define paraphrasing in counseling

Reflecting and Paraphrasing

Part of the ‘art of listening’ is making sure that the client knows their story is being listened to.

This is achieved by the helper/counsellor repeating back to the client parts of their story. This known as paraphrasing .

Reflecting is showing the client that you have ‘heard’ not only what is being said, but also what feelings and emotions the client is experiencing when sharing their story with you .

This is sometimes known in counselling ‘speak ‘as the music behind the words .

The counselling skill of paraphrasing is repeating back to the client parts of their story

2 FREE Downloads - Get your overview documents that describe reflection and paraphrasing and how they are used in counselling.

Free handout download.

Click here to download your Reflection in Counselling handout

Click here to download your Paraphrasing in Counselling handout

It is like holding up a mirror to the client; repeating what they have said shows the client they have your full attention. It also allows the client to make sure you fully understood them; if not, they can correct you.

Reflecting and paraphrasing should not only contain what is being said but what emotion or feeling the client is expressing.

Let’s look at an example:

Client (Mohammed): My ex-wife phoned me yesterday; she told me that our daughter Nafiza (who is only 9) is very ill after a car accident. I am feeling very scared for her. They live in France, so I am going to have to travel to see her, and now I have been made redundant, I don’t know how I can afford to go.

Reflecting skill in counselling is showing you understand what the client said as well as the emotions it brings up for the client

Counsellor: So, Mohammed, you have had some bad news about your little girl, who has been involved in an accident. You are frightened for her and also have worries over money now you have lost your job.

Client: Yes, yes ... that’s right.

Notice that the counsellor does not offer advice or start asking how long Mohammed and his wife have been separated, but reflects the emotion of what is said : ‘frightened' and 'worries'.

Reflecting and paraphrasing are the first skills we learn as helpers, and they remain the most useful.

To build a trusting relationship with a helper, the client needs not only to be ‘listened to' but also to be heard and valued as a person.

"Reflecting and paraphrasing should not only contain what is being said but what emotion or feeling the client is expressing."

Definition of Reflection in Counselling

Reflection in counselling is like holding up a mirror: repeating the client’s words back to them exactly as they said them.

You might reflect back the whole sentence, or you might select a few words – or even one single word – from what the client has brought.

I often refer to reflection as ‘the lost skill’ because when I watch counselling students doing simulated skill sessions, or listen to their recordings from placement (where clients have consented to this), I seldom see reflection being used as a skill. This is a pity, as reflection can be very powerful.

When we use the skill of reflection, we are looking to match the tone, the feeling of the words, and the client’s facial expression or body language as they spoke .

For example, they might have hunched their shoulders as they said, ‘I was so scared; I didn’t know what to do.’

We might reflect that back by hunching our own shoulders, mirroring their body language while also saying ‘I felt so scared; I didn’t know what to do.’

Using Reflection to Clarify Our Understanding

We can also use reflection to clarify our understanding, instead of using a question.

For example, suppose the client says:

‘My husband and my father are fighting. I’m really angry with him.’

For me to be in the client’s frame of reference, I need to know whether ‘him’ refers to the husband or the father. So I might reflect back the word ‘ him ’ with a quizzical look.

The client might then respond:

‘Yeah, my dad. He really gets to me when he is non-accepting.’

So you can get clarification in this way. You can adjust where you are to make sure that the empathic bond is strong and that you are truly within the client’s frame of reference.

"When we use the skill of reflection, we are looking to match the tone, the feeling of the words, and the client’s facial expression or body language as they spoke".

Definition of Paraphrasing in Counselling

Paraphrasing is repeating back your understanding of the material that has been brought by the client, using your own words.

A paraphrase reflects the essence of what has been said .

We all use paraphrasing in our everyday lives. If you look at your studies to become a counsellor or psychotherapist, you paraphrase in class.

Maybe your lecturer brings a body of work, and you listen and make notes: you’re paraphrasing as you distill this down to what you feel is important.

How Paraphrasing Builds Empathy

How does paraphrasing affect the client-counsellor relationship?

First of all, it helps the client to feel both heard and understood. The client brings their material, daring to share that with you.

And you show that you’re listening by giving them a little portion of that back – the part that feels the most important. You paraphrase it down.

