counseling skills

Confrontation, reflecting, focusing & influencing

The final basic counseling skills post, focuses on the more advanced skills: (confrontation, influencing, focusing, & reflection of meaning). Included below is a “quick & dirty” overview of these skills….

“Confrontation is not a direct, harsh challenge.  Think of it, rather, as a more gentle skill that involves listening to the client carefully and respectfully; and, then, seeking to help the client examine self or situation more fully. Confrontation is not “going against” the client; it is “going with” the client, seeking clarification and the possibility of a creative New, which enables resolution of difficulties. (Ivey, et al, 2010, p. 241)


Of all the basic counseling skills, I am notoriously fearful of confrontation.  My supervisor utilizes motivational interviewing to engage in a form as way to elicit change.  However, I’ve noticed that confrontation doesn’t have the same connotation as it does in daily life.  In my own family, confrontation is a dirty word that we avoided at all costs.  Consequently, when there confrontation did occur, the air was filled with an awkwardness that you could cut with a knife.  In the end, cause we were never good at airing our differences, the end result was always misunderstanding….

So with this as my own personal background, the idea of confronting clients is especially terrifying.  To be honest, I’m afraid of a creating misunderstand and realize  at times its necessary to bite the proverbial bullet.  Confronting clients is a risk-taking venture that challenges the therapeutic relationship that you work hard to build.  However, the potential payoff is that we can provide the client an opportunity to challenge their own beliefs and perceptions.  My course textbook describes confrontation as involving three steps:

“First: Listen and identify conflict in clients’ mixed messages, discrepancies, and incongruity” (Ivey, et al, 2010, p. 243).

Discrepancies can be a divergence between one’s actions and beliefs, or simply feelings of ambivalence. For example, my therapist once directly confronted me after I told her for the fifty-millionth time that I need to start exercising and losing weight. She responded, you’ve been wanting to do this for five years but have never gotten around to it, what has been stopping you?

“Second: Clarify and clearly point out issues to clients and help them work through conflict to resolution.” (Ivey, et al, 2010, p. 243).

Relationships difficulties can be an excellent source of ambivalence. I like to start out by asking questions that can clarify the issues my client is struggling with.  Having all the facts and viewpoints in a particular situation is the next logical step to helping the client find a resolution…

“Relationship is critical here as we make the conflict clearer to the client”  (Ivey, et al, 2010, p. 243).

The scariest step for me is where you make the nature of the conflict clear to the client.  This can involve paraphrasing, or summarizing what the client has said.  This can often provide the client an opportunity to reflect on what they have said.

Finally: Listen, observe, and evaluate the effectiveness of your intervention on client change and growth” (Ivey, et al, 2010, p. 243).

Evaluating the client’s response is useful in ascertaining where the client is along the stages of change. My textbook concludes by noting that “confrontation itself is a not a distinct skill; it is a set of skills that may be used in different ways. The most common confrontation uses the paraphrase, reflection of feeling, and summarization of discrepancies observed in the client or between the client and her or his situation. (Ivey, et al, 2010, p. 256)

“Focusing is a skill that enables multiple tellings of the story and will help you and clients think of creative new possibilities for restorying Use selective attention and focus the interview on the client, problem/concern, significant others (partner/spouse, family, friends), a mutual “we” focus, the interviewer, or the cultural/environmental/contextual issues. You may also focus on what is going on in the here and now of the interview” (Ivey, et al, 2010, p. 241).

I am a student therapist who is also in therapy  I find the biweekly sessions simultaneously therapeutic and educational.  Every time I see my therapist I leave with several insights about my life that had previously not occurred to me.  I think it helps that I have started to see a new therapist.  I marvel at how naturally he utilizes these counseling skills without a single thought.

However, I must admit, there are times when the technique of focusing aren’t especially useful.  For example, previous therapists I have had, haven’t utilized this skill very adeptly.  Consequently, I found attempts to focus our conversation on certain issues to be frustrating.  When based on limited understanding I find myself struggling to find the opportunity to discuss the issues I struggle with most. I believe firmly focusing is not useful as a skill without a simultaneous attempt to ensure you and your client are on the same page.

“The goal of reflection of meaning is to facilitate clients in finding deeper meanings and values that provide a guiding sense of vision and direction for their lives. e goal of interpretation/reframing is to provide a new way of restorying and understanding thoughts, feelings, and behaviors, which often results in new ways of making meaning. Clients usually generate their own meanings, whereas interpretations/reframes meanings that are close to core experiencing. A reflection of meaning looks very much like a paraphrase but focuses on going beyond what the client says. Often the words ‘meaning,’ ‘values,’ ‘vision,’ and ‘goals’ appear in the discussion” (Ivey, et al, 2010, p. 293-294).

The final advanced skill discussed in my textbook are various influencing techniques.  These skills provide a more direct approach to client change and are useful in helping the client see things from a different perspective.  Five influencing skills were discussed: (Ivey, et al, 2010).

  1. SELF-DISCLOSURE – I have learned to be cautious about self-disclosure & am mindful to do so in if it provides something beneficial to the client. Self-disclosure provides the client e a unique perspective on a similar experience as food for thought.
  2. FEEDBACK – Feedback in encouraging the client to acknowledge strengths or recognizing how far they have come.
  3. INFORMATION/PSYCHO-EDUCATION – When I utilize psycho-education, it is usually to help the client  understand symptoms and/or diagnoses in order to manage their overall well-being more effectively.
  4. LOGICAL CONSEQUENCES – For example, I might discuss the client’s potential options in a particular situation, in order to determine the best alternative.  By writing them out and seeing it in front of them, this can be a useful and influential tool to see things more clearly.
  5. DIRECTIVES – the textbook (Ivey, et al, 2010), discusses direction as another influential tool, although this is something I don’t use very often – if at all.

References

Ivey, A.E; Bradford Ivey, M; & Zalaquett, C.P. (2010). Intentional Interviewing and Counseling.  Belmont, CA:  Brooks/Cole.

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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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Active Listening Skills

DEFINITION : “Listening is the attending, receiving, interpreting, and responding to messages presented aurally” (Prout & Watkins, 2014, p. 132).

