an interview. Rapport and trust have already been

QUESTIONS: OPEN INVITATION TO TALK

established. The segment here starts with a summary of what the client has said previously. (Classification of Responses may be found at the end of this chapter.)

1. Counselor: Cherilyn, so you say you are a single parent, that it has been hard for you at times, and that you would like to explore some issues about some difficulties with your children.

2. Client: Yes, that’s right. I’ve been a single parent for six years now.

________ 3. Counselor: Could you tell me a little bit about your life? Maybe some frustrations that you have had?

4. Client: Oh, yes, there’s been many. You’d think after six years, I’d really have it all together. You know, I have a career, I’m an counselor. And I have two daughters, and a decent apartment and all the usual things, but it’s really hard bal- ancing, trying to do everything, trying to be everything for my daughters, you know, helping them with homework, disciplining them, doing everything I am supposed to do. It’s just difficult managing it all.

________ 5. Counselor: Cherilyn, I can sense it’s a big task. Could you give me a specific example of one of the issues? (Comment: Using the client’s name helps personalize the interview. Do try to use the client’s name periodically throughout any session.)

6. Client: Well, I guess the thing that’s bothering me most is that I am a counselor and I work with students and then I come home at the end of the day, and I see my own kids having such a difficult time getting along. They fight with each other, they hit each other, and they argue about everything, about clothes, about their friends, about computer and screen time, everything imaginable. And I just can’t seem to be able to help them out and it’s very frustrating.

________ 7. Counselor: Could you tell me about an example where you had those difficulties? (Comment: Note that the counselor has used three “could” questions in a row. The client is encouraged in each one to become more specific and clear.)

QUESTIONS: OPEN INVITATION TO TALK

8. Client: Well, last weekend I took them out to buy school clothes. Then we stopped for lunch. A friend saw us and joined us. Next thing the girls started pinching and poking and hitting and teasing right at the table. I didn’t want to say anything because my friend was there, but I kept getting angrier with them.

________ 9. Counselor: Their behavior catches you by surprise and you get mad. How old are the girls? (Closed question useful for context—note that “how” and “what” questions can sometimes really be closed—“What age are they?”)

10. Client: Well, they’re eleven and thirteen. You’d think by that age they’d be able to handle themselves in public. And, it is starting to get violent.

_______ 11. Counselor: I understand your frustration. Do they hit each other all the time, Cherilyn?

12. Client: Well, every day I’m sure. In fact endlessly, yes.

_______ 13. Counselor: Do you ever hit them? (Comment: Ultimately, this is an important question to ask. Children who express violence often come from a violent home. Other useful, perhaps more indirect, questions here might have been “How do you react when they hit each other?” or “How do you feel about hitting as a way of discipline?”)

14. Client: No, I don’t hit them and that’s why I can’t understand why they hit each other.

_______ 15. Counselor: Maybe they . . . Do you think they get it from their friends? Do their friends hit each other? (Comment: Here the coun- selor has become trapped by closed questions. Closed questions can lead you to guessing what is in the client’s mind and most of us aren’t good “mind-readers.”)

16. Client: I don’t know. I’m confused.

QUESTIONS: OPEN INVITATION TO TALK

_______ 17. Counselor: Let’s go back, Cherilyn. Earlier you said you were trou- bled by their behavior. Could you tell me more about that? (Comment: When things aren’t going well in the interview, use a basic rule or attending behavior—go back to an ear- lier comment and ask an open question about that issue. Again, using the client’s name respectfully is a useful adjunct to rapport and sometimes can get you through your errors. It is not the mistakes we make that are so bad—all of us will make errors. What is important are our recovery skills!)

18. Client: Yes, I was embarrassed. I know that the way one’s chil- dren behave often reflects on what’s going on at home. I worry about the interpretation that others are going to place on me. I don’t hit my children, but I worry that others will think I do.

_______ 19. Counselor: Why do you think the children are hitting each other? (Comment: The potentially dangerous “why” question has been asked. It can put clients off, but if the relationship is good, sometimes useful information appears.)

20. Client: (breaks into tears and stammers) I think they are still reacting to the divorce. I do my best, but I can’t manage them. My ex husband used to hit us all.

In the example above you see a variety of questions used to bring out information from the client. Closed questions bring out specifics and open questions help clients explore more from their frame of reference. In this example, the counselor got too involved in specifics at one point, but was able to salvage the situation. The counselor did this through saying at 17. “Let’s go back” and there he asked an open question about a previous topic. This is an example of how attending behavior (return to an earlier topic when you feel lost) helps you get started again.

As you gather data through open and closed questions, you can gradually learn the client’s story and the client’s plan for the future. Again with less verbal clients, pay special attention to focused questions that require shorter answers.

QUESTIONS: OPEN INVITATION TO TALK

OPEN INVITATION TO TALK WITH FAMILIES AND GROUPS

Most family counselors and family therapists use questions extensively. The fast moving and complex pace of the family session requires action on the part of the counselor. Family sessions can easily swing totally out of control and the skilled use of questions provides you with powerful alternatives for action.

All of the questioning principles described in this chapter can be applied to family and group work. However, it is important to add the critical words “family” and “group” to at least some of your questions.

“Could you tell me the strengths of this family/group? What seems to work well for you?”

“What’s happening in the family/group right now?”

“How are you feeling right now about this family/group?”

“Why do you think this group/family is having this difficulty?”

In each of the examples above, the focus on the family or group helps each member to be aware that they are just that—a member of a group. Families and groups each have their own typical interaction style, rules, and norms that need to be examined.

PRACTICING OPEN INVITATION TO TALK

Again, it is your ability to use questions in your own helping interviews that is most critical. Here are specific suggestions for the practice session. You may want to refer to the earlier discussion of practice for attending behavior for more specifics.

1. Develop a working group of a pair, a triad, or four people.

2. Assign roles for the practice session.

a. Counselor

b. Client

c. Observer/operator

d. Second observer

QUESTIONS: OPEN INVITATION TO TALK

3. Determine topic for role-play. The suggested topic for this role-play is a story from the community genogram, or a significant life event such as divorce, marriage, death, obtaining a new job, an important dating experi- ence, reactions to a new child, a significant success experience.

The task of the counselor is to use open questions to bring out the facts, feelings, reasons, and the general experience via what, how, why, and could questions. A few closed questions should be used for variety. In addition, the counselor should ask at least one question aimed toward specifics. “Could you give me a specific example?”

4. Record interview and provide feedback. Be specific and nonjudgmental.

5. Rotate roles so all participate.

GROUP/FAMILY PRACTICE IN OPEN INVITATION TO TALK

It is suggested that couple counseling be tried for this practice session.

1. Develop a working group.

a. Two members become the couple

b. Counselor

c. Observer/recorder

2. Determine topic for role-play. We often start with a focus on family difficul- ties. Here community genogram stories (see pages 58 on how to conduct a community genogram) can start discussions on a more hopeful direction. However, any type of couple conflict is appropriate for this practice session.

3. Planning. The counselor’s task is to draw out the couple’s conflict with as much information as possible. Ideally, the counselor will want to know the facts of the situation as seen by each member of the couple, the feelings each has, and any reasons the couple can generate to explain what is occurring. The task is to draw out data and information, not to problem solve.

During planning time, the role-played couple can generate a tentative “script” concerning their “difficulties.” The observer can study the observer form and prepare any recording equipment.

QUESTIONS: OPEN INVITATION TO TALK

4. Watch time carefully and provide feedback. The role-play should last approximately 10–15 minutes. Allow 15–20 minutes for feedback.

5. Rotate roles as time permits.

OPEN INVITATION FEEDBACK SHEET

(Feel free to photocopy this for your practice sessions.)

During each practice session, count the number of open and closed questions. As you make your counts, notice the response of the client to different types of questions. How long does the individual talk? What body movements do you notice in response to questions?

Session Number of Closed Questions

Number of Open Questions

1. Was the counselor able to use all four basic open questions? What was the result of each in terms of what the client said? Was a general picture of the problem brought out? Were the important facts and feelings discussed? Were the underlying reasons explored?

Could: ______________________________________________________

What: _______________________________________________________

How: _________________________________________________________

Why: _________________________________________________________

QUESTIONS: OPEN INVITATION TO TALK

2. What closed questions were used and what was their impact on the client?

3. Nonverbal observations of both counselor and client’s behavior.

4. One specific suggestion for the counselor to follow-up on would be:

DO-USE-TEACH CONTRACT

The Do portion of the contract is concerned with whether or not you actually can engage in a skill. Can you demonstrate attending behavior and questioning skills in an interview? The feedback sheets are concerned with your ability to engage in or do the skills.

QUESTIONS: OPEN INVITATION TO TALK

The Use aspect of the contract is concerned with taking the concepts of the chap- ter out and using attending behavior, questions, and other skills in your daily life. What are some of the ways you can take the concepts of questioning out and use them to help you in your own daily communication? Generally speaking, the most effective use contract is to make an agreement with yourself or with your group to practice the learning of this chapter outside of the practice workshop and then report back what happened. This practice is what will make you an expert with the skill. Report below your own unique plan to use the skill of questioning and how well it worked for you.

USE: I plan to use open invitation to talk in the following context:

The skills of this book are designed to be shared widely. Managers in business concerns, nurses and physicians, and other professionals use these same skills in much the same fashion as counselors. The context and content may vary, but the communication skills remain the same. Similarly, parents, children, teenag- ers, and others use these skills. They can profit from learning what you have learned. Thus teaching the skills of this book is an important aspect of your own training and the work of the effective counselor.

The Teach aspect of Basic Attending Skills is critical. You will want to turn to the teaching methodology in Chapter 8 for more data and learn how to share what you know with others. The model of teaching communication skills suggested in this book is simple, but has been proven and tested through over many years of clinical training with hundreds of thousands of learners in fields as varying as counseling and law, medicine and community hot-line work, and the teaching of skills to parents and elementary children.

Also, recall that teaching attending behavior and questioning skills to clients may be a particularly effective treatment mode in its own right. It provides clients with

QUESTIONS: OPEN INVITATION TO TALK

useful social skills that they can use with their families, in their work, and in many other places.

The teaching model has been described in Chapter 1. To review:

1. Introduction/Warm-up. When you teach the skill, provide a brief commen- tary or experiential exercise on what you are going to teach.

2. Reading about the skill. Have the person you want to teach read informa- tion in the microcounseling manuals (particularly the first manual in each chapter).

3. Modeling. You may want to demonstrate the skill yourself. You may want to develop your own audio or video training examples. It is most helpful to your trainee to see the skill in action.

4. Practice. You’ll then want to have the individual you are teaching practice the skill so that real mastery can be developed. You can serve as client and your student can be counselor.

5. Generalization. With your student, work on a way that they can use the Do-Use-Teach contract format.

Develop your own plans for teaching someone else the skill and summarize what happened in your own words in the space provided below or on a separate page:

Plan:

QUESTIONS: OPEN INVITATION TO TALK

Result:

Classification of Responses

3. Open 7. Open 11. Closed 15. Closed 19. Open

5. Open 9. Closed 13. Closed 17. Open

Nothing is more satisfying than being heard.

The minimal encourage helps you draw out the client’s story.

The restatement uses several key words, even an important sentence to encourage the client to

elaborate.

The paraphrase shows the client that you have accurately heard their story and issues.

CHAPTER 4

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

The skills of attending and questioning are useful in assisting the client to start talking. The skills of this chapter, the minimal encourage, the restatement, and the paraphrase facilitate further conversation in more depth. These skills show the client that you have heard what has been said. When a person feels heard, they tend to build trust in the listener and are willing to say even more.

You will find that the minimal encourage is a most simple skill—yet it is one of the most powerful. The minimal encourage and the paraphrase both focus on using the key words of the client and then saying back to them the most important things they have said to you. At first glance, “saying back” what has been said sounds easy. However, selecting key words for encourages and accurate para- phrasing are two of the most difficult and important skills you can master.

The exercises and readings in this chapter will help you to:

1. Recall how you have felt when you have been heard and contrast that to when you were not heard. The two skills in this chapter are critical in help- ing clients to feel that you have listened to their stories.

2. Define the encourage, restatement, and paraphrase.

3. Distinguish how the paraphrase differs from the interpretation.

4. Demonstrate the skills in a practice interview. In addition, you may wish to try the skills in a group or family situation.

5. Use the skills in interviews and in your daily interactions with others. You will also be asked to consider yourself as a teacher of this skill both to cli- ents and other counselors.

EXERCISE: WHAT DOES IT FEEL LIKE TO BE HEARD? NOT HEARD?

All of us have had times when someone didn’t hear us. Perhaps you felt lost and lonely when someone didn’t listen to a real concern or perhaps an important

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

accomplishment was ignored. You have also experienced the joy of someone hearing you—it is a wonderful gift when someone truly listens to you. Take a moment and think of the importance of those times. Reflect on the feelings that occurred in being heard and not heard.