And if you do that accurately and correctly, and it matches where the client is, the client is going to recognise that and to feel heard: ‘ Finally, somebody is there really listening, really understanding what it is that I am bringing.’

This keys right into empathy, because it’s about building that empathic relationship with the client. And empathy is not a one-way transaction .

..."Empathy [is] the ability to ‘perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto as if one were the person, but without ever losing the 'as if' conditions." Carl Rogers (1959, pp. 210–211)

In other words, we walk in somebody’s shoes as if their reality is our reality – but of course it’s not our reality, and that’s where the ‘as if’ comes in.

I’ve heard this rather aptly described as ‘walking in the client’s shoes, but keeping our socks on’!

Empathy is a two-way transaction – that is, it’s not enough for us to be 100% in the client’s frame of reference , understanding their true feelings; the client must also perceive that we understand .

When the client feels at some level that they have been understood, then the empathy circle is complete.

Spotted out-of-date info or broken links? Kindly let us know the page where you found them. Email: [email protected]

Clinical psychology

Anxiety disorders
Feeding and eating disorders
Mood disorders
Neuro-developmental disorders
Personality disorders
Affirmations
Cover Letters
Relationships
Resignation & Leave letters

Psychotherapy

Personality.

Table of Contents

How Can Paraphrasing Be Used in Counseling? (3+ Main Indications)

As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.

The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.

In this article, we will be discussing the topic: paraphrasing in counseling, which is one of the main counseling skills of a counselor. We will be looking at nature, importance, and the way of using this skill in the process of counseling.

Paraphrasing in counseling

Paraphrasing refers to one of the counseling skills which holds paramount importance in the process of counseling. It is that skill which the counselor uses to repeat what the client has said at the present moment using fewer words and without any intention of changing the meaning of what the client conveyed through his words.

The main intention behind paraphrasing is to feedback on the essence of what the person has just said. Paraphrasing is useful in the following situations:

When you want to let the client know that you are actively listening and understanding the information provided by the client
When you want to clear and clarify doubts concerning confusing content, given by the client.
When you want to highlight issues that need more explanation and precision
When you want to evaluate the accuracy of your perceptions as a counselor.

Though paraphrasing looks quite simple and quick, it demands a sufficient amount of concentration and articulation skills from the side of the counselor. It is more difficult than it appears to be. While paraphrasing the words of the client, they should not end up feeling interrupted or misunderstood, in the process. The paraphrase should be kept, short, precise, and simple. There must be no unwanted complications or assumptions involved in it.

Although, if the paraphrase is kept too short, it would make the client feel confused and sometimes, dejected for being interrupted in between. Hence, paraphrasing must be initiated and put into action in a non-complex and understanding manner. It is very important to practice paraphrases that come in various lengths, variations of content, or emphasis of the wording. This will help you to understand what works best for your intentions and goals, as a counselor.

It is also important to understand that over-reliance on paraphrasing to the point of avoidance of reflection is indicative of discomfort on the part of the counselor, for encouraging the client to be emotionally open and expressive.

Emphasis on essence

The intention of a counselor, when using paraphrases must be to reveal the essence of the client’s words. The client should get clarity, in terms of the paraphrases you use to communicate with them and must not feel confused or at loss for words once they’ve heard you out. They must be able to smoothly continue with their communication and not be intimidated or taken aback by your choice of words.

Growth of empathy

Paraphrasing in counseling has a huge impact on the relationship between the therapist and the client. First ad foremost, it aids both the therapist and client to feel heard and understood. This forms the foundation for the client-therapist relationship. The client feels more free and brave to share their innermost and private experiences with the therapist. In turn, the therapist actively listens to the client and provide genuine feedback to the client on the most relevant parts of the client’s information using paraphrasing.

If paraphrasing is carried out accurately and without the creation of confusion, it helps the client in recognizing the effort of the therapist and the amount of empathy the therapist holds for their state of mind. Hence, paraphrasing, in one way, helps in building the empathetic relationship between the client and the therapist which is important as empathy is not a one-way transaction.