In the counseling field, listening requires much more than simple comprehension of the verbal messages receive from our clients.  As therapists, we must capture the meaning of the messages communicated the client, utilize this to develop an understanding of our clients and form a plan for therapy.  In other words, our ability to listen requires the skills of effective communication, empathetic understanding & attending skills (Drab, n.d.)   One interesting comment from my textbook, includes the need to act as an “authentic chameleon” (Prout & Watkins, 2014, p. 133), by adjusting our interactive style to the needs of the client.  Also of interest is a review of three key types of listening in everyday life discussed in research:

  1. MARGINAL LISTENING:  “individuals are hearing but not paying attention to the other person.  The listener may be distracted or involved in formulating the next response, and this inattention is likely to lead to a less than ideal interaction.”  (Prout & Watkins, 2014, p. 133)
  2. EVALUATIVE LISTENING: “involves concentrating intently on what is being said, but this type of listener focuses only on the literal meaning of the words and does not acknowledge subtle verbal cues or nonverbal communication.”  (Prout & Watkins, 2014, p. 133)
  3. ACTIVE LISTENING: “entails receiving verbal and nonverbal messages from others, processing them and responding in a way that encourages further discussion.”  (Prout & Watkins, 2014, p. 133)

Therapeutic Listening: Skills Required…

The above-listed types of listening (marginal / evaluative / active) come from research on forms of listening in everyday relationships.  What are some unique considerations for listening as a counselor? Prout & Watkins (2014), note that “people who are new to counseling are frequently preoccupied with learning what to do to help clients, instead of focusing on how to be – the facilitative condition for being able to enact those specific counseling strategies.” (p. 138). What follows are random insights from my textbooks that provide “food for thought” as I consider “how am I being” while I see my clients???

Empathy, Genuineness & Unconditional Positive Regard…

“Genuineness, unconditional positive regard and empathy are the key components of Rogers’s…facilitative conditions of therapy…[they] create an environment that allows clients to grow and change” (Prout & Watkins, 2014, p. 134).  These qualities are essential to truly understand the meaning in what the client express and appreciate their lived experiences more fully (Prout & Watkins, 2014).  This is easier said than done when in the midst of a counseling session.  Thus far, I’ve noticed that counseling practice, requires us to think on our feet as we follow our gut, education, and lived experience while “making things up as we go along”.  People are complicated and there are no exact recipes for success.

For example, there are times, when I’ve entered a counseling relationship and find struggling with a nagging uncertainty as I realize that there I don’t have many common experiences to draw upon.  In this case, personal education and supervisory consultation are critical.   There are other situations in which I find myself relating to the client’s situation very well.  At such times, I become concerned that my understanding of their situation reflects more my own past experience, than their current reality.  In this case, I’m aware of the potential risk of transference issues. So what is the solution here?  Empathy, is a two-fold process that involves accuracy of perception and effectiveness of communication.  Therefore, “active empathetic listening” (Prout & Watkins, 2014, p. 134) involves a conscious effortful attending by the counselor that communicated effectively to the client.  

My course textbook breaks down the process of active empathetic listening into three stages:

  1. FIRSTLY, we must be able to pick up on all the verbal and nonverbal communication.
  2. SECONDLY, we must be able to understand the meaning & content of what is expressed.
  3. FINALLY, We must process this information, my textbook describes two types of processing that occur while we listen “top-down” & “bottom-up”  Since, I didn’t like the definitions provided in my textbook, I found this video to help clarify things:

Affect Tolerance & Mindfulness….

Listening within counseling is unique since the therapeutic relationship is inherently imbalanced.  What makes the relationship between therapist and client so unique is its one-sided nature.  In fact, the ACA (2014) code of ethics prohibits dual relationships where a counselor provides services to a friends, family members or significant others.  What follows is a description of the counseling relationship from the ACA Code of Ethics Manual

“Counselors facilitate client growth and development in ways that foster the interest and welfare of clients and promote formation of healthy relationships. Trust is the cornerstone of the counseling relationship, and counselors have the responsibility to respect and safeguard the client’s right to privacy and con dentiality. Counselors actively attempt to understand the diverse cultural backgrounds of the clients they serve. Counselors also explore their own cultural identities and how these affect their values and beliefs about the counseling process” (American Counseling Association, 2014, p. 4).

In other words, while healthy relationships are two-sided in nature, the therapeutic relationship is one sided: focused specifically on “client growth and development” (American Counseling Association, 2014, p. 4).  In order to facilitate the development of a relationship like this good attentive listening skills are required.  “Counselors must be able to hear, and perhaps tolerate vicariously experiencing distressing emotions that may occur during counseling” (Prout & Watkins, 2014, p. 138). My course textbook provides two suggestions:

  1. AFFECT TOLERANCE:  Counselors must “Develop affect tolerance to respond empathetically to client’s experiences of distress without overly identifying with it or avoiding it.  Affect tolerance has been described as being willing and open to experiencing feelings” (Prout & Watkins, 2014, p. 136).
  2. MINDFULNESS:  “suggested as a practice that can help counselors train their minds to attend fully to their clients…defined as…paying attention in particular way: on purpose, in the present moment and nonjudgmental” (Prout & Watkins, 2014, p. 136).

Observational Skills…

“In working with [clients[, if you miss those nuances…if you don’t notice when their emotions, gestures, or tone of voice doesn’t fit what they are saying, if you don’t catch the fleeting sadness or anger that lingers on their face for only a few milliseconds as they mention someone or something…you will lose your [clients]” (Ivey, et al, 2010, p. 123).

Observational skills are a critical tool in determining how the client interprets the world.”  (Ivey, et al, 2010, p. 141).  In discussing observational skills, there are two points I’d like to touch on:

#1: What are we supposed to observe?

    1. CONFLICT:  Much of the time spent in therapy centers around working through the conflict, stressful situations, ambivalence, and incongruence (Ivey, et al, 2010).  Are there discrepancies between a client’s actions and words?  Does the client hesitate or resist talking about certain subjects?  Are there discrepancies between the client’s inner world and external situation:?  What conflicts exist in the client’s relationships?
    2. NONVERBAL BEHAVIOR:  What sort of nonverbal communication does the client display?  What do you notice about their facial expressions and eye contact?  How about the client’s body language and mannerisms?
    3. VERBAL BEHAVIOR:  “Noting patterns of verbal tracking for both you and the client is particularly important.  At what point does the topic change and who initiates the change?  Where is the client on the abstraction ladder?…Is the client making I or other statements?” (Ivey, et al, 2010, p. 141).

#2:  How can we improve our observational skills?

  1. TIP ONE – AWARENESS:  “Looking at your way of being an be equally important as, or more important than observing your client.  Start by taking brief inventory of your own nonverbal style” (Ivey, et al, 2010, 134).
  2. TIP TWO – MULTICULTURAL SENSITIVITY: “Note individual and cultural differences in verbal and nonverbal behavior…Use caution in your interpretation of nonverbal behavior (Ivey, et al, 2010, p. 141).

Reflective Listening

Once the skills of paying attention, empathy, and observation are in place, it is possible to begin developing advanced listening skills defined in my course textbook as reflective interviewing (Prout & Watkins, 2014)

types of reflective statements:

  1. SIMPLE REFLECTIONS: “made by repeating or rephrasing the client’s statements” (Prout & Wadkins, 2014, p. 139).
  2. COMPLEX REFLECTIONS: “When making a complex reflection, a mental health professional is making an interpretation of ta client’s statement by substituting a word or making a guess at unspoken meaning.” (Prout & Wadkins, 2014, p. 139).