When someone listened to me, I felt:

When I wasn’t heard, I felt:

With those feelings and thoughts in mind, we can examine the central skills of active listening—the encourage and paraphrase. They are closely related. The first helps the client explore issues in more depth; the third facilitates accuracy of understanding and truly indicates to the other person that you have listened. Together these skills bring clarity to the counseling session.

THE ENCOURAGE AND RESTATEMENT: BASIC SKILL #3

Encourages are small indicators to another person that you are with her or him. Once you have asked a question (or used any other counseling skill), you want to encourage the client to keep talking. You’ll be surprised how very little in way of specific counseling leads are necessary if you just encourage the client to “keep going.”

Nonverbal encourages should be considered first. They are elaborations of attend- ing behavior. For example, your client will talk more easily if you maintain cultur- ally appropriate eye contact, your body leans forward with interest, and you use

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

facilitative open gestures. Head nods are used by many counselors unconsciously and seem to facilitate talk. Remember to smile naturally and appropriately.

In short, don’t be wooden; find your own natural body style of encouraging others to share themselves with you. On the other hand, beware of awkwardness and moving too much. You’d like your body to be in tune with your client.

Verbal encourages are brief utterances through which you can help the client move further or into more depth. Here are some useful examples:

1. “Oh?” “So?” “Then?” “And?”

2. “Umm-hummm.” “Uh-huh.”

3. “Tell me more.”

4. The repetition of one or two key words.

5. Simple restatement of the exact same words of the client’s last statement.

Silence as an encourage. On occasion the most valuable encourage may be silence. Professional counselors talk about “response latency time” which means the number of seconds a counselor waits before making a response. Many times the counselor should give the client time to respond or to continue. The most clas- sic example of inability to develop a satisfactory waiting period before continuing is the lecturer who finishes a point and then asks the group, “Any questions?” Before anyone has a chance to respond, the lecture continues.

Your own comfort level speaks in important ways to silence. If there is a quiet space in the session and you are uncomfortable, the client will sense that. If you indeed are uncomfortable, remember attending behavior. Focus on something the client just said and aim to pick out key words, perhaps repeating them as an encourager.

The restatement. There is also the restatement where you select words that rep- resent key ideas and repeat them back exactly. The restatement overlaps with the encourager when you use only two or three key words, but sometimes it is useful to repeat exactly key ideas word for word. This works like an encourager, but focuses in more depth on a key issue.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

The importance of restating key words: When single words or short phrases are repeated back to the client, they almost inevitably will respond by elaborating on the concept in more detail. One of the best ways, and least intrusive, to obtain further information and opinions from a client is to repeat back a key word or two or the exact same words of a short phrase. You may find that using a questioning tone of voice helps at times, for example, “sad and lonely?” Research shows that this type of encouragement is used more and more by effective professionals and nonprofessionals as they grow over their careers.

Paraphrasing is closely related to the key word minimal encourage, but it focuses on what has been said and covers a longer time frame. In the paraphrase, you again want to use the client’s key words as you say back to them the essence of their comments.

THE PARAPHRASE: BASIC SKILL #4

One of your most basic tasks is to hear the clients clearly and to let them know that they have been heard. Accurately hearing and sensing another person is the basis for all the skills in this series. Paraphrasing is a special type of attending which demands that you demonstrate your ability to “give back” to that person what he or she has said accurately. Effective paraphrasing often implies a giving of self to another person to help him or her gain increased clarity on their issues.

Consider the following client statement:

I’ve been having a terrible time with Susan. She just got promoted over me and she came on the job after me and I taught her how our systems work. She seems to have a big head. She’s giving me a terrible time and keeps telling me what to do. I don’t think anyone likes her.

Encourage: “Promoted over you?” (or “Terrible time?” or “Telling you what to do?” “No one?”)

Restatement: “She’s giving you a terrible time and keeps telling you what to do.” Or “You don’t think anyone likes her.”

Paraphrase: “Juan, you’re saying that Susan was promoted over you and is giving you a terrible time.”

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

Note that the encourage tends to lead Juan to elaborate in more detail on varying topics. The first leads to discussion of what happened over the promotion, the second focuses on Juan’s difficult personal experience, while the third on other employees in the office. Each type of encourage might lead Juan in a very differ- ent direction. By way of contrast, the paraphrase feeds back to Juan what he has been saying and indicates that he has indeed been heard. Note that some of the most important words that Juan used were repeated in identical form in the par- aphrase, but that the interviewer/counselor has shortened the statement, picking up the essence of what has been said.

The encourage and restatement helps the client present more detail while the par- aphrase indicates accurate listening. The paraphrase often leads to more detail, but it also serves to help a client move on to what he or she considers important.

The structure of the paraphrase should be considered. The most effective para- phrases consist of:

1. The client’s name and/or the pronoun “you.” There is clear evidence that personalizing the paraphrase makes it more effective.

2. The most important key words of the client.

3. A distilled, shortened, and clarified counselor statement that catches the essence of what has been said.

The Check-Out: Occasionally, verify the accuracy of your paraphrases with the check-out, a closed question that gives the client a chance to react to your state- ment. Example check-out questions to follow your paraphrase are:

Is that right? Am I close? Is that what you said? Am I hearing you accurately? OK?

If your paraphrase is successful, the client will likely reward you with words such as “exactly, “ “yes,” or “right.” If the client needs to talk in more depth, the para- phrase facilitates more extensive talk. If the client has talked enough on a topic, the paraphrase facilitates movement to a new subject. There are clients who say the same thing over and over again. Paraphrasing can help them move on to other issues.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

DISTINGUISHING PARAPHRASING FROM INTERPRETATION

In encouraging and paraphrasing we seek to help the client tell his or her story with minimal influence on our part. You want to hear how the client views a conflict, experienced a trauma, or thinks about a career decision. In listening, you want to hold back your ideas and interpretations and give the client prime attention.

Consider the following interviewing situation. Note that the helping leads— encourage and restatement, paraphrase, and interpretation—represent points on a continuum. The first two focus on the client’s view of the situation. The inter- pretation focuses on the interviewer’s view of the same situation and may bring a new meaning to the situation. Interpretations can be useful, but only after the client’s story has been fully heard.

Client: I’m really feeling lost. My Dad drinks a lot and sometimes he hits my Mom. It’s really tough at home. I find it really difficult to study or even do anything.

Counselor: (Encourage) “You feel lost.” or “Difficult to do anything.”

(Paraphrase) “You’re feeling lost because it’s really tough at home and you can’t do anything.” (Italics emphasize client’s key words.)

(Interpretation) Sounds like your Dad is an alcoholic. That really makes it tough for any teenager.

Note that the interpretation may indeed be accurate, but it is the counselor’s view- point, and it may not be the client’s. Helping theory holds that it is best if the client can come to the interpretation on his or her own. If you have worked with alcohol problems, you are well aware that naming a “drinking problem” as alcoholism is a big step. Thus, it is recommended that you first focus on the client’s worldview through careful listening and save your interpretation until later.

Keep the following maxim in mind:

If you listen first, clients are much more likely to accept your ideas, advice, and interpretations later in the interview.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

Even better, if you listen first, many clients will develop useful new interpretations and meanings on their own.

The above brief example should illustrate that finding the differences between encourage and restatement, paraphrase, and interpretation is not easy. Clearly in each case above the counselor has selectively attended to what the client has said about the problem. The minimal encourage involves the counselor minimally in what the client talks about while the paraphrase is the counselor’s effort to give back the essence (as the counselor sees it) of what has just been said. The inter- pretation focuses on the counselor’s frame of reference rather than the client’s view.

Paraphrases serve three purposes at this stage: 1) they convey to the client that you are with her/him, that you are trying to understand what is being said; 2) they crystallize a client’s comment by making it more concise, thus helping give better direction to the interview; and 3) they provide a check on the accuracy of the per- ceptions of the interviewer.

INTEGRATING QUESTIONS, ENCOURAGES, AND PARAPHRASING

Basic Attending Skills are sequenced so that you can integrate the skills as each new dimension is added. For example, when you use the skill of questioning, you still need to continue culturally appropriate attending behavior. When you add encouraging, restatement, and paraphrasing, questions can be integrated to facilitate client expression.

As clients tell their stories and talk about important life events, they develop new understandings which enable them to move on and sometimes even to rewrite their past history. Your task as a listener is to draw out the client’s story as accu- rately as you can. It is the client’s story and you want to keep your ideas and reactions out of the story.

Negative example. The first example below illustrates how your own interpreta- tions can interfere with the client’s story. As you read the counselor leads, clas- sify each one as an open or closed question (O?, C?), minimal encourage (E), restatement (R), paraphrase (P), or interpretation (I). Also look for check-outs

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

(C-O), which appear very similar to closed questions, but are clearly used for a different purpose. More than one counselor lead occurs in some of the state- ments. (See the end of this chapter for classifications of skills.)

____ 1. Counselor: (To depressed client) What’s going on with your family?

2. Client: They don’t visit me at all anymore.

3. Counselor: They don’t visit you.

____ Why do you think that is?

4. Client: They don’t like me, I guess.

____ 5. Counselor: Perhaps it’s because you don’t pay any attention to them.

6. Client: (defensively) Well, they don’t pay any attention to me either.

As is common with many depressed clients, this client gives relatively short responses. There is a need to focus on specifics and encourage more concrete description.

Positive example.

____ 7. Counselor: Alisia, you say that they don’t pay attention to you.

____ Could you tell me how it went the last time they came to see you? (Note the focus on concrete, specific events. This is useful with all clients, but particularly with less ver- bal clients.)

8. Client: It wasn’t good. (Note that counselor open questions don’t always get long answers. With such clients, move to the search for concrete specifics.)

____ 9. Counselor: It wasn’t good.

____ Could you give me a specific example of something that wasn’t good? (It is important to use client key words in questions. This helps clients explore issues of underlying meaning in more depth.)

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

10. Client: Well, last time Mom didn’t like the way I was wearing my hair. She had hardly got here, but that she was trying to get me to fix it like she wants it.

____ 11. Counselor: Your Mom wanted you to wear your hair the way she wants it.

(Note use of client key words.)

12. Client: Yeah, she’s always telling me what to do. It’s almost eas- ier to have nothing to do with her. (Small events between a client and parents often speak to and represent larger family issues.)

____ 13. Counselor: Alisia, I hear you saying that your Mom wanted you do things her way and it’s easier for you to have nothing to do with her.

____ Is that right?

14. Client: Exactly, I just clam up and I don’t say anything.

____ 15. Counselor: Uh-huh, You clam up and don’t say anything

____ Tell me more about what happens.

16. Client: I used to fight back when my Mom picked at me. Somehow I learned it is easier to just sit and do nothing and ignore her.

____ 17. Counselor: So, Alisia, I hear you saying you don’t pay your parents much attention because you’ve found that it is easier to sit back and do nothing.

In the first example above, you have seen that clients can be “turned off” by inter- pretations of their situations. The second example focuses on the client’s actual story of the visit. Through questioning, minimal encourages, and paraphrasing, the client’s version of the story is brought out. Now that the story has been heard as the client wants to tell it, there is more possibility for working with the problem and finding a positive resolution.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

Recall the following maxim:

The first step in helping clients change the meaning of stories, or their behavior, feelings, or thoughts, is to hear their story as they interpret it.

Finally, note in the above example how the counselor used the major, key words of the client, whether using the minimal encourage or the paraphrase. Furthermore, questions that include key words of the client are also preferred.

USING THE CLARIFYING SKILLS WITH GROUPS AND FAMILIES

The encourage, restatement and paraphrase are used with equal effectiveness with groups and in family work. You can bring out less verbal group or family mem- bers through focused and concrete open questions coupled with encouraging and paraphrasing. In such cases, the skills are used in much the same fashion as with individual work.

More difficult, but equally important, is using the paraphrase with the group or family as a whole. Here you need to use the key words “family” and “group” and paraphrase the essence of what all are saying. For example:

Mother: Sonya isn’t eating. We’re afraid she’s anorexic.

Father: No, I don’t think she is. She just wants to keep her weight down.

Counselor: Sonya? (Encourage)

Sonya: I don’t have any problem. Like Dad says, Mom’s just making a fuss.

Counselor: The family seems to look at Sonya differently. Mom’s worried about anorexia, but Dad thinks she’s just trying to keep her weight down. Sonya thinks that Mom’s just making a fuss. How do such differences of opinion get worked out in this family?

1Another useful technique is circular questioning. Here you ask one member of the group how she or he thinks another member would answer the question. Through using this type of questioning, you will often discover unsaid things in the group or family.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

The example is obviously shortened. If you were working with an individual (and it could be Dad, Mom, or daughter), you would focus on how one per- son thinks. In family therapy and group work you have several individuals to respond to, but you also need to be aware of focusing on the group or family as a whole.

When paraphrasing what is happening in a group or family, you do much the same as you would with an individual, but you focus your helping statements on the group as a whole. A common family therapy and group technique is to ask each member of the group the same question and then to talk about how the family or group works on the question together.