This is because it is important for the client to feel the empathy that is being conveyed by the counselor. Empathy is not just the counselor being able to put themselves in the client’s state of mind and understand their issues. It also involves the client receiving the empathetic energy that is being conveyed through the words and actions of the counselor.

A form of acknowledgment

Paraphrasing is a form of acknowledgment that is provided by the counselor. This is done by mindfully restating the words of the client, conveying empathy, acceptance, and genuineness. A therapist’s role does not comprise of reading the minds of the clients or assuming their emotional states. Hence, it is very essential to learn the art of rephrasing the client’s words briefly and acknowledge them with honesty.

By engaging in paraphrasing, you are letting the client know that you are understanding what they are trying to convey and you are ready to be corrected in case of any misunderstanding.

The important thing to be kept in mind is not to make judgemental statements or use biased terms in the form of paraphrases. This puts off the client and makes him/her trust the therapist less. You must allow the client to come to conclusions on their own and not put words in their mouth.

Tone of voice

It is a good thing to keep a tab on the tone of voice used with the client while paraphrasing the client’s words. Be mindful of the following:

A high or low voice
A loud or soft voice
Fast or slow voice
Accommodating or demanding
A lighthearted or gloomy voice

Be aware of the moderations used in voice, pitch, tone, and your body language as well. The client places an immense amount of trust in the therapist and they tend to remember how the therapist made them feel, at the end of the process. Therefore, it is imperative to be careful and gentle while dealing with clients and the information they provide. At the end of the day, the aim of the counselor must be to help the client feel validated and more confident through the usage of paraphrases.

Alternatives that do not define paraphrasing

Paraphrasing is not equivalent to repeating what the client just said. That is called repetition. Paraphrasing involves empathetic understanding and the right choice of words to help the client feel safe and heard.
Parroting the words of the client reveals the idea that the therapist is not there with the client mentally and might cause irritation and frustration in the client. Eventually, they might even stop communicating, as a consequence.

In this article, we discussed the topic: paraphrasing in counseling. We saw the importance of paraphrasing as a counselor’s skill, its emphasis on the essence, how it helps in the theme growth of empathy, and things to be kept in mind while using paraphrases.

FAQs: paraphrasing in counseling

Why do counselors use paraphrasing.

Paraphrasing is one of the most important skills that is required, in the process of counseling. Paraphrasing in counseling is a way of responding, which informs the client that the counselor has precisely heard what the client has conveyed. These kinds of paraphrases, encouragers, and summaries are important and helpful for the client to feel understood in the process of counseling. They make the client feel more comfortable and less vulnerable in the relationship with their therapist. Paraphrasing and summarising are active and efficient ways of communicating to the client that they have been heard.

What is the difference between paraphrasing and reflecting in counseling?

The difference between paraphrasing and reflecting in counseling is that in paraphrasing you are only summarizing what the client has conveyed. When the client conveys certain information to you, you use paraphrasing skills to reaffirm the meaning of what the client conveyed through his words. On the other hand, the skill of reflection is slightly different. In reflection, you go beyond the process of summarizing what the client said to try to identify the feelings and thought patterns the client may have not identified, but their words and attitudes indicate the presence of such feelings and thought patterns.

How do you reflect in counseling?

Reflection is an extremely useful and comprehensive skill use by counselors in the process of counseling. It can be compared to holding up a mirror to see the reflection of yourself in it. While reflecting on what the client said, you repeat the client’s words back to them in the exact way they conveyed it to the therapist. In the process, the therapist might choose to reflect on a selected set of words, the whole sentence, or sometimes, just a single word is used for the purpose. This helps the client in gaining insight into his thought process and how it works. It also helps him to connect many events in his life to his way of thinking and feeling and how it affected those events. Clients find the process of reflection a potential tool for growth and meaningful understanding of their obstacles in the process of counseling and how to overcome them.

How is paraphrasing helpful?

Paraphrasing is important for the mutual understanding of both the client’s and the therapist’s understanding of the client’s situation. It helps the client in revealing the source of his thoughts and emotions in many instances and it acts as a breakthrough for the client in the process of counseling. The therapist also makes good use of the paraphrasing skill to confirm and reaffirm the meaning and tone of emotion used to convey anything that is said by the client, to clear the air of doubts or confusions and make the process of counseling smooth and hassle-free. It provides a good deal of understanding between the client and the therapist.