Tips for reflective listening…

Mirroring the client’s affect is a useful way of showing empath.   Using the client’s vocabulary is Often more useful than the uh-huh’s and academic language I use frequently.   At times, directing the subject matter to ensure the client stays on topic can allow for a more in-depth discussion of matters.  Finally, listening requires us to uncover the underlying themes and/or bigger picture as we utilize these insights to determine our best course of action..

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References

American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author.
Drab, K. (n.d.) The top ten counseling skills. Retrieved from: http://www.people.vcu.edu/~krhall/resources/cnslskills.pdf
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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Basic Attending Skills

I realize it might seem ridiculous to devote a blog post to “paying attention” as counseling skill….

After all, shouldn’t it be obvious?  Can you imagine a therapist falling asleep or becoming distracted during a session, nothing would be more painful, angering, or infuriating.  Keep in mind, one of the many purposes of this blog is to create a resource of information that can aid in my ongoing professional growth.

Learning to become mindful in my interactions with clients has been crucial for me thus far.  During weekly sessions with my supervisor, I’ve become aware of two things:

#1.  I use more counseling skills than I am aware of.

#2.  There is definitely room for growth.

What is Attending Behavior?

For this blog post, I dug up my very first course textbook for this graduate program.  It reviews essential counseling skills and describes attending behavior as an essential component in conversation:

“Attention & Consciousness are the foundations on which create an understanding of the world.  Together they form the ground upon which we build a sense of who we are.  [Attention and consciousness enable us to] define ourselves in relation to the myriad off physical and social worlds we inhabit.  They are also the basic foundations that give rise to ‘the mind'”. (Ivey, et al, 2010, p. 62)

Kranz & Sanders (2006) add that in the counseling field…”all that we do is determined by our attentiveness” (p. 107).  “Well-developed skills assist…in two ways. First, they help…demonstrate that [we] care and are involved.  Second, they enable counselors to observe unspoken messages and respond more appropriately to immediate client needs.” (Ivey, et al, 2010, p. 62).  Effective communication achieves the following goals: “communicates interests; sets a climate of respect, motivates self-expression in others; assists concentration; establishes a base for constructive exchanges; prepares on to access information accurately”  (Kranz & Sanders, 2006, p. 107).

The Basics of Paying Attention.

What follows below, is information from an array of resources that describe the essential skills involved in basic  attentive behavior.  (Again, I realize it may seem obvious, however starting with the basics at this point is the most effective cure to my feelings of incompetence).  

Key Aspects of Attentive Behavior – (Kranz & Sanders, 2006).  

Basic attentive behavior involves both verbal and nonverbal communication.  It stays on topic, focus on the client, while maintaining eye contact, and an attentive posture, with silences when appropriate. (www.uccs.umn.edu, n.d.).  Kranz & Sanders, (2006) discuss three elements of attending behavior:

  1. Contextual Attending:  involves preparing the setting in which the interaction is supposed to occur and preparing in advance with arrangements necessary for positive interaction, (Kranz & Sanders, 2006).  To the issue of contextual attending, I would like to add that this should include any necessary preparatory work prior to first meeting.  This can include, understanding the client’s reason for seeking therapy, and any relevant background information.  The sociocultural background and specific concerns determine how one can best prepare in advance.
  2. Postural Attending: (Kranz & Sanders, 2006) define postural attending as an awareness of how you communicate an interest in the client.    Do you have any distracting behaviors?  What about your eyes contact and nonverbal messages?
  3. Psychological Attending:  “psychological attending occurs when a sense of ‘one-ness’ is experienced between those involved….[it] can be observed by noting the congruity of ‘presence’ between counselor and client.” (Kranz & Sanders, 2006, p. 123).

“The 3 V’s + B of Listening” (Ivey, et al 2010).

“The first interviewing skill of the microskills hierarchy is attending behavior which consists of four dimensions and is critical to all other helping skills” (Ivey, et al, 2010, p. 65) and includes the following:

  1. Eye contact (visual)
  2. Speech (Vocal quality)
  3. Listening (Verbal tracking)
  4. Body Language….

Nonattention & Silence

Two final comments regarding the issue of attending behavior are worth noting.  Firstly, there are times when it is useful or appropriate to not attend to specific things a client says.  For example, a client recently discussed that she didn’t feel she was progressing very far in recovery.  However, it was clear that she was being hard on herself, and simply not aware of the how far she had come.  In such an instance, Ivey, et al, (2010) note that, “non attending may be useful.  Through failure to maintain eye contact, subtle shifts in body posture, vocal tone and deliberate jumps to more positive topics” it can be possible to switch the interview to another lien of discussion.    My course textbook concludes by noting briefly the utility of silence and its relevance in the coursing process.  “Counseling and interviewing are talking professions. But sometimes the most useful thing you can do as a helper is to support your client silently.” (Ivey, et al, 2010, p. 76).

ADDENDUM:  Improving my capacity to pay attention

In another textbook I found the following comment: “Counselors must be able to hear, and perhaps tolerate vicariously experiencing distressing emotions that may occur during counseling.” (Prout & Wadkins, 2014, p. 136).  There are skills all counselors must develop:

  1. AFFECT TOLERANCE: “to respond empathetically to client’s experience of distress without overly identifying with it or avoiding it” (Prout & Watkins, 2014, p 136).
  2. MINDFULNESS: “paying attention in a particular way: on purpose, in the present moment, and nonjudgmental.” (Prout & Watkins, p. 136).
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References

Kranz & Sanders, V. (2006).  A compendium of roadworthy skills for counselors. Australia: Quest Partners.
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.
www.uccs.umn.edu (n.d.) Basic counseling skills. Retrieved from: http://www.uccs.umn.edu/Training/docs/Basic%20Counseling%20Skills.pdf

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Empathy, what is it?

In a previous post, I describe a growing feeling of incompetence as a student therapist.  When I express these concerns to my supervisor he jokes: “Give it about 5 years”.  

As time has progressed, I’ve adapted to the “learning as you go process”.

As a therapy student, I’m focusing on learning those “basic counseling skills” everybody talks about. In this series of posts, I hope to reflect on what I’m learning slowly week by week from an experiential rather than academic perspective.   Therefore, I did a quick google search and am using three online PDF’s as a quick jumping off point.  In this post, I will focus on empathy…

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42).  It can be thought of as “the ability to perceive another’s experience and then to communicate that perception back to the individual to clarify and amplify their own experiencing and meaning. It is not identifying with the patient or sharing similar experiences, not ‘I know how you feel’!” (Abraham Lincoln University, n.d., p. 5).  In other words, empathy is a two-fold process that involves accuracy of perception and effectiveness of communication.   Two big questions naturally loom in my mind:

FIRSTLY, How can we improve our ability to appreciate another person’s perspective, thoughts & feelings?

SECONDLY, What considerations need to be kept in mind to communicate this empathy effectively?

4/12/17 @ 2:30 p.m.