PRACTICING THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

1. Develop a working group.

2. Assign roles as counselor, client, operator/observer, and second observer.

3. Determine topic for role-play. While any topic may be used, we have found talking about a family story is most useful. This can be the family of origin or the present living family of the client. The family story can be positive or negative, past or present. The task of the client is to use attending behavior and questions to bring out the story and then to use a variety of minimal encourages to keep the client talking and elaborating. At several points in the interview, the counselor should paraphrase what the client has been saying, using the key words of the client.

4. Watch time carefully and provide feedback.

5. Rotate roles.

GROUP/FAMILY PRACTICE IN THE ENCOURAGES, RESTATEMENTS, AND PARAPHRASING

It is suggested that structured group counseling be tried for this practice session. However, couple counseling or family counseling may be practiced as well if you prefer.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

1. Develop specific roles for the practice session.

a. Three or more individuals form the “group”

b. Group facilitator

c. Observer/recorder

2. Determine topic for role-play. Three possible topics for the group are: a) a current problem in ethnic or race relations in the community; b) problems which members might have in their work setting; c) future career plans of the group members.

3. Planning. The counselor’s task is complex in group work such as this. First, recall that your goal is to draw out individual and group stories, not problem resolution. Thus you would like to:

a. Draw out each individual’s story using questioning, minimal encour- ages, and paraphrasing.

b. Find group themes. You will find that some members of the group tell similar stories and you can relate them together through paraphrasing. Furthermore, the group itself will have a style and you can use the key word group to help members look at the group interaction.

c. Focus on the topic itself. Not only do individuals and groups have sto- ries, but also you will find it possible to construct a joint picture of the problem or topic as the several individuals view it.

Group work makes it possible for (a) individuals to tell their stories; (b) see how their stories are similar to and different from others, and (c) learn more about the problem or topic.

4. Watch time carefully and provide feedback. A meaningful group interaction will take at least 30 minutes and the same amount of time will be required for feedback and exploration of what happened. In the feedback session, give special attention to the role of the group facilitator.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

RATING AND BEHAVIORAL COUNT SHEET FOR ENCOURAGES, RESTATEMENTS, AND PARAPHRASING2

List the main words of each counselor statement and indicate whether it is an open or closed question, minimal encourage, paraphrase, restatement, or other skill (O?, C?, E, P, R, OS). You will find that listing the main words of each counse- lor statement will enable you to reconstruct the total session after it is completed even if you do not video or audio record.

With group or family practice, observers may also need to make brief notes of group and family members comments.

___ 1. _______________________________________________

___ 2. _______________________________________________

___ 3. _______________________________________________

___ 4. _______________________________________________

___ 5. _______________________________________________

___ 6. _______________________________________________

___ 7. _______________________________________________

___ 8. _______________________________________________

___ 9. _______________________________________________

___ 10. _______________________________________________

___ 11. _______________________________________________

___ 12. _______________________________________________

___ 13. _______________________________________________

___ 14. _______________________________________________

2Continue this format on a separate sheet of paper. You will find that maintaining records of individual, group, or family interviews will greatly facilitate your feedback sessions and your understanding of what happened. Use this feedback sheet as you practice other skills in this book as well.

CLARIFYING: THE ENCOURAGE, RESTATEMENT, AND PARAPHRASE

DO-USE-TEACH CONTRACT

How are you going to use and teach these concepts?

Do In practicing and/or observing these skills I learned or noticed:

Use I plan to use these skills outside this practice session as follows:

Teach I plan to teach these skill to others as follows:

Classifications of Skills

1. O? 7. P, O? 13. P, C-O

3. E, O? 9. R, O? 15. E, R

5. Interpretation 11. P 17. P

No cognition without emotion, no emotion without cognition.

Jean Piaget

CHAPTER 5

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

The most effective interviewers are gifted at entering the world of their clients, drawing out their stories, and understanding what has been said. Empathy is another word for this process. Your goal is to understand how clients see, feel, and hear the world around them. This is not your world, but you seek to enter the client’s world without mixing in your own thoughts and feelings. Think of walking in another person’s shoes, seeing the world as they see it, and experiencing their feelings, but you also manage to stay separate from them.

Basic to empathy are the listening skills of this book. However, many believe that the skill of reflection of feeling—the accurate sensing of the emotional world of the client—is the most important skill for developing empathic understanding. Emotions and feelings are at the core of our life experience.

Emotional regulation is a term from neuroscience that further clarifies the impor- tance of reflecting feelings. Research now clearly shows that your client’s emo- tions, when recorded through brain imaging techniques, show first in the brain’s limbic system. This is followed shortly by action in the prefrontal cortex (PFC). The PFC is our executive control center where we make decisions of many types. And, a central function of the frontal cortex is noting and regulating emotions. Our cognitions, our thoughts, and our behaviors start from an emotional base. As we help clients understand their emotions and feelings, we are strengthening execu- tive brain functioning, thus furthering client emotional control and regulation.

The words feeling and emotion are used interchangeably here. Neuroscience offers a distinction between feelings and emotions. Feelings are associated with bodily experience, while emotions are seen as constructed from internal basic feelings and experience with the outer world. For example, we might experience bodily fear, the most well-established feeling of all, but words such as scared, afraid, anxiety, worried, and terror describe different emotional events and all are based on the basic feeling of fear.

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

For practical purposes, the fear/emotion distinction may be useful as a background, but the helping fields and even the dictionary use the two words interchangeably.

The exercises and readings in this chapter will help you to:

1. Name emotions and understand their importance in the helping interview.

2. Define the skill of reflection of feeling and offer some practice in distinguish- ing it from other skills.

3. Examine some gender and multicultural issues around emotion. The skill of acknowledging feelings may be helpful in reflecting emotion to many clients.

4. Demonstrate the skill of reflection of feeling in a practice individual inter- view. In addition, you may wish to try the skill in family and group practice sessions.

5. Use reflection of feelings in your own interview practice and in daily life. You will also be encouraged to think about teaching this skill to others.

NAMING FEELINGS AND EMOTIONS

While many of us like to think that we make decisions rationally, in truth we aren’t really satisfied unless the decision “feels good.” Similarly, we may talk about our problems in an intellectual fashion, but unless we deal with the emotions under- lying the issue, we are likely to continue old ineffective behavior. Talking about something does not necessarily mean that we are dealing with key underlying emotional issues.

For example, you may work with the child of an alcoholic family or with someone who experienced abuse. The facts of the situation may be clear, but the emotions may be buried. In cases such as this, your main task may be to uncover and help the client deal with complex, sometimes troubling and confusing emotions. Knowing that one should leave a bad relationship is one thing—having the emo- tional strength to do it is another.

Emotions are important in all helping relationships. The client may rationally choose a career, but later feel unsatisfied because emotional issues were ignored.

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

The facts and the reasons for their decision may be clear, but until the client deals with underlying feelings about the job, something will remain unresolved. Most job problems are related to interpersonal and emotional issues rather than compe- tence or ability to do the task.

Feeling words. As a first step toward responding to a client’s feelings, you must be able to recognize and name those feelings. Some basic emotional states are listed below followed by some other related words. Extend that list yourself with even more words. The richer your feeling vocabulary, the more you will be able to understand the world of the client. Start with the basic “mad, glad, sad, scared.”

Mad: anger, annoyed, hate

Glad: joy, happy, excited

Sad: misery, hurt, guilt

Scared: fear, worry, anxiety

Additional emotional words which fit in one or more of the above categories include: relieved, exhausted, embarrassed, inadequate, indifferent, courageous, infatuated, tender—the list of feeling words can go on and on. List as many addi- tional feeling words as you can on a separate page. This sounds like a simple task, but it takes practice and awareness to become truly competent in joining the emotional world of the client.

Mixed feelings. Often your clients will present confused or mixed emotions. In many situations, we feel combinations of several emotions. We may be in love,

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

but anxious about the result. We may be very pleased about a new job opportu- nity, but scared at the same time. Sorting out these mixed feelings is an important part of the helping process.

Some key examples indicating that a client has mixed feelings include the words upset, torn, mixed up, confused, unsure, perplexed, troubled, and ambivalent.

These words are not themselves usually important underlying feelings. Rather, they often represent a surface description of deeper, complex feelings. A client may say that he or she is upset about a difficult relationship. If you listen fur- ther, you may find that the underlying feelings are hurt, anger, rejection, but also remaining love and caring.

When you hear words which represent complex, mixed feelings, reflect the sur- face word, but continue your listening to find underlying, more basic dimensions of emotion. Just reflecting back the key words “you feel torn” or “you were upset” may be enough for the client to elaborate emotions in more detail. On the other hand, questioning emotions can be helpful. For example, “You say you feel torn. Could you tell me more about what that word torn means to you?”

Feelings expressed as metaphor. Some clients will talk about feeling like a “limp dish rag,” that they have “reached the bottom of the barrel,” or perhaps they feel like “a case of dynamite about to explode.” In each case, single words really can’t express the depth of emotion. You will also want to be aware of metaphor as an important key to understanding the emotional world of your client. Metaphors are also like mixed feelings—there is more going on than just the surface expression.

Both verbal and nonverbal clients may find it easier to express their emotions via metaphor. Ask your client to imagine the way they feel and then to describe what it is like for them. Some of the most successful therapists and counselor work very effec- tively with metaphor. Metaphors could be described as the poetry of emotional life.

What are some emotional metaphors that occur to you?

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

Nonverbal feelings. Be alert to the client’s smile, the jiggling foot (which may indi- cate restlessness, anger, or boredom), and any form of body movement.

Crossed arms or legs may indicate anger or defensiveness and wiping one’s nose may indicate personal discomfort. Emotions are located in the body and careful observation of body movement will often give you better clues as to what is occurring in clients than the words they say.

Nonverbal feelings, however, are sometimes gender and culturally determined. Note body movements, eye contact breaks, etc., but always with some caution until you understand the meaning of the gesture or movement for the unique per- son from a unique cultural background.

Relating at the emotional level is difficult for many of us, as we have been taught in many cultures to control feelings. Yet, our feelings often obscure and confuse our thought processes. This very important skill of helping requires you to work hard to achieve both sensitivity to others and mastery of the skill.

REFLECTION OF FEELING: BASIC SKILL #5

How can you help others to express the central concerns they are experiencing? One excellent way is to listen for and respond to the feelings of the client. Through reflecting feelings, you can facilitate the client’s movement toward more complete self-acceptance and self-understanding. You would like to communicate to the client that you can accurately sense the world as he or she is feeling and expe- riencing it.

Most central to this skill is being alert to and responding to the feeling being expressed rather than the content. What the client is saying is the content por- tion of the message. You must also listen to how the client gives a message. For example, the client may speak more quickly when communicating enthusiasm, more slowly when communicating discouragement, etc. It is this feeling portion of the communication to which you are asked to give special attention.

In reflecting feelings, the following steps are most essential:

1. The feelings are named. This may be through the actual words used by the cli- ent, through metaphor, or through observation of nonverbal communication.

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

2. Begin sentences with phrases such as “You seem to feel . . . ,” “Sounds like you feel . . . ,” “I sense you’re feeling . . . ,” and add the labeled emotion.

3. The context may be paraphrased for additional clarification: “You seem to feel ______ when ______.” or “You feel ______ because ______.” Here we have a combined paraphrase/reflection of feeling.

4. If you are not sure of the emotion, add a checkout “Is that close?” “Is that the way you feel?” “Is that right?” This gives the client a chance to reflect on, add to, or correct your emotional reading.

Reflections of feelings are most often useful if immediate here and now feelings in the interview are labeled and worked through. Rather than working in the past tense (“You felt ______”), try to reflect present in-the-moment feelings (“Right now, you feel ______”).

Let us expand on reflection of feeling with the acknowledgment of feeling and issues related to gender and culture.

ACKNOWLEDGING FEELINGS: MULTICULTURAL AND GENDER CAUTIONS

Trust is important if your clients are to share their feelings with you. However, even in the most trusting relationship, some clients will have difficulty sharing and exploring their feelings with you.

For example, in most cultures, men are expected to hold back their feelings. You aren’t a “real man” if you allow yourself to feel emotion. While many men can and do express their feelings in the helping interview, some should not be pushed too hard in this area in the first phases of counseling. Later, with trust, exploration of feelings becomes more acceptable.

In general, women in all cultures are more in touch with and more willing to share feelings than men. Nonetheless, this will vary with the cultural group. Some cul- tures (for example, Asian, Native American) at times pride themselves on their ability to control emotions. However, this may also be true with those of English or Irish background.

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African-Americans and other minorities have learned over time that it may not be safe to share oneself openly with White Americans. In cross-cultural counseling situ- ations, trust needs to be built before you can expect in-depth discussion of emotions.

The acknowledgment of feeling, a shortened form of the reflection of feeling, can be helpful with many men and clients who are culturally different from you. Rather than delve deeply into emotion, the counselor simply notes the feelings briefly and moves on without further probing. The only real difference between a reflec- tion of feeling and acknowledgment of feeling is that the acknowledgment occurs briefly in passing form whereas the reflection of feeling often becomes a major focus of the interview. For example,

Sounds like that made you angry. And what happened next?