What are some counseling skills?

The most essential and primary ten skills required in counseling are as follows:

Listening: the counselor must be able to provide their undivided and complete attention to the client, while they are sharing their thoughts, emotions, and their queries. Empathy: the counselor must be empathetic, genuine, non-biased, and able to sincerely understand the emotional state of their clients. Genuineness. Unconditional positive regard: the counselor must be non-judgemental and completely accepting of the client as a person, without any expectation of personal gain or rewards. being concrete Open-ended questioning: open-ended questioning is a form of questioning process which is used to assist the client in clarifying or exploring thoughts. Self-disclosure of the counselor Meaningful interpretation and explanation skill Appropriate and helpful delivery of suggestions, when needed Consistent removal of obstacles in the way of change.

What is the primary goal of counseling?

The primary goal of counseling is to enable the client to make their own decisions, concerning various aspects of their life, such as career, education, personal growth, relationships, and health. The client should be able to think and act for themselves, without the aid of external influential sources. Counseling will help the clients gain information and also to clarify emotional concerns that may interfere with or be related to the decisions involved. It enhances their problem-solving skills and let them depend less on people’s opinions and judgments.

http://www.csun.edu/~hcpsy002/Psy460_GrpTask05_Paraphra.pdf

https://counsellingtutor.com/basic-counselling-skills/reflecting-and-paraphrasing/

https://www.basic-counseling-skills.com/paraphrasingtone.html

Was this helpful?

Find hope and healing through online counseling on betterhelp.

At some point in our lives, we all face challenges that can feel overwhelming and difficult to overcome.

BetterHelp offers accessible, affordable, and confidential online counselling that can provide you with the support and guidance you need to navigate life’s ups and downs. Our licensed therapists specialize in a variety of areas, including depression, anxiety, relationships, and more, and can provide you with personalized therapy that fits your unique needs and circumstances.

Don’t struggle alone – sign up for BetterHelp today and start your journey towards healing and growth with the help of a compassionate and experienced therapist.

How to tell your therapist you want to take a break, betterhelp negative reviews, does talkspace take medicaid (+3 advantages).

Paraphrasing in Counselling

Table of Contents

In essence, paraphrasing is a micro skill that allows counselors to create an authentic bond with their clients Together with encouraging and summarizing, paraphrasing plays a crucial role in therapeutic communication, making the client feel understood and listened to. In other words, paraphrasing in counseling is what makes the client say, “ Finally, someone who understands what I’m going through.” Without this essential ingredient, counseling sessions would be nothing more than dull and impersonal exchanges of ideas.

What is the difference between reflecting and paraphrasing in Counseling?

Paraphrasing and reflecting are close synonyms for most people, both playing a crucial role in any form of communication.

Although paraphrasing and reflecting are fundamental counseling communication skills [1], these two processes can have slightly different connotations in a therapeutic context.

In essence, reflecting is like putting a mirror in front of your clients, helping them gain a better sense of the thoughts, emotions, and behaviors they experienced in a situation that has meaning for them.

Of course, this does not mean you have to parrot their message; simply highlight the link between different ideas and emotions and how one influences the other.

When reflecting, it is vital to match the client’s tone and even body language so that he/she knows that you’ve received the message and the feelings that accompany his/her story.

On the other hand, paraphrasing is about capturing the essence of their story with a brief statement that emphasizes the underlying emotional vibe.

This technique is particularly useful when clients know how ideas and emotions can merge to create a subjective experience, but you want them to feel understood and listened to.

In a way, we could argue that paraphrasing is a brief version of reflecting.

Let’s look at a brief example of paraphrasing in counseling:

Client: I had a huge fight with Andrew last night. At some point, he stormed out and didn’t come back ‘til morning. I tried calling him all night, but his phone was switched off. I was worried sick and thought he did something stupid. This whole thing was like a nightmare that I could not wake up from.

Therapist : It seems this unpleasant event has put you through a lot of fear and anxiety.

Now let’s take a look at reflecting:

Therapist : I can only imagine how terrifying it must have felt to see your partner storm out after a huge fight without telling you where he is going or when he’ll be back.