I’m in the car, dictating another post into my IPhone.  A few thoughts have sprung to mind regarding the importance of empathy as a result of several events over the last several weeks…  

Therapy seems to require a dialectical thought process of oppositional perspectives.  We must discern diagnostically while remaining nonjudgmental empathetically.  The process of diagnosis first requires the observational skills to develop a phenomenological diagnostic understanding.  Then, in order to guide our progress an ever-changing case conceptualization provides an complex causal understanding.

In complete contradiction to this is the empathetic perspective which requires us to suspend judgment.  In those moments, you are attending to the human being before you and simply honoring the validity of a person’s experiential reality with a goal of developing a deeper felt understanding of it.  The divergent nature of these two simultaneous tasks makes the counseling process is oddly dualistic at times.  As a newbie, I’m interested in getting down the basics.

How can I know if my understanding of the patient’s felt & experiential reality is correct???  How can I be sure that I’m adequately conveying this empathetic understanding???  Here are a few random thoughts:  

Marsha Linehan on Suspension of Judgment 

Within every definition of empathy, the suspension of judgment is highlight as an essential characteristic.  Regarding the judgment suspension, I am reminded of something John Malkovich said once about characters and the importance of not judging them.  As I’ve observed, this requires a constant questioning, do I understand everything? What am I missing? Where are my blind spots?

A great way to begin answering this question is to first examine those instances where I experienced a lack of empathy from others who were trying to be “helpful”  

For example, in an earlier post I discussed an  abusive and dysfunctional relationship in college.  While I don’t tend to share this story often, it isn’t necessarily a secret.   I have on a few select occasions shared this experiences with people.  One response I real is: “why the hell did you put up with him for so long”, or “why didn’t you leave?”  Then there are those who attempt to be sympathetic yet misconstrue my motives or very nature.  The helpless victim who just lacks self-esteem.

All these responses fall short of the reality of things.  The fact is, I was a child who had experienced chronic invalidation and shame growing up….  

I discuss these experiences in greater length in posts on ostracism, bullying, & rejection amongst extended family members.  A professor I had last quarter made an interesting comment regarding battered women & why they don’t leave.  She noted that the key is to understand the issues they have not worked out.  When she said this, I silently thought to myself what it was I needed to work out.  It was simply a desire to not re-experience the hurt, rejection, and isolation I had in my childhood.  As a parasuicidal teen, who held on for no other reason than not to hurt her family, I met that “it” at a vulnerable time in my life.  I had just left home and was trying to fit in but experiencing difficulty as a freshman.  Years of isolation from sixth grade on, left me feeling “different” from fellow dorm-mates who had “grown up fast”.

It comes down to something I heard John Malkovich say about creating characters.  To do so successfully, you need to view them without judgment.   Doing so requires that we – for a moment – set aside our preconceived notions, and see the world through their personally experienced reality.  What would it be like, if you experienced chronic rejection, isolation, and invalidation as I had growing up?  These experiences were so bad, I was parasuicidal, hanging on day by day, just promising myself to keep going.

I simply desperately sought validation & acceptance from someone as a way of avoiding the possibility of re-experiencing the hurt I had long ago…..

I would take promises of acceptance & validation (even if he never did deliver),  like a carrot on a stick, over nothing at all.

Imagine yourself in my situation as a child, minus the judgment.  There would be  someone who had no other context in which to view herself than what others reflected to her.   You would then be left with a one-sided view of yourself as a result of a lot of unhealed baggage.  This would cause you to seek the first solution to avoid dealing with with the unresolved crap from your childhood.

The idea of re-experiencing the hurt similar to the childhood rejection in my childhood was overwhelming.  I just couldn’t do it.  

I would just like to conclude with some comments by Marsha Lenehan , founder of DBT.  There is a quote from something she published on validating a person’s emotions when they are suicidal.  This notion contradicts the sentiments of workers in the mental health care environment who all make a potion of  telling you that what you did is wrong and you did a bad thing and you were wrong to do this.   There is no one who is simply listening to what you’re saying and appreciating your story and how you feel without judgment that is the critical thing and the thing that often goes overlooked.

“Perhaps nowhere is the ability to empathize with another person more important than when one is interacting with a person who is on the brink of suicide.  This is true whether one’s views one’s task as helping the individual choose continued living over suicide or, more rarely, as helping the individual make a wise chose between suicide and continued life.  The ability both to hold a person within life, when that is needed, depend on an experiential appreciation of the other person’s worldview.  Finding hidden or obscure ways out as well as seeing that there is no way out require both the ability and the willingness to fully enter the experience of the individual ready to suicide and, at the same time, not become that experience…In attempting to apply standard behavioral therapy to severely and chronically suicidal individuals…focusing on client change is often experienced as invalidating by clients who are in intense emotional pain…focusing on understanding in absence of a…efforts help the client change..is often experienced by these same clients as invalidating because it does not recognize the uninsurability….of the present unremitting pain…” (Linehan, 1997, p. 353-354).  

Brene Brown on Empathy

In the above video, Brene Brown begins describing the difference between sympathy and empathy.  As a fan of her work, I feel the need to include this brief view by her in this post.  She states that empathy requires four critical factors:  (1) Perspective taking, (2) remaining nonjudgmental, (3) recognizing the feeling in others and (4) effective communication of this effectively.  In other words, empathy requires much more than putting ourselves in someone else’s shoes, we must be able to effectively communicate this to others. In the next section, we discuss how to communicate empathy effectively.

Rogers on Empathy

“I have come to believe that empathetic listening is one of the most powerful forces for growth that I know…. (Rutsch, 2015).

“…When I can let myself enter the softly and delicately into the vulnerable inner world of the other person…(Rutsch, 2015).

“…When I can temporarily lay aside my views and values and prejudices…(Rutsch, 2015).

“…When I can let myself be at home in the fright, the concern, the pain, the anger, the tenderness, the confusion that fills their lives…(Rutsch, 2015).

 “…When I can move about in that inner world without making judgment…(Rutsch, 2015).

“…When I can see that world with fresh unfrightened eyes…(Rutsch, 2015).

“…When I can check the accuracy of my acceptance with him or her and be guided by the responses I receive…(Rutsch, 2015).

“…Then I can be a companion to that person, pointing at the felt meanings of what is being experienced.  Then I find myself to be a true helper…(Rutsch, 2015).

As I stated earlier, empathy is a two-fold process that involves accuracy of perception & effectiveness of  communication.   In this section I’d like to begin by consider how to communicate it effectively.  After reviewing old papers, I noticed there are two that discuss the effective communication of this concept.  I include them below, for my own education / review….

PAPER #1 – Active Empathetic Listening 

Active empathetic listening is defined as an “active and emotional involvement of a listener during a given interaction – an involvement that is conscious on the part of the listener but is also perceived.” (Prout & Wadkins, 2014, p134). As a multidimensional concept involving sensing, processing, and responding, it isn’t enough to simply attentively listen and consciously process information. Affectively communicating this empathetic understanding is critical as well. With this in mind, what follows are key factors that are of a concern to this author from the standpoint of skill development.