It hurt you then. What happened just before?

In the examples above, the counselor briefly acknowledges feelings and moves on.

Minorities, women, and gay people may experience discrimination, racism, sex- ism, or heterosexism as part of their daily life experience. If you are a majority person or a male, trust may be more difficult to generate with those different from you. Acknowledging the reality of discrimination and oppression and its personal and group hurt can be an important part of the trust building process. Similarly a minority person working with majority clients may expect some distrust toward them as well. The acknowledgment of feelings of possible distrust may be helpful if used carefully. For example,

Right now, you’re not so sure that you want to share more on this. That’s OK. Perhaps later. Let’s go ahead. You were saying earlier . . .

For a client to share his or her emotional experience with you is an expression of trust. You must earn that trust with each client.

PRACTICE EXERCISES IN REFLECTING FEELINGS

In the examples below, you will have an opportunity to select statements that indi- cate you understand the client’s feelings and internal emotions. Select the state- ment that would most likely evoke a client response of, “That’s right!” Label each response as a question, paraphrase, minimal encourage, or reflection to feeling.

REFLECTION OF FEELINGS: EMOTIONAL REGULATION

Client: So I’m wondering if you can help me find a new major. (pause)

I suppose if I did find one, I’d just mess it up again. I just didn’t do well last term.

Counselor: a. You really want to find another major, but you’re not sure it would work out.

b. You feel very discouraged right now, but you still have some hope for pulling it out.

c. You’d just mess things up again.

d. What majors are you considering?

e. Why do you feel that way?

In this first example, b is the only reflection of feeling. Note that a positive emotion as well as the negative has been reflected. Counselor lead a is a reasonably good paraphrase, but ignores the underlying emotional aspects of the client’s commu- nication. C is a minimal encourager which may lead to more feeling discussion. Counselor lead d is a question and tends to be a topic jump leading the client away from self-exploration into a new area. Finally, e is another question which does partially respond to feeling, but the “why” dimensions tend to put the client on the spot with a very difficult question to answer at this point.

Client: What do you think I ought to do—run away, get a divorce, or just give in and take it? I feel so sad and lost.

Counselor: a. There just doesn’t seem to be any way out!

b. (Noting tears) You feel really sad right now.

c. Are you thinking seriously of running away?

d. (Silence)

e. You’re really concerned and troubled. It’s really getting to you.

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Example 2 has two possible reflections of feeling—b and e. Either could be appro- priate. B is an accurate reflection and shows that the client has been heard.

After hearing full emotional expression, the counselor can later bring in more supportive and helpful data. The temptation in moments like this is to comfort, give sympathy, and provide answers. We believe it is best to allow full emotional expression before moving on. Response a, a paraphrase, might very well be as successful as the reflection of feeling as it seems to catch the essence of the client’s state of being.

C by outward appearances would be an ineffective question, unless the context warrants it. The minimal encourager of silence might be very effective, but of course is not a reflection of feeling. Response e is another reflection and may be useful. It does not seem to go into as much depth as b, but may be more appropri- ate depending on the immediate situation. In reflecting feelings, it often helps to use the major feeling words of the client even though you might add other words as well.

Client: You know, it’s funny, but when I talk to you, I just feel shaky. It’s the silliest thing!

Counselor: a. Are you anxious in many situations?

b. You wonder why you do this.

c. Right now you feel very shaky talking to me; it confuses you to feel that way.

d. Could you share a little more about how you feel toward me right now?

e. You’re laughing as you tell me you feel shaky and scared.

The final example has two reflections of feeling, c and e. C has the advantage of here and now immediacy, e the advantage of pointing out the mixed messages of feelings. Question a may be a good approach if the feelings have already been explored and are known and acknowledged; it does respond to emotion and gives the client room to explore. It would be unwise, however, if this is new information.

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Question d has immediacy and gives the client room to explore emotion, thus underlining the fact that one need not stick exclusively to reflections to help oth- ers express their emotions. Questions, however, still do not fully acknowledge the experience of the client. B impresses us as a poor minimal encourage, but even this response could be good if the counselor’s vocal tone is warm and supportive. Your personhood may be more important than what you say.

The above examples illustrate an important point. No single response is going to be “right” or “wrong.” What you want is to have several alternatives available. We obviously favor, at this point, the reflective listening skills—especially giving spe- cial attention to feelings. At other times you’ll find advice, interpretation, and other skills useful with your clients. It is your ability to have many possibilities in reserve that will enable you to reach many clients.

SORTING OUT COMPLEX MIXED FEELINGS

Very few of us have what we might call “pure” emotions. Our emphasis thus far has focused primarily on identifying and reflecting single emotions.

What are mixed or ambivalent feelings? All of us experience them daily, some of them produce deep conflict and problems difficult to resolve. Here are some common situations that we all face:

An examination is coming up which is very important. Your best friend suggests a movie.

The mixed feelings underlying this decision might include enjoyment of movies, fear of failing the exam, boredom with studying, caring for your friend, etc. Resolution of even a simple decision such as this can be facilitated by exploring the many rich and varied emotional factors.

You face a major conflict with a loved one.

The mixed feelings here may include positive feelings of caring, love, and trust. The negative feelings (hurt, anger, fear) conflict with the positive. Sorting out such mixed feelings is often a basic goal of counseling.

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Often complex feelings are hidden by words such as “confusion,” “torn,” and “ambivalent.” If a client says he or she is confused, it is important to use ques- tions and reflection to discover the more precise feelings underneath the vague term of confusion. Too often counselors and interviewers settle for the feeling of confusion and fail to find the underlying complex emotions.

How does a counselor cope with the wealth of emotion underlying key decisions? The beginning is reflection of identified feelings plus focused questions that help the client explore emotional experience.

Useful skills in facilitating this exploration are:

1. Noting of double messages and mixed feelings. The body might say one thing while the words say something else. For example, “You sound like you are very sure of yourself, but your body seems to be giving a different mes- sage.” This lead, of course, is best reserved for those clients who are aware of body language and its meaning. It does no good to reflect emotions that the client will only deny.

2. Questions, which provide openings for the individual to share more emo- tional experience in words. “What are your feelings?” “What’s going on in your body as you say that?” “How did you feel when that happened?”

3. Reflections of feeling which name the mixed emotions.

4. Checking-out the client’s reaction to your reflection. “Is that close to the way you feel?” “Does that make sense?”

More than one emotion is shown in the following examples. Name the emotions and then write how you might respond to them. Use reflections, questions, and the checkout to help clients explore their underlying emotions.

Client: Things have been going better with my husband’s drinking lately, and I’m feeling more hopeful. But my friends at Alanon (support group for families of alcoholics) worry me. They say it’s only a phase.

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What feelings do you note? How would you respond?

Client: (Having just gone through the breakup of a long-term relationship.) It’s been such a struggle to become independent, and I’ve waited so long. I guess I didn’t anticipate the feeling of loneliness that it was going to bring.

What feelings do you note? How would you respond?

Client: I really feel confused. One side of me says, hey, let’s move to that new job. It’s exciting and challenging. The other side of me feels afraid. And I end up just feeling torn and confused, I’m not sure what I want.

What feelings do you note? How would you respond?

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TRANSCRIPT OF REFLECTION OF FEELING

Making decisions is not always a rational process. The emotions and feelings underlying the decision often determine what the person decides. In the following brief example you will find that the rational facts of an important job decision are less impactful on the final decisions than the underlying emotions.

The following transcript is particularly effective in its use of reflection of feeling. As you classify the helping leads, you will discover extensive use of the skill. In addi- tion, note the way that questions are often focused on exploration of feelings and you will even find some minimal encourages which focus on feelings. In cases where reflections and paraphrases are combined, note them both in classifica- tions. Classify leads as O?, C?, E, P, R, and RF. Note the checkout with a CO. (See the end of this chapter for classification of listening skills.)

_____ 1. Counselor: Could you tell me about your new job opportunity Bill?

2. Client: Well, it’s really an exciting one. It’s in another state and the colleagues are absolutely fantastic, the salary is a lot better than I have now. And I certainly could use the money.

_____ 3. Counselor: You sound really excited about it.

4. Client: I really am. It’s really just like I feel the opportunity of a lifetime. Really the opportunity of a lifetime. But . . . ? Even as I talk I sort of say, wow, I’m not quite sure what that would mean. A long way from here and the kids are here and in college and I’d like to be with them and that’s a long way away.

_____ 5. Counselor: Bill, you sound sort of hesitant—anxious about it? (The questioning tone of voice serves as a checkout. Here the counselor has given the emotional word to the client.)

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6. Client: Exactly, and I really do get anxious because the oppor- tunity is fantastic and yet, there are a lot of things hold- ing me here too. For example, you know, I mentioned the kids, I’ve made a lot of friends. I like the people I work with, I don’t have any real strong . . . nothing really push- ing me away, it’s more an exciting new challenge. And yet, the thought of leaving where I am, it does make me feel very anxious.

The next counselor lead summarizes what has been said so far. You are asked to classify the three parts of the summary. The summary will be discussed in the next chapter.

_____ 7. Counselor: As I hear you saying, you’ve talked about the excitement about moving, a new challenge, the people you’ll be work- ing with and that sounds very exciting.

_____ And on the other hand, you’ve got some nice things going here. You’ve got colleagues that you’ve worked through lots of relationships with, and you understand them. Finally, you’ve got your kids here.

_____ And so there’s kind of confusion between the two, and you know, what looks better. The excitement out there or your feelings for your family and your comfort here. Am I hearing you accurately? (The mixed feelings around the decision are confronted.)

8. Client: You sure are. What I’m sure of here is that I do like to go to work; I find the people I work with compatible, I find them interesting, I like the students. I certainly love New England, and that’s certainly a major plus. It’s fall now and it really feels pretty good, really nice. At the same time New England has certain problems. The economy is ghastly. I get very frustrated and angry with the fact that there’s never enough time and money to do what I want to do.

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_____ 9. Counselor: Frustrated and angry about . . . ?

10. Client: Well, for example, frustrated and angry in terms of, like, I find myself trying to do a good job, but worrying that the job may not exist in a year or so. The economy just doesn’t seem very promising.

____ 11. Counselor: So you’re wondering if this move . . . if now’s the time to make the move?

____ What has been your experience with moving in the past? And how have you felt when you moved?

12. Client: Well, that’s helpful. When I first . . . the first major move I made was from Pennsylvania to Colorado, and that was an absolute up. I just felt that any time I could move, I could leave all the mistakes behind me, and you know me, I had plenty of mistakes! As I got to Colorado . . . and I just fit in, wonderful time, loved it professionally. It just was really a real high professionally at least.

____13. Counselor: So that first move was excellent, and it was exciting, wonderful.

14. Client: Really exciting. It was really good.

____ 15. Counselor: And then what happened?

16. Client: And then I moved to New England and when we arrived here, nobody basically spoke to us for the first six months. New England’s a great place, but it takes a long time to become accepted.

____ 17. Counselor: So you felt a little lonely when you first got here?

18. Client: Yes! It was absolute agony. And I mean literally even now at this moment, it almost brings tears to my eyes about leaving those people I cared so much about in Colorado. And now . . . and it took me, I’d say four years before I felt comfortable here.

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____ 19. Counselor: So it took you a long time to settle in here and you’re maybe thinking that it might take a long time to settle in a distant new state. You seem to feel anxious about this. Is that close to what you think and feel? (Note that while emotions are central in this example, the facts of the situ- ation remain important.)

20. Client: I don’t only think, I know, and the thought of leaving my kids here is not good, because they wouldn’t be coming to visit as often.

____ 21. Counselor: How would that make you feel Bill?

22. Client: It’s terrifying, because maybe I wouldn’t be that much ahead financially. And just that whole pain of separation and then starting again with new people would be really overwhelming.

____ 23. Counselor: So you’re wondering if the pain is worth all the excitement of the new job, that even though there’ll be an exciting new job and a new challenge, with all the pain, would it be worth it? You know, in terms of the pain. The trade-off. (This also is a summary as it integrates much of what has been said so far.)

24. Client: And at this moment, as I start balancing, maybe it isn’t worth it.

This transcript is presented as it illustrated clearly the importance of underlying emotions. You will find that often your clients come to you with little awareness of how important emotional experience is in their decision making and total life process. Focusing on and reflecting feelings can be an invaluable part of the counseling and therapy process. Reflecting feelings can be helping at its best.

REFLECTION OF FEELINGS IN GROUP AND FAMILY INTERVIEWS

Family problems often rest on a sometimes explosive foundation of emotion. The problem with the family may be presented rationally and clearly and yet you

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can sense the strong feelings underneath. The same applies to group sessions. Individuals present issues, then you find what they are really feeling as the group progresses.

