Questions & Listening Responses


Reflective Listening…

For my new position as a PLMHP, I’m asked to review a Clinical Training Manual in which we’re provided an overview of basic counseling skills.  In this clinical training manual it describes essential skills for the beginning therapist.  This manual defines reflective listening as follows:

“listening is not a passive skill eflective listening can be broken down into four components: listen, understand, clarify, and energy” (Capstone, n.d.).  

“Listening involves the nonverbal communications that occur while someone is talking and includes active listening sills discussed here.   Understanding involves paraphrasing what the client has said and helps to establish trust and rapport with the client, since they feel that you understand what they are saying” (Capstone, n.d.).  Finally, reflective listening involves clarifying, when necessary, in order to make sure you understand what the client is saying.  Additionally, when utilized properly, reflective listening “injects energy into the conversation” (Capstone, n.d.)

Asking questions

Next, in this series is information pertaining to those basic communication skills that are most relevant to my experiences as a new therapist.  Establishing effective communication requires an ability to ask questions and provide listening responses that encourage elaboration.  One of my course textbooks provides the following advice on asking effective questions:

“Effective questions open the door to knowledge and understanding. e art of questioning lies in knowing which questions to ask when. Address your first question to yourself: if you could press a magic button and get every piece of information you want, what would you want to know? Thee answer will immediately help you compose the right questions.” (Ivey, et al, 2010, p. 93)

As a new therapist, the questions I ask are useful in getting a conversation started.  Open questions are useful in eliciting elaboration from the client on their life story.  An example of closed questions can be when we paraphrase what the client says for clarification &/or reflection. Finally, the manner in which questions are asked determines the responses I receive.  What follows is a “quick and dirty” definition of open questions and closed questions…

Open Questions

“Open questions are those that can’t be answered in a few words. ey encourage others to talk and provide you with maximum information. Typically, open questions begin with what, how, why, or could: For example, “Could you tell me what brings you here today?” You will find these helpful as they can facilitate deeper exploration of client issues” (Ivey, et al, 2010, p. 94).

Closed Questions

“Closed questions can be answered in a few words or sentences. ey have the advantage of focusing the interview and obtaining information, but the burden of guiding the talk remains on the interviewer. Closed questions often begin with is, are, or do: For example, “Are you living with your family?” Used judiciously, they enable you to obtain important specifics” (Ivey, et al, 2010, p. 94).

Listening responses

“Listening is the attending, receiving, interpreting, and responding to messages presented aurally” (Prout & Watkins, 2014, p. 132).  In this respect, it requires more than hearing and understanding what our client is saying.  Effective communication of what we hear, is essential to ensure we are interpreting our client accurately.    “Verbal person centeredness (VPC) focuses on …highly person-centered communication, which is characterized by explicit recognition of the other person’s feelings and encouragement to elaborate and contextualize those feelings according to the perspective of the other.” (Ivey, et al, 2010, p. 44).   What follows is a description of different types of listening responses that are useful in guiding the course of the conversation with a client…

Encouragers

Encouragers are minimal responses such as head nods, hand-gestures or the infamous “Uh-huh”.  They are utilized to indicate you are listening and “help clients feel comfortable and keep talking in the interview” (Ivey, et al, 2010, p. 151).  Now, I personally would caution against utilizing these encourages too much.  When I start receiving the frequent “uh-huh” responses in rapid succession, I realize I’ve neared the end of our conversation.  Doing this to my therapist could be quite distracting…

Seeking Clarification

At times the client may be making contradictory statements.  On occasion, the therapist isn’t entirely certain about how to interpret the meaning in what the client is saying.  Seeking clarification simply requires restating what you heard the client said,  it lets the client know you are listening & provides reassurance you are both on the same page.

Paraphrasing

Paraphrasing simply involves restating & summarizing what the client is saying.  It can be useful in helping the client to reflect on what they just said.  However can be annoying when used too frequently. My textbook describes the paraphrase as consisting of four elements (Ivey, et al, 2010):

  1. A SENTENCE STEM: “it sounds like…”
  2. KEY DESCRIPTORS USED BY THE CLIENT: “….you’re struggling to make sense of his response to your questions about the relationship…”
  3. STATE IN SUMMARY WHAT YOU HEARD THE CLIENT SAID: The above response, can be my question after hearing the client describe recent changes in the relationship as she describes how frustrated and confused she is feeling….
  4. FINALLY,  THE GOAL OF A PARAPHRASE IS TO ASK FOR ACCURACY.  

Reflections

Reflections of content can provide the client an opportunity to reflect thoughtfully on what they are saying.  For example, if a client expresses confusion regarding a comment somebody made, I might ask, “what confuses you.”  However, reflections can also be more complex and privide the therapist to test their hypothesis.  For example I might say, “it sounds like you’re frustrated by the lack of communication.”

Summarizing

“Summarizing what the client has said is different from paraphrasing the mes- sage. When you are ready to summarize you have arrived at a succinct and clear understanding of the client’s perspective. You are encapsulating not only what the client said but also adding and integrating the material that was generated by your responses to the client” (Ivey, et al, 2010, p. 148).

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References

Capstone, (n.d.) Clinical Skills & Clinical Skill Enhancement. Capstone Behavioral Health.
Ivey, A.E; Bradford Ivey, M; & Zalaquett, C.P. (2010). Intentional Interviewing and Counseling.  Belmont, CA:  Brooks/Cole.
Prout, T.A. & Wadkins, M.J. (2014).  Essential interviewing and counseling skills.  New York, NY: Springer Publishing Company.

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