Top-Down Processing & Culturally Inclusive Empathy.

Top-down processing is one of two forms of listening discussed in our course textbook. It involves the utilization of education and experience to contextualize the meaning of the communication with clients. It is a critical counterpoint to the bottom-up processing that exists as at a more automated level in which we respond to what is said at a face value (Prout & Wadkins, 2014, p135).

In fact, when considering the concept of top-down processing in the process of active empathetic listening, the author is reminded of a related concept: Inclusive Cultural Empathy. Discovered coursework elsewhere in this program, it is defined as “a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context” (Pedersen, et al, 2008, p.41).   In considering this concept as a part of the active empathetic listening process, it is clear to this author that such skills require an ongoing lifetime commitment to skill development and self-reflection.

Affect Tolerance & Mindfulness.

Two final concepts are of concern to this author as key skills in the active empathetic listening process. Firstly, our textbook describes affect tolerance as an ability to handle distressing emotions experienced vicariously through hearing the client’s story without “becoming engulfed” (Prout & Wadkins, 2014, p136). Alongside this concept, the textbook mentions the notion of meditation as an ongoing practice. Essential in paying attention more fully, when considering such factors the idea driven home is a realization that one gives to others based on who they are and not just what they do (Prout & Wadkins, 2014). With this in mind, much work on oneself is necessary and essential, as an ongoing process of growth and personal development.

Active-Empathetic Listening Scale

            In this portion of the paper it is the goal of this author to review the Active-Empathetic Listening Scale discussed in our course textbook (Prout & Wadkins, 2014, p135).   As per the instructions I am to rate “how frequently [I] perceive each of the following statements to be true for [me] on a 7-point scale ranging from 1 (never or almost never) to 7 (always or almost always true).” (Prout & Wadkins, 2014, p135)

  1. “I am sensitive to what others are not saying.” (Prout & Wadkins, 2014, p135) – Based on an honest self-assessment I would rate myself around the 6-7 range.
  2. “I am aware of what others imply but do not say.” (Prout & Wadkins, 2014, p135) – Very similar to the question above, I would also place myself around the 6-7 range, depending on circumstances and degree of personal stress.
  3. “I understand how others feel.” (Prout & Wadkins, 2014, p135) – I rate myself at a 7 here. In fact the skill of affect-tolerance is an important skill for me as a result.
  4. “I listen for more than just the spoken words.” (Prout & Wadkins, 2014, p135) – As a mother to a teenager, and CNA/Psych tech, I actually spend quite a bit of time doing this and would be around the 6-7 range.
  5. I assure others that I will remember what they say.” (Prout & Wadkins, 2014, p135) – As mentioned above, I spend the majority of my time caring for others. I’m constantly being asked to reassure others I’ll remember what they are requesting and/or desiring from me. In this respect I do this as well all day long, and would be around the 6-7 range.
  6. “I summarize points of agreement and disagreement when appropriate.” (Prout & Wadkins, 2014, p135) – This factor doesn’t occur as much in the work context for me. In my personal life as much, (as I do agree it is a critical personal skill), I can at times get more caught up in making points than summarizing them. I would at about 5 here.
  7. “I keep track of points others make.” (Prout & Wadkins, 2014, p135) – As stated above, I do need a bit more work here and would rate myself at about a 5.
  8. “I assure others than I am listening by making verbal acknowledgements.” (Prout & Wadkins, 2014, p135) – As someone who cares for others, I do this all day long, and would be in the 6-7 range, in acknowledgement of the fact that nobody can ever be perfect.
  9. “I assure others that I am receptive to their ideas.” (Prout & Wadkins, 2014, p135) – I the context of my work as a C.N.A./psych tech, I am often acting as an “ambassador”. On the one hand there are the needs of the client and on the other hand there are the parameters that need to be followed according with the doctors plan of care. Finally, the hospital has its rules that we all must follow such as visiting hours and no smoking. With this in mind, I also work to reassure clients of this fact, and do my best to advocate for their needs. Based on this fact I would rate myself in the 6-7 range.
  10. “I ask questions that show my understanding of others’ positions.” (Prout & Wadkins, 2014, p135) – This skill isn’t utilized as much in the context of my job. While pretty good at it, I’m probably not as adept as in other areas and am about a solid 6.
  11. “I show others that I am listening by my body language.” (Prout & Wadkins, 2014, p135) – With many stresses and demands in my life, I find my ability to care for others is often depleted by these things.   While I am good at verbally showing that I listen and try my best, sometimes my body languages reflects my exhaustion and stress levels more than anything. I would rate myself at around a 5 here.

Effectiveness of Self-Rating

            After completing this scale, it must be acknowledged that as a self-rating method the results are clearly skewed on that basis. How I think I may come across to others may not be the same as how they tend to experiential first-hand encounters of me. It would be interesting to have key individuals in my life review my answers and provide their own feedback. The ultimate conclusion likely made would be that I may not communicate my intentions as well as I hope to. Additionally, as I will discuss next, any plan for improvement must acknowledge the depth to which these skills exists as core elements of how we choose to be in the context of our lives.   In this respect they really do require an ongoing commitment of personal growth and self-awareness as an lifelong process.

Plan for Improvement

In completing this assessment, this section briefly reviews my plan of improvement. It will combine insights from the scale above, with key skills this author feels are important.

  1. GOAL ONE – Multicultural Competency. Culture exists as an unseen paradigm in our lives defining not just our values and beliefs, but patterns of thinking and overall affective style, (Hays, 2008). With this in mind, active empathetic listening, does require a skill described in literature as inclusive cultural empathy (Pedersen, et al, 2008). Making an ongoing commitment to the development of multicultural competency is critical with this in mind.
  2. GOAL TWO – Mindfulness Practice & Self-Care. – The one biggest lesson from the self-rating scale its reaffirmation of the idea that self-care is critical.   Being there for others requires that I be there for myself first so I have something to give. Alongside this notion, is the idea of a daily mindfulness meditative practice that can aide in reducing stress levels and still my busy mind.
  3. GOAL THREE – Affect Tolerance. – It is natural, when encountering difficult emotions from others in the context of an interaction to take them in to a degree and personally experience them as well. We can take on some of the emotions of others and feel for them in an active empathetic sense. While clearly a good thing in some respects, over-identification is not healthy. This skill has been very critical in the acute mental health setting, and is one that requires much patience and active commitment to engage in at times.
  4. GOAL FOUR – Seek Volunteer Experience for New Learning Opportunities. Yet another insight from the self-rating skill is the fact that certain elements of active empathetic listening are practiced more than others.   When reflecting on the reasons underlying this, the hospital environment I work in, seems conducive to some forms of listening over others.   Engaging in brief communication more often than lengthy discussion, certain skills aren’t practice as much. It would be necessary, therefore, to seek other volunteer opportunities to engage with clients in a different capacity than what I’m familiar with at work.
  5. GOAL FIVE – Improve Listening Skills. Reviewing the basic listening and interviewing skills periodically, and being mindful of them as I engage with others, can be an effective way of learning to naturally incorporate them in the context of my interaction with others. 