Not only do members of families and members of groups have feelings, but there is also a joint “feeling tone” which is not the feelings of any one member, but speaks to the whole group. For example, you may work with a group who does not know each other well. The various members may be expressing themselves clearly, but underlying disagreements or emotions may be buried. Your task as a group leader or family counselor is to help the members examine deeper emo- tional issues in a safe fashion.

In group and family work you will want to acknowledge and reflect individual feel- ing. In addition, you may also want to focus your reflections on the total group or family itself through questions oriented to emotion, minimal encourages, and reflection of feeling.

This family/group seems to have something unsaid right now? What do you think it is?

There seems to be tension in the air for all of us right now. What is the group/family feeling?

This group/family has been sitting here for awhile. What emotions and feelings seem to represent this group/family?

What was the impact of what was just said on the group/family?

The group/family seems (sad, glad, relieved, angry, etc.) right now.

Note that the skill remains the same, but the focus turns to the total group or fam- ily. As in all other listening skills discussed in this book, reflection and exploration of feelings that focus on the group as a whole can be especially valuable.

PRACTICING REFLECTION OF FEELING

1. Develop a working group.

2. Assign roles as counselor, client, operator/observer, and second observer.

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3. Determine topic for role-play. The genogram again will be most useful here. It is suggested that the client talk about a time which involved some type of separation from loved ones. Important separations in life include leaving home for work or education, one’s own breakup of a relationship or the divorce of one’s parents, the death of a loved one, children growing up and leaving home. There are many important separations we face over the life cycle. These separations often form an important part of the issues that you will face in helping relationships.

A note to the client—you must be emotionally expressive or it will be very difficult for your counselor to reflect feelings.

4. Give special attention to complex, mixed emotions. If you hear vague feel- ings such as “confused,” “torn,” or other ambivalent messages, use ques- tions to help sort out the deeper feelings underneath. You will find yourself naturally including reflection of feeling with the paraphrase.

5. Watch time carefully and provide feedback.

6. Rotate roles.

GROUP/FAMILY PRACTICE IN REFLECTION OF FEELING

It is suggested that family counseling be tried for this practice session.

1. Develop a working group.

a. Three members become the family.

b. Counselor

c. Observer/recorder

2. Determine topic for role-play. Family problems often arise during key times of separation during the life cycle. The couple may be divorcing, moving to a new location, a child may be leaving home for college, a grandparent may be moving in, one of the parents may have lost a job, or any one in the family may be seriously ill.

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3. Planning. The counselor’s task is to draw out the family separation issue, but pay special attention to individual feelings. Ideally, the counselor will want to know the interpretations and feelings around the separation situa- tion as seen by each member of the family. The task is to draw out data and feelings, not to problem-solve at this time.

The counselor should look for a general family feeling tone. How is this family functioning, as a whole unit, at an emotional level?

4. During planning time, the role-played family can generate a tentative “script” concerning their separation issue. The observer can study the observer form and prepare any recording equipment.

5. Watch time carefully and provide feedback. The role-play should last approximately 10–15 minutes. Allow 15–20 minutes for feedback.

6. Rotate roles as time permits.

RATING AND BEHAVIORAL COUNT SHEET FOR REFLECTION OF FEELING

1. During the practice session, list the emotions you observe in the client or family/group—both verbal and nonverbal.

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2. List each reflection of feeling used by the counselor. Use exact words as closely as possible. How well do they match the feelings listed in #1 above?

3. List observations of nonverbal behavior.

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4. Cite one strength of the interview and one specific area on which the counselor might want to improve. Be as direct and clear as possible.

5. If a second observer is available, record each counselor statement. In this way the content of the session can be readily reconstructed.

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A DO-USE-TEACH CONTRACT

Do: I did use reflection of feelings during the practice sessions (when, where, and with what effect?):

Use: You will find it interesting and helpful to practice acknowledging feelings in your daily life—at restaurants with a busy waitperson, with clerks in the store, with busy coworkers on the job, even with family members. There are many emotions you encounter constantly.

I plan to use this new skill outside this session in the following manner:

Teach: At this point in the book, you may want to think about how you could help train peer counselors or family members in listening skills. Naming and reflecting feelings is an important part of any such training.

My plans to teach this important skill to someone else are as follows:

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Classification of Listening Skills

1. O? 9. E 17. RF

3. RF 11. P, O? 19. P, RF, CO

5. RF 13. RF 21. O?

7. RF, P, RF-CO 15. O? 23. P, RF

To summarize, put the client’s thoughts, feelings, and behaviors

together accurately.

Not only will the client feel heard, but also you will understand what the client has been

saying more fully.

CHAPTER 6

SUMMARIZATION: INTEGRATING CLIENT BEHAVIOR, THOUGHTS, AND FEELINGS

Summarization is a rather straightforward skill. Doing it well, however, is another matter. This skill is similar to the paraphrase and reflection of feeling, but requires deeper concentration on client statements over time. It also requires you to syn- thesize a number of client statements into a more integrated whole.

You will find that summarization is a particularly valuable skill, both to you and to the client for it helps us understand what is actually being said more com- pletely and fully. For example, many clients “talk around” their problems, but through careful listening you gradually begin to understand what is really going on. Through summarizing the “bits and pieces” of what a client has said, both you and the client gain important understandings of complex issues, concerns, and client problems.

The exercises and readings in this chapter will help you to:

1. Understand how the skill of summarization helps organize interviews and client thinking about problems.

2. Define the skill of summarization.

3. Demonstrate the summarization skill in a practice interview, and consider its implications for family and group interviews.

4. Use summarization in your daily practice of interviewing, and consider how you might teach this important integrative skill to others.

SUMMARIZATION AND ITS IMPORTANCE IN ORGANIZING INTERVIEWS

The clients who come to you are often confused. They may have so many things going on in their lives that they don’t know which way to turn. They may experi- ence mixed emotions. Important facts regarding decisions may be overlooked. At

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other times, you may work with clients who seem very organized, but actually are rigid and missing important parts of their own daily life.

One of the major tasks you face as a counselor, or therapist is to help clients organize themselves, clarify thinking and feelings, and in the process learn how to look at themselves more clearly. When we use summarization, we recapitulate, condense, and organize the essence of what clients have said.

The skill of summarization involves listening to a client over a period of time (from three minutes to a complete session or more), picking out relationships among key issues, and restating them back accurately to the client.

By using summarizations periodically, we can check out our perceptions with clients to see how accurate our listening has been. Also, this skill aids clients in seeing their own personal distortions. By accurately condensing what has been said, we offer clients a chance to examine their own thinking.

You may want to brainstorm or list some examples where you have felt disorganized. This could be in your own personal life or even in your own past work as an interviewer.

INTERVIEWING AND COUNSELING CHANGE THE BRAIN

Let us repeat: Piaget told us, “No cognition without emotion, no emotion without cognition.” You can think of paraphrasing as focused on cognition and thoughts, while reflection of feeling focuses on our emotional side. An effective summariza- tion brings thoughts and feelings, beliefs and emotions together in an integrated framework.

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Each time you meet with a client in a supportive empathic relationship that is effec- tive and meaningful to the client—you are literally impacting the brain through the development of new neural networks. And, as you learn about the client, you too are generating new networks in your brain.

Meaningful empathic summarizations are particularly effective in promoting exec- utive functioning in the prefrontal cortex? Why is this so? If confusion reigns in the mind of our client, executive function is not operating well, and decisions are obviously going to be less effective. Furthermore, we know that emotions under- lie decisions and our cognitions and thoughts. Our feelings confuse issues even more. Thus, if use the basic listening skills, particularly the summary, we are help- ing the client organized their thoughts and their feelings more clearly.

Summarization leads to clarity of thoughts and feelings, cognitions and emotions, key emotional regulation and a better process of decision making. The integration provided by a summary can enable a client to make decisions about the present and future, without you giving any advice at all.

Needless to say, many clients will need what we call the influencing skills described in our follow-up text and video demonstrations, Basic Influencing Skills. Nonetheless, if you listen, research says that we are 30% of the way toward a solid relationship. We suspect that really effective listening and caring will enable many clients to resolve issues on their own.

SUMMARIZATION: BASIC SKILL #6

Summarization is not often identified as a skill used in counseling. We are prone to think of attending behavior, reflection of feelings, the use of questions, and par- aphrasing as the essential dimensions of listening skills. Yet, it is summarization that brings together information gained via these other skills and helps the client “pull it all together.”

The key purpose of summarization is to help another individual integrate behav- ior, thoughts, and feelings. A secondary purpose is to check on whether or not you as counselor have fallen into distortion. When a summarization is accurate and without distortion, it can help move the interview from exploration to action

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and problem solving. A good summarization provides a crucial lever, indicating to the client that you have heard the entire story thus far.

Summarizations are similar to paraphrases and reflections of feeling. A summa- rization of feeling is close to a reflection of feeling with one major exception: a summarization of feeling covers a longer time period and involves a broad range of feelings that the client has expressed. A summarization of content is similar to a paraphrase, but differs in the same respect. The time period covered by a sum- mary is longer. A paraphrase deals with the client’s last few sentences or a short paragraph. A summary puts together a number of client paragraphs, an entire session, or perhaps even issues expressed over a series of several interviews.

Usually, we do not distinguish between a summarization of feeling and a summa- rization of content. This is because you usually want to integrate both emotions and content in your interviewing practice. The distinction between summarization of content and summarization of feeling remains useful, however, as it reminds us that we need to think of both dimensions when we help clients integrate their thinking.

Examples of Summarization

The following summarizations cover both emotional and objective content:

To a client who is struggling with a difficult employer and has been told of a possible layoff.

As I understand what you have been saying over the past hour, there seem to be three key things: 1) you’re very angry and hurt at what’s being done to you; 2) nonetheless, you feel that you need and want to look at what you can do to improve your job performance; and 3) as we’ve talked, it sounds like you would like to meet again next week to work on that. Have I heard you accurately?

To a parent troubled by a son taking drugs (third session of a continuing series):

You now seem to be feeling very aware that your control of your son, making him “toe the line” on every issue, may have been overly harsh

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and one of the reasons he joined the drug scene. This contrasts with your feelings of anger the first time we met when you said that the school was at fault. You also seem to be saying that you “gave up” on him too soon and now want to take a new, more balanced approach. Is that right? Have I missed anything?

In each of the examples above, the counselor gives back to the client the essence of what has been said while exploring both cognitive and emotional dimensions of the problem. Before moving on, note that the checkout is especially important so that you can see if you have heard accurately and not distorted the message.

Specific behaviors and things to think about as you summarize:

1. Use questions, encourages, restatements, paraphrases, and reflections of feeling, to indicate to the client that you are attending and with her/him.

2. Note important behaviors, thoughts, and feelings throughout the interview. Look for repeating patterns. Also, search for inconsistencies in feelings or facts. Most people have mixed feelings toward important people or situa- tions and reflecting to the client these mixed feelings may be especially valuable.

At other times, you will find your client telling you two different stories in the same session. Summarization helps you and the client clarify what has happened.

3. When the client is making a decision, give special attention to central threads of information throughout the session. Note the main issues so you can give them back later.

4. At several points during the session, time your comments appropriately and summarize for the client what you have heard so far.

5. Include frequent checkouts to ensure accuracy of hearing.

The summarization skill may be helpful to:

1. Begin an interview (“You said you wanted to see me about ______.” “In our last session we talked about ______.”).

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2. Clarify what is happening, particularly when the interview is particularly com- plex (“Could we stop for a moment and see where we are to this point?”).

3. Provide smooth flow from topic to topic during the interview (“So far you’ve been saying ______. Now what’s on your mind?”).

4. Bring together what has been happening in the interview over the entire period of an interview (“Today, we talked about ______”).

5. Bring together threads of data over several interviews (“Last week you said ______ and today you say ______”).

TRANSCRIPT OF SUMMARIZATION IN ACTION

You will now examine an interview that demonstrates summarization. Ordinarily, one does not summarize as frequently as illustrated in this example, but when you have a highly verbal client, you will find it helps both you and the client to summarize frequently. Otherwise you may become confused by the client’s com- plex message. You will also find that good summaries help stop the client from saying the same thing over and over again.

The following interview is from the second session. You will find that the counselor is very active, but is constantly bringing data together in summaries as she chal- lenges the client to respect what she, the client, really wants.

Again, classify the counselor’s leads with O?, C?, E, P, R, RF, and S. Give special attention to the checkout (CO). In the counselor’s leads below, give special atten- tion to distinguishing between a combined reflection of feeling/paraphrase and the summarization. Recall that the summarization covers several statements and longer period of time. (See the end of this chapter for skill classifications.)

1. Counselor: Jaylene, the last time we were talking, I recall you talked about being a single parent and that requires organizing your time. You also are proud of your recent masters in business, although it was quite a struggle to do that while you worked as a teacher. (Classify #1 and 3 together. They represent a single skill.)

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2. Client: (Interrupts) Oh, yes, for sure.

_____ 3. Counselor: And you have an enormous responsibility in raising chil- dren between that and your career, there is not much time for a personal life. And you’re saying, how do I get all that together? Given that, what would you like to focus on today?