Paper #2 – Inclusive Cultural Empathy

Culture and Emotion

The singular most beneficial lesson throughout this course is the realization of how culture exists as an unseen paradigmatic influence in our lives.   Definitive of our worldview, it represents a learned perspective that consists of instilled values, beliefs, and norms.

Beyond these obvious influences though, are less visible culturally impacted factors such as identity, emotion, and metacognition. Discussed often from a psychological, individually reductionist perspective, this paper will instead provide a unique sociocultural point-of-view of matters.

In determining the exact focus for this paper, I chose the topic of culture and emotion based on insights gained from the second exploratory paper activity. In the process of reviewing related literature for an interview with my mother, I came across the following:

“To the Filipino, actions always speak louder than words, so instead of conveying love and fondness with words, parents will endure extended periods of separation and/or hold down two jobs so that they can send their children to the best schools, pay for lessons and activities, and provide material support and other opportunities. This is the way they express their affection, and children are expected to recognize and value it. If they do not express or show appreciation, parents might perceive them as lacking utang na loob – serious infraction of social mores.” (Fortune, 2012, p12).

This quote manages to summarize a huge misunderstanding that existed between my mother and I throughout much of my childhood. As an American child, I failed to understand my Filipino mother’s expressions of love through action, (Fortune, 2012).   Preferring to hear and witness outwardly visible affective indicators of her love, it was instead an unseen dedication to her duty as my mother. As I only am able to contextualize now, it seems the underlying the cultural gap between us, was the byproduct of a failure to acknowledge key differences among us. At the core of these differences were varied views of what it means to be a person in the world, and what perspective we are to take it in from.

With this in mind as the focus of the paper, I begin with a discussion of the concept of inclusive cultural empathy. This concept provides a view of empathy from a unique multicultural perspective. Understanding how this concept as it relates to the overall notion of culturally competent counseling is critical if I am to effectively communicate it in such a manner. Also included in this paper is a brief review of the relationship between emotions and culture, and concluding commentary on with how to incorporate these insights into my future career development.

Inclusive Cultural Empathy.

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42). From this perspective, empathy can be thought of as an ability to understand another’s experiences as if they are your own.   Best understood as an ability to relate to others due to shared experiences, the western Euro-American definitions predominating mental health are clearly problematic (Pedersen, et al, 2008). With traditional conceptions of empathy tending to reflect this cultural viewpoint, a more culturally inclusive perspective is vital. (Chung, 2002; Pedersen, et al, 2008).  What follows is a definition of this concept from literature:

“Inclusive Cultural Empathy describes a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context.” (Pedersen, et al, 2008, p.41)

In light of this definition, it is useful to note that providing empathy in a culturally relevant manner requires more than simply understanding. Adding to the ability to “put yourself in the clients shoes”, is the notion of being able to adeptly communicate this (Pedersen, et al, 2008). After all, as a shared experience the therapist communicates and the client experiences, this notion encompasses two often culturally diverse perspectives. With culture as the key divergent component it is important to understand its influences over our emotions and our preferred means of affective communication. Therefore before beginning to discuss inclusive cultural empathy as a component in multicultural counseling I will discuss research on the nature of emotion from both a cultural and biological perspective.

Understanding Emotion.

“Emotions can be defined as psychological states that comprise thoughts and feelings, physiological changes, expressive behaviors, and inclinations to act.” (Vohs, et al, 2007, p285). Overall, two divergent perspectives exist regarding research that focuses on the nature of emotion.  Appraisal theories are based on the premise that emotions result from the way we appraise and interpret our environment. Research that utilizes this theoretical perspective focuses on culture and its influence over our manners of emotional regulation, perception and interpretation (Ellsworth, 1994). In contrast to this, categorical theories tend to view emotions as universal, innate and discrete.   Focusing on basic emotions such as fear or sadness, research from this theoretical perspective tests the hypothesis that feelings are hardwired byproducts of neural programming. (Ellsworth, 1994, p28).

Then & Now.

In reviewing literature for this paper, I found it interesting that research seemed to reflect the field’s developmental history overall. Based upon a predominantly westernized Euro-American perspective, the mental health field historically focused on DSM-based empirical data (Hays, 2008; Pedersen, et al, 2008). Along the way, notions such as social context and cultural relativitism seem to have been forgotten until recently. Interestingly, it seems the meaning of empathy in literature has undergone a shift in definitive focus reflecting these changes:

“The underlying assumptions about psychology are moving from a mono-cultural to a multicultural basis with profound consequences for counseling. The old rules of psychology focused on dissonance reduction. The new rules focus on the tolerance of ambiguity.” (Pedersen, et al, 2008, p224)

As per this historical shift, I begin with a review of biological perspectives of emotions, and then discuss emotions in relation to culture. I will then conclude by reviewing inclusive theories providing insights from both perspectives.

Emotion: A Biological View.

Universality Thesis. Some research exists that focuses on a limited number of innate and universal emotions as “basic” in nature. (Ellsworth, 1994). Described as matters of neural programming hardwired into the species overall, this research reflects a “Universality Thesis of Emotions.” (Effenbein & Ambady, 2002). While still asserting some degree of cultural variation this perspective stresses the universality to facial expressions in relation to basic emotions across culture. (Ellsworth, 1994; Ekman & Friesen, 1971). Referred elsewhere as categorical theories, research utilizing this perspective comprises the following key propositions: “(1) universality of facial movement as a form of emotional expression, (2) universality of attribution and understanding of key facial expressions, and (3) an associated rate of correctness regarding these attributions across culture” (Russell, 1994).

Examples of Studies. In one study by researchers Ekman & Friesen, the universality of facial expressions across cultures, was examined (Ekman & Friesen, 1971).   Using samples of individuals from cultures with little exposure to western society, research results supported their hypothesis, (Ekman & Friesen, 1971). Nonetheless, it is important to note in this research that “The growing body of evidence of pancultural element in emotional facial behavior does not imply the baselessness of cultural differences” (Ekman & Friesen, 1971).

While this study exists as an example of research that predominated the field prior to its focus on multicultural competency, recent literature focuses on contextualize these results. For example, Elfenbein & Ambady in 2002 re-examine the universality of emotional recognition, (Elfenbein & Ambady, 2002). In this study, it is found that while emotions were universally recognized, varied degrees of accuracy were noted. With greater in-group accuracy in expression and recognition, an advantage was also seen in culturally diverse settings (Effenbein & Ambady, 2002). Also notable was the fact that minority groups displayed greater degrees of accuracy in recognizing emotions from majority groups, as opposed to the other way around, (Elfenbein & Ambady, 2002).

Emotion: A Cultural Perspective.

Appraisal Theories. Appraisal theories of emotions interpret emotions as byproducts of the way people interpret and understand their environment, (Ellsworth, 1994). Research utilizing this theoretical perspective has traditionally focused on a few key dimensions such as: (1) individualism/collectivism, (2) certainty/uncertainty (3) Attention to Novelty (4) Valence/Degree of Perceived Pleasantness, (Ellsworth, 1994). Differences in emotional expression are largely attributed to emotional regulation, stating that culture defines the beliefs about appropriateness of emotional expression. Accounting for differences in understanding of emotional expression, the assertion is made that culture “provides a framework for understanding culturally general emotional phenomena,” (Ellsworth, 1994). With this as a quick and dirty overview of current research from this perspective, what follows are key insights I found particularly intriguing.

Emotion as a Social Function. Emotions function as cultural scripts that are comprised of an array of biological and cultural factors, (Kitayama & Markus, 1994). Developed as a result of individual, interpersonal and collective experiences, they represent culturally constructed adaptations to our surroundings. In this respect emotions are a “psychological process that may be seen primarily as social and cultural in nature” (Kityama & Markus, 1994):

Emotion as a Perceptual Process. When viewed within the context of a perceptual process, emotions can be seen as a level of readiness in response to immediate events (Frijda & Mesquita, 1994). For example, individuals experience emotions in response to events they encounter that are deemed significant. This significance is determined by the manner in which this situation is then appraised. This form of appraisal exists as a byproduct of both individual temperament and cultural influences. Culturally this appraisal reflects a system of meanings that are social in origin. Emotion then can be seen as a form of readiness to act, that reflects norms of expression based on cultural imbued interpretations (Frijda & Mesquita, 1994).

Emotion From a Goffmanesque Perspective. Yet another perspective of emotions can been seen when taken in the context of social interaction.   From this perspective they aren’t internal affective states influenced by cognition but a form of interaction with others and our surroundings. (Frijda & Mesquita, 1994). For example, witnessing emotional displays in others can be viewed as a social event. In expressing these feelings we “transmit important messages about ourselves in relation to our surroundings” (Leu, 2001). When we then interpret someone’s behavior we do so within the framework of norms regarding behavior, and cultural meaning systems. As a result of this event appraisal and the emotional responses we can then respond accordingly. Emotion in this respect contains five characteristics reflective of culture including: “1. quality, 2. intensity, 3. behavioural expression, 4. the manner in which they are managed and 5. Organization.” (Leu, 2001) This all occurs within what may be called a cultural framework defined as follows:

“A cultural framework includes a group’s sense of and attitudes toward emotions, that is what emotions are or feelings are, why they are experiencing, and what their significance is in social life, as well as the implicit answers to questions like when does one feel, where does one feel, and how does one feel.” (Frijda & Mesquita, 1994, p.99)

Culture & Biology: An Integrated Perspective.

In pulling together the insights from all of the above research, it seems to me all of the insights above play a part as elemental insights into what makes us work as humans. In other words, there are both biological and cultural factors that exist in influencing emotions. What follows is an example of research that considers particular/cultural factors, alongside the universal/biological ones.

Affect Valuation Theory. In an article titled, “Cultural Variation in Affect Valuation”, a key differentiation is made between ideal and actual affect, (Tsai & Fung, 2006).   Whereas our ideal affect reflects what we want to feel, our actual affect reflects our current emotional state. Based on the Affect Valuation Theory this research hypothesizes a difference between ideal and actual affect with greater cultural influence on ideal affect preferences, (Tsai & Fung, 2006).

With results of the study supporting their hypothesis, a brief example is provided that compares collectivist and individualistic cultures. With an individualistic cultural orientation likely to endorse values such as elation and excitement, participants from such cultures are likely to express this as an ideal affect orientation (Tsai & Fung, 2006) In contrast to this, collectivist cultures value a calm peaceful and relaxed state and participants are likely to endorse these as ideal affect preferences (Tsai & Fung, 2006).

As an interesting side note to this, it may be useful to mention the Marsha Linehan’s research that focuses on the concept of Dialectical Behavioral Therapy. I learned about this theory while in therapy myself.   Differentiating between primary and secondary emotions as a way of better understanding our emotions, it is a useful application to the above research.

While primary emotions comprise our immediate reactions to an event, our secondary emotions are aessentially our own interpretations of our emotional states. In other words, secondary emotions exist as “feelings about our feelings”. Utilizing the above research as an example, individuals from a collectivist culture would display more negative reactions to their own displays of excitement as a result of their own cultural references.

Empathy & Multicultural Counseling.

“Empathy has been described as the counselor’s ability to enter the client’s world, to feel with the client rather than for the client, and to think with the client rather than for or about the client. Empathy requires the therapist’s ability and effort to place him- or herself symbolically in the position of the client and understand the client’s world, “(Chung & Bernak, 2002, p154).

After a brief review of relevant literature on the nature of emotion and its relation to culture, a clearer understanding of inclusive cultural empathy seems vital. What follows is a bit of clarification on the concept, and how it fits in within the concept of cultural competency.

Clarifying the Concept.

Defined as an ability to put yourself in someone else’s shoes, empathy is a culturally relevant concept. Traditional perspectives of empathy are naturally self-limiting, based on a perspective that is largely empirical and individualistic in orientation. In contrast, culturally inclusive empathy is a useful dynamic perspective that requires two seemingly divergent viewpoints. Essentially, this concept requires that a counselor hold onto their own cultural perspective while maintaining an appreciation for their client’s culture (Chung & Bernak, 2002). Ensuring the counselor holds onto their own cultural perspective can be a useful and essential assurance against potential countertransference (Chung & Bernak, 2002) At the same time, appreciating and understanding a client’s culture is critical in the difference between sympathy and empathy (Chung & Bernak, 2002).   With this clarification in mind, what follows are key recommendations for the development of inclusive cultural empathy.

Developing Inclusive Cultural Empathy.

It seems in reviewing all of the above research, the best advice I found to develop inclusive cultural empathy existed as a reiteration of what I learned in this course. Essentially, two bits of advice stand as key insights I intend to utilize in moving forward. I discuss these each in turn below.

Attitudes, Knowledge, & Skills.  The concept of inclusive cultural empathy can best be understood as a dynamic process that exists as an exchange between client and counselor, (Pedersen, et al, 2008). It comprises three key skills: Affective Acceptance, Intellectual Understanding, & Appropriate Interaction (Pedersen, et al, 2008). With intellectual understanding best understood as a knowledge of similarities and differences, it is an essential to note this is not enough in and of itself. Affective acceptance requires that a counselor acknowledge culturally learned assumptions underlying divergent forms of affective communication (Pedersen, et al, 2008).  Finally, effectively communicating this means developing key interactive skills and abilities through ongoing direct contact within the community (Pedersen, et al, 2008). It is interesting to note that this discussion reflected much of what discussed in the class handout titled, “AMCD Multicultural Counseling Competencies” (Arredondo, et al, 1996).