4. Client: I guess I would like to talk about my career. I’ve been feel- ing like I haven’t been going any place; like I’m at a stand- still. You know I went on in the midst of a separation and divorce and did get a masters degree in business and I’d like to move to that area. As a teacher, I’ve done some con- sulting and some workshops and I seem to be able to do it right within the school system, you know, I don’t venture out too far. I’ve been reasonably successful, but I just can’t seem to make that break from moving from teaching into something else, into consulting, or perhaps into business. I’m trained to work in the area, but somehow I’m kind of afraid to move.

_____ 5. Counselor: So on one hand here, you are feeling good that you’ve accomplished all this, getting your degree and you ought to be moving forward and doing something different; and on the other hand, it’s fairly comfortable sitting where you are with the present job you’ve got. Have I got that straight?

6. Client: Yes, it’s very comfortable. I like the people I’m working with and the schedule; it matches my children’s schedule. I have the same holidays they do, and the same summer vacations and when you’re a single parent, that’s impor- tant. I can be with them and help them with their activities and homework and all those kinds of things. I’m kind of afraid though if I move away from education and go into business, I would be much busier. You know, it would be eight to five and weekends perhaps and two weeks vaca- tion. That’s a big change for me, from teaching.

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_____ 7. Counselor: Well, are you saying that if you leave the school system, the responsibility of taking care of your children is such that you can’t take on the responsibility of a new job? And that it’s probably going to be more demanding. (Note, the ques- tion mark after “job?” does not indicate a question. Rather, counselors often raise the tone of their voice at the end of a paraphrase, reflection of feeling, or summarization with an implied question. This questioning tone functions much like a check-out, but is not classified. Do not confuse questions with a questioning tone of voice.)

8. Client: Well, I’m kind of worried about whether or not I can handle all that responsibility. I can barely hold it together as it is now. But money is tied in there too, because as you know, education is not the place to be these days. I mean you don’t make a lot of money when you’re working in school systems and I would be able to make more money if I moved out and did some things in business. But, you know, it’s like . . . you know, the trade-offs are there all the time. I just don’t know if I can make it in a new field.

_____ 9. Counselor: So, in other words, there are the successes that you’ve had in your career, the success that you’ve had in bringing up your children, suddenly the . . . really the heavy money burden is getting more so with the economy where it is now. And now you’re faced at a point where you want or have to make a change.

_____ And what’s going to happen to you and your family if you make that change?

10. Client: Yes . . . Well I think it might be an upheaval for my kids and for myself . . . it will be a whole change in our lifestyle and things have been going fairly smoothly, and fairly success- fully, and you know, I’m afraid to rock the boat. Yet, on the other hand, I’d like to try some new things.

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____ 11. Counselor: Let me throw something out to you. If you were a man, and faced with this dilemma, what do you think would happen?

12. Client: Well, I think men are trained to move up the hierarchy just a little bit easier. I mean, they just take those risks and they move up, and I think women, you know, aren’t trained that way. We’re looked to be successful if we raise our kids and the kids turn out pretty well and if we hold a reasonably com- petent job, then we look pretty successful. And I don’t know.

____ 13. Counselor: I hear you talking about women, but are you describing yourself? (The client has talked in general terms about women. The counselor asks her to focus on herself.)

14. Client: Yes, I think right now I look pretty successful in the eyes of a lot of other women and a lot of my friends. And I’m not sure I’d find that same success out in the business world.

____ 15. Counselor: So there is something in the fear of a failure at this point? (Again, the questioning tone of voice.)

16. Client: Right, a fear of failure, and not being so successful.

____ 17. Counselor: Jaylene, let’s go back to what does success mean to you?

18. Client: Well, I think it is important that my kids turn out well and that is very important. I’m very proud of their accomplishments so far. I think it’s important to be personally satisfied, perhaps satisfied in a career. It’s important to be financially independ- ent or responsible enough that I can manage things without too much difficulty, and of course that’s a big thing right now. I also would like to, you know, just push myself a little more. Push myself to those limits and see what those limits are. That sort of gets in the way of all these other things.

____19. Counselor: Let me summarize again. One, it’s important for you to be a good parent, the other, it’s important for you to have a career, the other, it’s important . . . the economics is impor- tant. But there’s another thing that I heard, that maybe you’d like to push yourself. You know, maybe take a chance. And

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maybe you think that . . . or maybe it would be helpful for us, for you to focus on maybe yourself, personally, and not that the others aren’t important, but why don’t we focus on you, Jaylene, and where you’re going to go?

20. Client: What I’m going to do with my life, you mean?

____ 21. Counselor: Several times, Jaylene, I’ve asked what you want. You seem to focus on other’s needs and seem to find it very hard to speak about what you want. One of the things that I’m picking up is that you’re not willing or anxious to look at what you really want even though we are talking about it right now. You really don’t feel it’s time to think of just Jaylene. Am I hearing you correctly?

22. Client: I’m afraid you’re right. I guess I don’t.

____ 23. Counselor: You’re afraid I’m right.

24. Client: You know it’s hard for me to get an image of what I would be beyond what I’m doing now. Well, maybe, you know, having a job with more responsibility, being in contact with more adults, maybe doing something new. It’s real hard for me to get a handle on that. I don’t know. I don’t see any models out there of what I want to be like. I’ve seen a lot of models of what I’m like right now, but I don’t see the other.

It’s very hard to imagine it.

____ 25. Counselor: It’s hard to imagine. So far, I’m hearing very much that you’d like to move on and use your masters degree? I hear that you feel good about what you’ve done professionally and personally. And I hear you struggling now with the desire to move toward some action. Am I hearing you right?

26. Client: Exactly, I think I need to talk more precisely about getting out and looking for a new job. It sounds like I’m spinning my wheels again and again. My kids are getting older and perhaps we could manage the change.

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You will often work with clients who present diffuse, confused thinking on complex topics. They need help in organizing the major issues and clarifying their thinking. The example above is fairly representative of verbal clients who are trying to take many factors into account in making a major decision. You will also work with less verbal clients who have even more complex decisions to make. Here again, the ability to summarize and bring data together is a most important skill.

SUMMARIZATION WITH FAMILIES AND GROUPS

In some ways, the summarization skill is even more important in group and family counseling. Not only do you need to summarize what occurs with each individ- ual, you also need to be able to summarize the many complex interactions of the family or group. Some might argue that the summarization skill is second in importance only to questioning skills when you work with groups. Certainly, sum- marization is a skill that can help groups and families build better understanding and more harmonious relationships.

The following are some specific types of summarizations that can be useful in group and family interviewing.

1. Beginning or ending a session. It is especially helpful to a group if the coun- selor summarizes where they were in the last session or what happened during a session. This provides you with an opportunity to include everyone, make observations on group interaction, and highlight important issues.

2. Summarizing sequences of conversation or behavior. Often you will see a family or group in which certain people speak first and then others either agree or disagree in a continuing sequence. It helps a group to look at itself when you point out, for example, “Father just reprimanded Jennifer. Jordan then moved closer to his Dad. Mother comforted Jennifer. I’ve seen this pattern several times today. What do you make of it?”

3. Summarizing diverse points of view or issues of conflict. You can be on the spot in family counseling or in group sessions. If you summarize what each person has said, you have shown ability to hear everyone equally. This sup- ports each group member, gives you some neutrality in complex situations, and helps the group look at its own process.

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4. Summarizing group process. A major distinction between individual and group/family work is a focus on what is happening among members. Almost any type of summarization in which the words “family” or “group” are used (instead of individual observations) represents this type of summarization. For example,

This group has a pattern of starting slowly.

This seems to be a family that is very careful of protecting its members.

This group seems to enjoy conflict.

This family appears to need conflict to hold it together.

Each of these summary statements needs to be amplified by examples, but at times, the one line summary above will produce considerable action and reaction in the family or group.

PRACTICING SUMMARIZATION

1. Develop a working group.

2. Assign roles as counselor, client, operator/observer, and second observer.

3. Determine topic for role-play. A very useful topic is your own career future and the decisions you need to make around it. Almost any decision you have to make which involves multiple dimensions, however, is appropriate.

4. Task of the interviewer. Begin the interview with an open question, use some paraphrases and other skills to bring out data, and then summarize what the role-played client says periodically, making sure to end the prac- tice interview with a checkout.

5. Watch time carefully and provide feedback.

6. Rotate roles.

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GROUP/FAMILY PRACTICE IN SUMMARIZATION

It is suggested that couple counseling be tried for this practice session. A family or group session could be attempted, but will involve a fairly long time for adequate problem development.

1. Develop a working group.

a. Two members become the couple

b. Counselor

c. Observer/recorder

2. Determine topic for role-play. Any type of couple conflict is appropriate for this practice session. The practice session will likely be more effective if the couple has a difference of opinion about an important decision—moving to a new job, having a child, making an important purchase, deciding where to spend vacation or how to spend money. Many couple problems occur in the process of making decisions.

3. Planning. The counselor’s task is to draw out the couple’s conflict with as much information as possible. Ideally, the counselor will want to know the facts of the situation as seen by each member of the couple, the feelings each has, and any reasons the couple can generate to explain the situa- tion. The task is to draw out data and information, not to problem-solve.

Particularly important for the counselor is to summarize the conflicting points of view accurately so that each member of the couple feels heard. In addition, the counselor should attempt to summarize the interaction of the couple and patterns that may be observed.

During planning time, the role-played couple can generate a tentative “script” concerning their “difficulties.” The observer can study the observer form and prepare any recording equipment.

4. Watch time carefully and provide feedback. The role-play should last approximately 10–15 minutes. Allow 15–20 minutes for feedback.

5. Rotate roles as time permits.

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CLASSIFYING AND RATING SKILLS FOR QUALITY

As you view video or listen to your own audio, practice classifying the leads of the counselor as O?, C?, E, P, RF, and S. Use “Other” for skills that are other than those which you have practiced. To facilitate interview recall, write the main words of each counselor response.

In addition, rate individual responses and the total interview on the following scale indicating your quality rating of the statement.

5 extremely helpful Use of skills greatly adds to and enriches communication

4 very helpful Use of skills adds to and enriches communication

3 helpful Use of skills adds slightly to communication

2 less helpful Use of skills detracts from communication (frequent daily interpersonal interaction)

1 destructive Use of skills disrupts and significantly hinders communication

Skill—Quality KEY WORDS OF COUNSELOR STATEMENTS

____ ____ 1. ___________________________________________________

____ ____ 2. ___________________________________________________

____ ____ 3. ___________________________________________________

____ ____ 4. ___________________________________________________

____ ____ 5. ___________________________________________________

____ ____ 6. ___________________________________________________

____ ____ 7. ___________________________________________________

____ ____ 8. ___________________________________________________

____ ____ 9. ___________________________________________________

____ ____ 10. ___________________________________________________

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____ ____ 11. ___________________________________________________

____ ____ 12. ___________________________________________________

____ ____ 13. ___________________________________________________

A DO-USE-TEACH CONTRACT

Do: I did use summarization during the practice sessions (when, where, and with what effect?):

Use: You will find it helpful to practice summarization when you help others make important decisions. It may be helpful to make lists of pos- itives and negatives of important decisions and use these written data as part of your summaries.

I plan to use this new skill outside this session in the following manner:

Teach: You may want to think about how you could help train peer counselors or family members in listening skills and how the skill of summarization fits into your plans.

My plans to teach this important skill to someone else are as follows:

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Skill Classifications

3. S 11. O? 19. S

5. P and CO 13. P/O? 21. S—CO

7. P 15. P 23. E

9. S—O? 17. O? 25. S—CO

A leader is best when people barely know that he [or she] exists,

Of a good leader who talks little,

When the work is done,

The aim is fulfilled

They will say, “We did this ourselves.”

Lao Tse

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CHAPTER 7

INTEGRATION OF SKILLS: STRUCTURING AN EFFECTIVE 5-STAGE INTERVIEW

How do you put all the skills of this book together in a well-structured 5-stage inter- view? This chapter provides specifics for organizing interviews that you can use both in sessions and in many interpersonal situations. This chapter also shows how to integrate the community genogram into a full results-oriented interview.

It is possible to conduct a complete and successful session using only listening skills. The basic listening sequence (BLS) is considered necessary for effective interviewing. And, you will find that listening skills themselves are sufficient for meaningful change. The information in this book will often be enough to enable clients to solve problems and to change their behavior, thoughts, and feelings.

Why are the listening skills so important? We believe the first task of the counse- lor is to listen to the client’s story and understand her or his point of view, feelings, and concepts. If you listen carefully to others, you can help them understand their issues and challenges and thus discover new opportunities for action.

However, the basic listening skills are not always sufficient for change to occur. Thus, for many clients, it may be time to move on to skills of interpersonal influ- ence. A companion book Basic Influencing Skills, with supporting video, dis- cusses skills such as interpretation, self-disclosure, and feedback. Yet, even as you move to more action in the interview, the basic skills of attending and effective listening remain central throughout, or the relationship may be lost.

The exercises and readings in this chapter will help you to:

1. Understand some challenges and opportunities in the single skills approach to learning utilized in this book.

2. Review the skills of this book as they are integrated in the basic listening sequence.

3. Define the structure of an effective interview.

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4. Demonstrate that you can integrate the several listening skills in a full prac- tice interview. You will also be encouraged to apply this framework in group and family sessions.

5. Understand how the community genogram can be integrated to enrich a session and provide strengths that will better enable clients to take charge of their own lives in a resilient fashion. “We solve our problems best with our strengths.”

6. Use the five-stage structure of the interview in your daily life and in your own helping practice. Finally, we hope that you will consider teaching this structure to others as a way to improve their communication skills.

THE MILLIPEDE EFFECT

A millipede was walking happily along on a sunny day on its thousand legs. A fly flew by overhead and commented—“You certainly are clever, millipede. How on earth do you coordinate all those legs?”

The millipede responded, “Fly, I never thought of it before. I guess I just do it,” and the fly buzzed off.

The millipede started to think, “The fly raises a good question. Now, do I alternate each leg down the line? Or do my left legs all go together and then the right? Just what do I do?”

The millipede collapsed and fell in the ditch. In the middle of all this thinking, the millipede’s natural coordinated movement was disturbed.

Moral: If you think too much about what you are doing, you may fall apart.

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The single microskills approach of this book has asked you to examine something you’ve done all your life without thinking about it. We natu- rally learn how to communicate and you may have found a temporary decrease in your skills when you focused on specific dimensions. That is a natural part of learning.

Perhaps you took piano lessons or ballet. There you must work on sin- gle skills. You learn the importance of pulling out scales or specific body movements and practicing them to perfection.

The same principles apply in tennis, basketball, golf, skiing, and other sports. The person with natural ability can improve at music, ballet, or sports if he or she is willing to take time out to practice single dimensions and truly master them.

But, when single skills are first practiced, there is a temporary decrease in performance and natural flow. Ultimately, natural abilities are improved by practice of important basic skills and the skills become integrated in the person.

And, this is so with Basic Attending Skills. When you think about and practice the skills for the first few times, expect some decrease in per- formance. But, if you continue your efforts with the skills, you will find a new level of expertise, often far beyond your original level. The skills will become integrated into your own natural style.

An important maxim for you to recall:

Skill practice may result in a temporary decrease in communication. However, if you work on the skills and learn them to near-perfection, they will become a natural part of you and you may find yourself a greatly improved communicator.

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THE BASIC LISTENING SEQUENCE: BASIC SKILL #7

You have practiced six specific skills with clients. All are based on a foundation of culturally appropriate attending behavior (eye contact, body language, vocal qualities, and verbal following). The next skills are classified by their verbal struc- ture: questions, minimal encourage, paraphrase, reflection of feeling, and sum- marizations. In addition to these skills, the checkout has been stressed as an important addition to your listening skills to help clients respond more fully.

The basic listening sequence (BLS) is a way to integrate all the skills of this book in one useful package. The BLS was discovered while observing a manager at a computer company. An employee came up to the manager with a problem on the production line. The manager engaged in good attending behavior and responded to the employee as follows:

“Could you tell me about the problem on the production line?” (open question)

“You say that the supply department hasn’t given you enough computer chips to keep your group moving smoothly.” (paraphrase)

“Uh-huh, tell me more about the defect.” (encourages were used to facilitate exploration on some key words used by the employee)

“Sounds like the situation really makes you angry.” (reflection of feeling)

The manager then summarized the employee’s view of the problem and only then did the manager start to look toward problem solving. Notice that questions bring out the basic dimensions of the problem while the minimal encourage and paraphrase clarify what is occurring. Acknowledging or reflecting feeling brings out the emotional dimensions. Finally, the summary brings it all together so that the total situation can be reviewed accurately.

As you can see, the BLS is also an excellent way to summarize and integrate the concepts of this book. Not only are the concepts useful in management, but they are equally vital in the helping process. Counseling and psychotherapy are founded on the basic listening sequence.

The BLS also reminds us that we need to draw out the facts of the situation or problem and how the client feels about those facts. We can get this information

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through encouraging, questioning, paraphrasing and reflection of feeling. We also need to note how the client organizes these facts and feelings. It is here that the summarization is so helpful to both you and the client.

It may be helpful for you to think about the BLS and the specific listening goals of drawing out the facts, feelings, and organization of your client’s concerns and issues. Interestingly, many times the sequence of questioning, encourage, para- phrasing, reflection of feeling, and summarization can be followed in systematic order. It is not recommended, however, that you follow the BLS order all the time, but knowledge of the BLS and the importance of facts, feelings, and organization should help you in a multitude of helping, counseling, and therapeutic situations.

THE FIVE-STAGE INTERVIEW STRUCTURE: BASIC SKILL #8

Interviews can be structured in many ways, but one effective framework consists of five stages. If you learn this one model, you can adapt it with many clients with widely varying issues and concerns. You will also find it useful in situations where you work with a person who is culturally different from you, but again it will have to be adapted to the unique person before you.

In outline form the structure appears as follows. Note that the basic listening sequence (BLS) is used again and again in this framework. As you examine the five-stage structure of the interview, keep in mind that it should serve as a check- list, a framework that you can shape to meet the needs of each individual.

Definition of Stage Goals in This Stage Skills and Multicultural Issues at Stage

1. Rapport and structuring. “Hello. Let me tell you

what we will do in this session.”

Develop a working relation- ship with your client. Share with your client how the ses- sion will be structured and its general purpose. Some personal sharing about yourself may be needed with some clients culturally different from you or who may be hesitant to speak.

Culturally and individu- ally appropriate attending behavior is the most impor- tant skill at this stage. You will want to generate an atmos- phere of trust. With some clients that may take much longer than with others. Give the client the chance to ask you questions.

(continued)

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Definition of Stage Goals in This Stage Skills and Multicultural Issues at Stage

2. Listening to Story, Gathering information, defining the problem, and identifying assets.

“How can I help?” “What are some of your strengths?”

Obtain a clear summary of the client’s story and issues. You will want to know the critical facts, feelings, and organization of the prob- lem. Also, focus on positive strengths of the client.

The BLS will be especially helpful in discovering rele- vant data. Once the client’s issues are fully understood, you are halfway there. With some clients, goal setting (Stage 3) may be com- pleted first.

3. Determining outcomes.

“What do you want to have happen?”

You don’t know where you’re going unless you have a goal. Interviews may be aimless un less you have a purpose for the client.

The BLS will be useful in drawing out client out- comes and how the client feels about and organizes these outcomes. A clear joint statement of outcomes can be especially useful when the client is different from you.

4. Exploring alternatives and generating solutions.

“What are the possibil- ities and what are you going to do about it?”

Having clarified the goal and the problem, you can turn to brainstorming solutions, making lists of possibilities, and prioritiz- ing possible actions. This phase of the interview is usually the longest.

Again, the BLS will be criti- cal. You will find that clients can often generate their own ideas if you use skillful questioning and encour- aging. If the client misses obvious possibilities, you may at this point want to turn to influencing skills. Some clients, both cultur- ally different and similar to you may want or demand your advice.

(continued)

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Definition of Stage Goals in This Stage Skills and Multicultural Issues at Stage

5. Generalization and trans- fer of learning.

“Are you really going to do something about it?”

This is the phase of the interview which is most often forgotten. It is impor- tant to contract with your client to ensure that they act on learnings from the session.

Again, the BLS will be use- ful in working with your client to determine some future action. You may need to share the reasons for follow-up.

THE COMMUNITY GENOGRAM AND THE FIVE STAGE INTERVIEW: BASIC SKILL #9

This section is designed to illustrate how you might use the 5-stages with the community genogram. It illustrates how you can bring sociocultural issues into the session comfortably and use the identified strengths and resources to facilitate client resolution of issues.

1. Rapport and structuring. You will have already established a reasonable relationship before you talk about the community genogram and its poten- tial value to the client. Take time to explain the value of the genogram and its focus on their unique background. Show them some examples of how the genogram can be constructed. Stress that we are looking for strengths and resources, even though we likely have issues with various parts of our community of origin.

It is possible in the here and now of the interview for the client to draw and complete the genogram. This provides a good opportunity for further devel- opment of trust and rapport. On the other hand, in many cases, it is best for the client to complete the genogram at home and share it in the next session.

2. Identifying strengths and listening to family and community stories. Here the client shares the genogram as a whole. There may be a holis- tic story about the community that gives you a good sense of the socio- cultural background of your client. Likely there will be positive and negative elements—recognize the problems and issues, but point that today we are focusing on strengths and positive stories.

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Usually, there are two or three aspects of the community that have been particularly supportive. Seek specifics of these stories and identify how they are strengths that can be taken into daily life.

3. Determining outcomes. This follows naturally from the stories. Here the two of your discuss specific goals of how these strengths can be part of one’s self-concept and worldview. It is here that we can work with clients on the importance of a positive psychology and wellness view of the world. The ideal goal is a positive view of self, community, and awareness of one’s strengths and resources.

4. Exploring alternatives and generating solutions. Continuation and elaboration of the outcomes is explored here. There may be specific issues and problems that have come from family and community. How can identi- fied strengths be used specifically for resolution?

5. Generalization and transfer of learning. What is your client going to do today and tomorrow to take action on personal positives? Aim for specific actions that are doable and measureable. Contract to discuss in the next session how successful the client was in finding new ways of thinking, feel- ing, and action. Longer-term planning on taking home and using the com- munity genogram needs to be part of the total process.

EXTENDING THE FIVE-STAGE INTERVIEW TO OTHER CONTEXTS

Although it was designed originally for full interviews, it is possible to use the five stage structure of the interview in short contacts with clients and even friends and family members who seek advice. When you are short of time and need to make contact with a client, recall the five stages as a checklist:

1. Do you spend some time in the contact on rapport and relationship? Time spent in developing personal relationships pays large dividends over time.

2. Do you draw out the facts, feelings, and organization of the client’s prob- lem? If you focus just on one dimension, you may lose valuable data.

3. Do you and the other person have a goal in mind or are you “just talking?” “If you don’t know where you are going, you may end up somewhere else.”

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4. Do you allow clients to generate ideas on their own before you give them your suggestions or advice? If you listen to their concerns first, they may solve the issues on their own.

5. Do you suggest specific follow-up actions so that new and useful ideas are tested rather than forgotten?

When it comes to using the five stage structure, you will have a large number of possibilities in your daily life outside of the interview.

USING THE FIVE STAGES WITH LESS VERBAL CLIENTS

In Chapter 3, suggestions are given for helping hesitant or less verbal clients in the interview. The importance of questions requiring shorter, concrete answers was mentioned. You will find those pages helpful in adapting the five stage struc- ture with less verbal clients.

At the rapport stage, for example, your own conversation should be concrete and clear with a minimum of abstract concepts. It can be helpful if you share a concrete experience of yours early on in the interview. If you stay at the concrete level, you will find that meanings between you and the client are more easily shared. Misunderstandings can arise when counselors talk in intellectualized, abstract language.

In defining the problem, search for specific examples. Be willing to listen to con- crete, detailed stories from your clients. In that way, they can express themselves more clearly. In establishing goals, focus on items which are very specific and observable. An abstract goal would be “I want to get along better with my family,” whereas a concrete goal would be “To get along with my family, I am going to start doing specific things with them (for example, playing games, helping around the house).

Brainstorming alternatives at the problem-solving stage can be a problem for the less verbal client. Help the client concretize ways to reach their aims by asking specific questions that can be answered relatively briefly. Rather than generate five alternative solutions quickly, focus on each one by itself and discuss it con- cretely in more detail before moving on.

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For both verbal and less verbal clients, making very concrete plans for generali- zation and taking new learnings from the interview is important. Specify changes in behavior as concretely as possible indicating with whom, at what time, and in what place attempts to change will take place.

With children and adolescents, the suggestions above may be useful. As men- tioned previously, younger children can talk more easily if they have toys, games, or art to use while they talk to you. Adolescents are often edgy and full of energy— it may be useful to have objects available for them to touch as they talk with you (but only if you have the ability to be patient with their “fiddling”). With many ado- lescents, it may be better to go out and play basketball, table tennis, or go for a walk rather than requiring them to sit quietly in your office.

STRUCTURING THE INTERVIEW WITH FAMILIES AND GROUPS

You will find that the five-stage structure of the interview is valuable when you plan a meeting or work with a group on problem-solving. It can even be helpful to list the s on newsprint or whiteboard to help keep group members on topic. It pays off to spend some time on structuring the meeting and on generating rapport and trust at the start of the meeting. If you do this, you’ll find that a lot of time has been saved, as the group now knows the purpose of the session and each have had some important personal recognition. Often it helps to go around the room and have each member share something positive about him or herself or the family/ group as you start the session.