An Ecclectic MAP/FACTS Approach. Alongside this ongoing commitment to the development of key skills as they relate to inclusive cultural empathy, is the need to utilize what our textbook describes as an eclectic approach, (Hays, 2008, p176):

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176)

Firstly utilizing the “Addressing Model” in a modified Axis-6 relevant to the DSM-5 (Hays, 2008), it will be essential to assess for sociocultural context throughout the counseling process, (Hays, 2008). Additionally, ongoing case conceptualization in the form of ongoing hypothesis formulation and testing will be important (Johnson, 2013; Pedersen, et al, 2008; Thomas 2007).  This ongoing hypothesis testing can occur much as described in the five-part FACTS Method approach including question formulation based on a knowledge and experience, and then assessing and adjusting as necessary, (Hays, 2008; Johnson 2013; Pedersen, et al, 2008; Thomas, 2007).   In conclusion, I wrap up this paper with a quote from an article titled “The relationship of culture and empathy in cross-cultural counseling.” (Chung & Bemak, 2002) This article contains a listing of seven useful guidelines in communicating cultural empathy:

“Counselors will not be effective working with clients from different cultural backgrounds if they cannot communicate cultural empathy in a way that demonstrates that they understand and appreciate the cultural differences and their impact on the therapeutic process.   Ridley (1995) identified the following seven guidelines for communicating cultural empathy….(a) describe in words to the client his/her understanding of the client’s self-experience; (b) communicate an interest in learning more about the client’s culture; (c) express lack of awareness regarding the client’s cultural experience; (d) affirm the client’s cultural experience; (e) clarify language and other mods of cultural communication; (f) communicate a desire to help the client work through personal struggles and challenges; and, (g) at an advanced level, help the client learn more about himself or herself and become more congruent.” (Chung & Bemak, 2002, p157)

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References

Abraham Lincoln University, (n.d.) Counseling Skills & Techniques.  Retrieved from:  http://courses.aiu.edu/COUNSELING%20SKILLS/10/10.pdf
Australian Institute of Professional Counselors, (n.d.).  Counselor skills series: Verbal & non-verbal communication skills.  Retrieved from:   http://courses.aiu.edu/COUNSELING%20SKILLS/10/10.pdf
Arredondo, P., Toporek, M.S., Brown S., Jones, J., Locke, D.C., J. and Stadler, H. (1996) Operationalization of the Multicultural Counseling Competencies. AMCD: Alexandria VA.
Chung, R. C., & Bernak, F. (2002). The relationship of culture and empathy in cross-cultural counseling. Journal of Counseling and Development : JCD, 80(2), 154-159.
Drab, K. (n.d.) The top ten counseling skills.  Retrieved from:  http://www.people.vcu.edu/~krhall/resources/cnslskills.pdf
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Frijda, N. H., & Mesquita, B. (1994). The social roles and functions of emotions. In S. Kitayama,            & H. R. Markus (Eds.), Emotion and culture: Empirical studies of mutual influence. (pp.    51-87) American Psychological Association. Retrieved from: doi:http://dx.doi.org/10.1037/10152-002
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Feeling the Incompetence

4/5/2017 @ 3:30 p.m.

I know this is the most retarded thing in the world but I’m trying to do is make the most of every available free second in my life. I’m trying to dictate a post for my blog while playing the role of taxi cab driver. I spend way too much time in this car, waiting to pick up or drop people off.  I discovered this feature on my Microsoft word app that allows me to utilize the microphone function to dictate documents! Yipee! Now I can begin writing in a way that prevents me from examining. No more careful editing allowed, only random stream-of-thought dictation. Exactly what I need to institute the changes I’ve been hoping to make on this blog 

My biggest frustration right now is just simply a feeling total incompetence.

How can abstract academic knowledge translate into practical action-based counseling skills? I guess the two are not one in the same. My attempts at counseling have focused on those basic rapport-building and listening skills. This morning during a session with a new client I really began to about worry how I could help the client achieve their goals. That delicate balancing act of building a rapport while attaining information during the interview, proved frustrating. I still haven’t mastered the art of taking notes in a manner that is not distracting to the client.

Later that morning, when I expressed these concerns to my internship supervisor he simply joked: “Give it About Five Years.” While I do appreciated this light-hearted response, a child-like impatience grew that yelled: “Goddamnit I don’t want to wait five years!!! I hate feeling clueless! This whole clueless head-up my-ass feeling is growing old.”

However, this complaining is getting me nowhere, right?

The insight of a fellow intern sticks in my mind right now. She’s just fine with the idea of not knowing what the hell she’s doing and is taking it one-day-at-a-time.   I admire here perspective. I’m feel like I’m running off empty and trying my best to carefully balance every aspect of my life.  Its like a minefield.  One wrong step and all the cookies begin to crumb.e  There’s no room left for error.

04/06/17 @ 8:30 a.m.

It’s now 8:30 and I just arrived at my internship site. I am sitting in the car right now, and trying to wipe the tears from my face.

I have an appointment at nine & need to pull myself together….

That post I wrote last night was big trigger, in ways I hadn’t realized. I will have to share it with my psychiatrist tomorrow. I was reading through this morning to check for typos while eating breakfast when a lump began to form in my throat. I then berated myself for even looking at this post today: “You should know better than to read this now, there’s no time for tears, you have an appointment!!!” I began to recall my husband’s concerns last evening while we were sitting on the sofa together. He was watching some car show on t.v. while I sat next to him, type on my latest blog post. Feelings of anger and sadness filled my mind as I furiously typed, and I suppose the emotions were clearly palpable from his end…..

Anyway in a desire to avoid my tendency to intellectualize, I’m simply letting the emotions flow for 5 minutes. I am crouched down in the car right now looking for a piece of old tissue paper so I can blow my frickin’ nose. As I furiously attempt to fix my makeup I begin praying to God for serenity….

04/06/17 12:00 noon

It is now lunchtime and I now have time to reflect on how my morning sessions went. I actually felt a sense of competence and that I was able to connect with my client. It actually felt good, and that we were able to connect.   Despite everything that I have going on I feel that this is job is something that’s I’m meant to do. I find working with others as a healing and growth process. I’m grateful to have the experience. So I guess well I’m trying not to get cocky, I have acknowledge that there are some basic skills sufficiently in place. Mind you, there are not impressive – per se – just the sort of thing that my supervisor is always telling me to focus on

The events of this day have pointed at two clear facts.  FIRSTLY, I need to improve my level of self-care & figure out a way to carve out more time for myself.   SECONDLY, I need to step back & relax.  I’ll get there in good time. Below, is a diagram from a textbook for the first class I took in this program.  It provides an overview of all the essential basic counseling skills that I need to attend to. I will discus each below and provide links to each….

Image: 1, 2,

References

Ivey, A.E; Bradford Ivey, M; & Zalaquett, C.P. (2010). Intentional Interviewing and Counseling.  Belmont, CA:  Brooks/Cole.

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