When you gather information at the second stage, often group members will start problem solving immediately. We suggest that they be gently asked to hold their ideas until the issues are defined fully. And, goal setting is equally important for if the group does not have a joint direction, the members will be heading “all over the place” with no common vision.

Once you have carefully brought out the problem and defined goals, exploring issues and new solutions becomes smoother and groups tend to work effectively if they have a common goal. Don’t forget generalization and getting specifics for action as the meeting ends as follow-up is needed. All too often a productive meeting flounders because a specific action plan was not developed.

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However, you will find that families and many groups do not follow the five stages as easily as do individuals. The diversity of interests and needs may lead to some people in the group being at the first rapport stage while someone else is ready to start brainstorming solutions.

Basic Attending Skills is not designed to make you an expert in group counseling. Nonetheless, you will find the foundation concepts helpful in dealing with both unstructured and structured groups.

Unstructured Groups

Group counseling usually occurs over several sessions with ten three-hour ses- sions being a common length. Those expert in group process note that unstruc- tured groups (encounter, marathon, or “T-groups”) often go through stages themselves that may or may not agree or be workable with the five stages discussed here. Many unstructured groups go through some variation of the following:

Forming. During the first stages of a group, particularly those that are unstructured or stranger groups, you will often find polite social interaction. However, the lack of leadership eventually leads to frustration. Attending skills and observations of group nonverbal behavior on the part of the leader may be useful here.

This group stage is parallel to the rapport/structuring phase of the interview as people are trying to know one another and find a structure for the group.

Storming. During the next stages of a group, particularly those that are unstructured or stranger groups, you will find considerable frustration as the group attempts to find itself and its direction. There is often a struggle for leadership and power. Your leadership skills of paraphrasing, reflection of feeling, and summarization are often useful here. The influencing skill of feedback may be particularly important—here the leader gives accurate feedback on what he or she observes in the group. Note the focus of leader comments is often on the group as a whole rather than on single individuals— “This group seems very angry right now.”

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In some ways storming is similar to the second stage of the five stages of the interview. The problem that the group wishes to work on may be defined, at least in preliminary form.

Norming. The group starts to settle down at this phase. Members share them- selves more freely. Cohesiveness develops which makes problem definition and goal setting possible. Norming corresponds closely to stages 2 and 3 of the five- stage interview. Problems and group goals may be defined here.

The group members start working on their own interaction or on a joint prob- lem. Norms and ways of interacting have been established and the leader can continue using the same skills as outlined earlier. If you have modeled effective listening and feedback, group members themselves may start using these same skills more effectively. Your importance as a model of effective communication cannot be over stressed.

Performing. This is the work stage of the group. Individuals may test out new behaviors. Disagreements may be worked out more constructively. Your focus on the group as a whole may pay important dividends here. Group members may start to look at themselves and how they relate to the total group process.

Again, your ability to listen and provide feedback is important. You may help the group and specific individuals examine how their behavior in the outside world is similar to their behavior in the here and now of the group.

Terminating/adjourning. As a group comes to the end, you will find that many of the old issues between members reappear and need to be worked through once again. The sense of loss when a group ends can be a problem for some members and old separation anxieties are brought out. The skills of summarization and reflection of feeling may be particularly important in helping a group work through this stage.

Unstructured groups can benefit from the concrete structuring of generalization offered within the five-stage interview. If each member can contract for a specific change or follow-up, the chances of long-term benefit from the group experience are greatly enhanced.

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The listening skills emphasized in this book are important starting points for group and family work. As you develop more knowledge and expertise in the helping field, you’ll find the information presented here on listening remains foundational.

Structured Groups

Structured groups also tend to meet with a defined period of time. The major dis- tinction is that the topic is agreed to before the group starts. You may find yourself leading a group of high school or elementary students exploring their common concerns over family alcoholism or divorce. You may conduct a structured group in consciousness-raising for women, minorities, the developmentally challenged, or LBGTQI populations. You may start a self-help group for cancer victims, fami- lies of Alzheimer’s patients, or people who have just lost their jobs.

You will find that the forming, storming, norming, performing, and adjourning con- cepts discussed above will also be a part of your work with structured groups, but usually, these stages are less pronounced as the group often had varying goals when they joined. However, the surprise personal discoveries in a struc- tured group often require you to use many of the same behaviors and leadership styles of the unstructured group process.

Initiating a structured group. We have found that letting the group know what to expect at the beginning of the first session can be most helpful. Among key points are the following:

1. Confidentiality. “What is said in the group stays in the group.”

2. Sharing of names. At times, short background information may be offered by each member of the group. Others prefer to let this happen naturally during the session(s). Watch out—how participants behave here may be an indication of those who seek to dominant—and certainly, those who are more hesitant to talk.

3. Key rules need to be shared with each group and they may vary. Among important rules is “no politics, no religion” or your group may end in tur- moil. Be ready to cut off these discussions as soon as they occur (unless, of course, your group has previously committed to exploring these issues openly).

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Feelings are a great place to start and break the ice. Start the actual group ses- sion at each (or most) meetings by holding hands in the circle and thinking of the group as joined together as it searches for bonding and support. In silence, the individuals are asked to meditate and think of a feeling or emotion that occurs for them. Upon opening the eyes, each member shares the feeling word and says nothing else. Then, go around the room and each member is asked to share sen- tences elaborating on their feeling word.

This may easily take an hour and has the special advantage that each member actually talks. It is far more difficult for one person to dominate. Members are encouraged to provide feedback to each speaker. It will be tempting for you as leader to reflect the feelings and summarize what the group member says. This is OK at times, but the real goal is to encourage empathy and cross-conservation in the group so that they do not always depend on your leadership. Think again about the following maxim:

A leader is best when people barely know that he [or she] exists,

Of a good leader who talks little,

When the work is done,

The aim is fulfilled

They will say, “We did this ourselves.”

Lao Tse

In structured groups, the five stages of the interview may be followed more closely, but you will find that entire sessions may focus on any one stage. For example, the entire first three-hour session is likely to focus on rapport building and learn- ing how a particular group is to be structured. You will seldom, if ever, actually go through the entire five stages of the well-formed in any group session.

Throughout this book, we have stressed that it is important to use the listening skills as group members talk in much the same way as you might use them when conducting individual sessions. We have also stressed that it is important to focus on the group as a whole. (“This group is anxious right now—everyone seems to want to avoid the pain and fear of the possibility of a cancer reoccurrence.” “This group seems to be telling self-defeating stories—there are people who have learned how to grow beyond alcoholism.”)

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We have suggested in working with structured groups that you give one-third of your time to the group topic (cancer, divorce, eating problems, racism, sexism), one-third of the time to personal thoughts and feelings around the topic, and one- third of the time to group process—how the group itself deals with the topic.

You will find that you can use attending behavior and the skills of the basic listen- ing sequence as your basic skill framework for much of your work with groups.

Family Sessions

Family counseling and therapy may be the most complex and difficult helping framework. Families move rapidly between forming, storming, norming, perform- ing, and terminating, sometimes all in one interview. Families often will want to focus on an individual when they need to look at their family interaction. And when one individual needs attention, the family may turn to discussing some other topic.

Your listening and attending skills will serve as good foundations for family work, but you will want to study much further before you attempt to work in depth with family counseling. If you are trained in individual counseling, you may be tempted to focus on individuals. In group work, it is important to focus on the word “group.” In family work, you will need to use the word “family” again and again to help the individuals focus on their interactions rather than on a single family member.

In your role-plays and practice sessions, the five stages of the interview are work- able frameworks for practice in family counseling:

1. Rapport/structuring. It is wise to spend time in a family session developing some sort of individual rapport with each member. At the same time you want to join the family as a temporary member and this means seeing your- self as both a family member and as an observer.

2. Problem definition. Many families come to counseling with an “identified patient,” perhaps the family alcoholic, the bulimic, or the acting-out child or adolescent. Many family therapists ask each member of the family to define the problem. They listen carefully and reflect back to each person what they have just said. Later the counselor often summarizes the varying family perspectives and reframes or reinterprets the individual issues as a family problem. The focus moves from the individual to the family interaction itself.

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The problem definition phase is vital in family work, perhaps even more so than in individual counseling. You will be tempted to focus on single individ- uals and their problems. Family therapy stresses the importance of seeing any individual issue always in the context of family.

3. Establishing goals. A process very similar to the above occurs in setting up family goals. Each person has her or his say and then the counselor helps the family establish joint family goals for more effective interaction. For example, instead of stopping an adolescent from acting-out, the goal of the family turns to becoming a family that works together more effectively.

4. Exploring alternatives. There are many theories and practices in family work that you will want to study and master. As you begin, your ability to listen will remain vital. If you listen effectively and focus on the family as a whole, often the family will begin to generate its own solutions.

Balancing your listening between family, individuals, and the topic (the fam- ily problem) will be helpful both as you begin and as you master family ther- apy. The counselor needs to balance focus on the agreed-on family topic (for example, how can this family work together more effectively and not be so focused on acting-out, bulimia, alcoholism, etc.), individual members’ thoughts and feelings, and specific instances of family group interaction here and now in the session with the counselor which relate either to indi- vidual reactions or the agreed-upon topic.

5. Generalization. Families seem to benefit from concrete homework assign- ments so that they can take what they have learned in the group/family situation and apply it at home.

In summary, structured and unstructured groups and family sessions are indeed different from individual counseling and therapy. Yet, the skills you learn in individ- ual work can be applied rather directly to groups and families. Again, it is important that you engage in further study and practice in this complex area. The material here is designed as a brief introduction to some of the key concepts of work with more than one individual.

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PRACTICE AND FOLLOW-UP WITH SKILL INTEGRATION

The task of this session is to demonstrate that you can conduct a full practice helping session using only attending and listening skills.

1. Develop a working group. To practice integration of skills, it will take more time. While groups of four are most desirable, it may be necessary to work in triads or pairs.

2. Assign roles as counselor, client, operator/observer, and second observer.

3. Determine topic for role-play. The five-stages of the interview are particu- larly effective in helping a client make a decision. Some useful decision top- ics include career choice, making a major purchase, deciding how to handle a specific interpersonal conflict, or your future as a professional counselor.

The following specific guidelines may be helpful for the role-played counselor:

a. Rapport/structure. Spend necessary time tuning yourself in with the cli- ent in your own way and inform him or her of the purpose of the interview.

b. Defining the problem. Use the BLS to draw out the client’s issue. Be sure to spend some time defining client strengths. Remember that the concrete question, “Could you give me a specific example?” used in varying form will be useful in all stages of the interview to expand and clarify what is happening.

c. Determining outcomes. Again, the BLS can be helpful in drawing out what the client sees as a goal or ideal outcome.

d. Exploring alternatives and generating solutions. Begin this section by summarizing the problem and the outcomes as desires. Ask the open question, “Could you tell me what ideas/possibilities for resolution come to your mind?” You will find that the organization of the problem offered by the BLS and the five-stage structure often helps many cli- ents find new and workable problem solutions here.

e. Generalization. Through attending skills and questioning, help your cli- ent define something specific he or she might do during the coming week to implement the ideas generated.

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4. Provide as much time as needed and provide feedback.

5. Rotate roles.

GROUP/FAMILY PRACTICE IN STRUCTURING THE INTERVIEW

It is suggested that couple counseling be tried for this practice session. A group or family session could be attempted, but will involve a fairly long time for adequate discussion.

1. Develop a working group.

a. Two members become the couple

b. Counselor

c. Observer/recorder

2. Determine topic for role-play. Similar topics as used for summarization are suggested. Any type of couple conflict is appropriate for this practice ses- sion. The practice session will likely be more effective if the couple has a difference of opinion about an important decision—moving to a new job, having a child, making an important purchase, where to spend vacation, or how to spend money. Many couple problems occur in the process of making decisions.

Use the same suggestions for structuring the interview as were summa- rized above for the individual session. But adapt the structure to meet the

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needs of the couple. You will find that the summarization skill is particularly important in couple, family, and group interviews.

During planning time, the role-played couple can generate a tentative “script” concerning their “difficulties.” The observer can study the observer form and prepare any recording equipment.

4. Watch time carefully and provide feedback. The role-play should last approximately 10–15 minutes. Allow 15–20 minutes for feedback.

5. Rotate roles as time permits.

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SKILL INTEGRATION FEEDBACK SHEET

Use the following form to classify the skills of the counselor. Make a note on the form when a new stage of the interview begins. Classify the leads of the coun- selor as O?,C?,E,P,R, RF, and S. Use “Other” for skills that are other than those which you have practiced. Write the main words of each counselor response. In addition, rate individual responses and the total interview on the following five- point scale indicating your quality rating of the statement.

5 maximally facilitative Use of skills greatly adds to and enriches communication 4 facilitative Use of skills adds to and enriches communication 3 minimally facilitative Use of skills adds slightly to communication 2 nonfacilitative Use of skills detracts from communication (frequent daily

interpersonal interaction) 1 destructive Use of skills disrupts and significantly hinders communication