As you can see, both processes require active listening. But while paraphrasing is a short statement that highlights the emotional tone of the situation, a reflective response captures “the vibe” of the story, along with other essential details.

How do you paraphrase?

Start by listening.

Whether the purpose is to paraphrase or reflect, listening is always the first step.

Through active listening, counselors gain a better sense of what their clients have experienced in a particular situation. Active listening means looking beyond the surface and trying to connect with the client on an emotional level.

To achieve this level of emotional depth, counselors listen with both their ears and their hearts. That means putting themselves in their clients’ shoes and zeroing in on the emotional aspect of the experience.

Focus on feelings and thoughts rather than circumstances

When we listen to another person’s story, the most visible aspects are related to the actual events that he or she has gone through.

But details like names, dates, locations, or other circumstantial issues are less relevant than how the person interpreted and consequently felt in a particular situation.

When it comes to paraphrasing, counselors are trained to look beyond circumstances and identify why a client has chosen to talk about a particular event.

In almost every case, the reason is a set of emotional experiences.

Capture the essence of the message

Although people can experience a wide range of emotions in a given situation or context, there’s always an underlying feeling that defines how they react.

That underlying emotional vibe is the “golden nugget” that counselors are looking to capture and express through paraphrasing.

If done right, paraphrasing in counseling creates an emotional bridge that sets the foundation for authentic and meaningful interactions. This will encourage clients to open up and share their struggles.

Offer a brief version of what has been said

The last step is providing a concise version that highlights the emotional tone of the story.

Once this message reaches the client, it creates a sense of understanding that builds trust and authentic connection.

Long story short, paraphrasing is a valuable tool for cultivating empathy and facilitating therapeutic change.

How does paraphrasing help in communication?

Cultivating clarity (on both sides).

Any form of communication, whether it’s a therapeutic process, a negotiation, or a casual chat between friends, involves exchanging ideas.

And when people exchange ideas and opinions, there’s always the risk of confusion and misunderstanding.

By paraphrasing what the other person has shared, not only that you cultivate empathy, but you also let him/her know that the message has been received and understood correctly.

Research indicates that paraphrasing in counseling helps clients clarify their issues. [2] The more clients understand the inner-workings of their problems, the better they can adjust their coping strategies.

In a nutshell, paraphrasing eliminates ambiguity and paves the way for clarity.

Facilitating emotional regulation

One of the main functions of paraphrasing is to build empathy between two or more people engaged in conversation.

But the effects of paraphrasing on emotions extend way beyond empathy and understanding.

One study revealed that empathic paraphrasing facilitates extrinsic emotional regulation. [3] People who receive empathy through paraphrasing feel understood, and that prompts them to engage in a more intense emotional regulation process.

What starts as extrinsic emotional regulation slowly becomes intrinsic emotional regulation. This is the reason why someone who’s going through a rough patch can feel better by merely talking to a person who listens in an empathic manner and doesn’t necessarily hand out solutions or practical advice.

Paraphrasing can be a vital skill in heated arguments where two people have opposing views that result in emotional turmoil.

If one of them manages to exercise restraint over their intense emotional reactions and tries to paraphrase what the other shares, it could change the whole dynamic of the conversation.

What is the role of paraphrasing in listening?

As we discussed throughout this article, paraphrasing is one of the critical aspects of active listening.

It’s what turns a passive individual who listens only to have something to say when it’s his/her turn to speak into an active listener who understands and resonates on an emotional level.

Furthermore, paraphrasing is a means by which we provide valuable feedback on the topic of discussion, keeping the conversation alive.

It is also the tool that allows therapists to build safe spaces where clients feel comfortable enough to unburden their souls by sharing painful experiences and gaining clarity.

To sum up, paraphrasing in counseling is a vital micro skill that creates an authentic connection, providing clients with the opportunity to experience a sense of understanding.

Knowing there is someone who resonates with your emotional struggles makes your problems seem less burdensome.

Paraphrasing

What is Paraphrasing?

Paraphrasing is repeating back your understanding of the material that has been brought by the client in your own words. A paraphrase reflects the essence of what has been said.

We all use paraphrasing in our everyday lives. If you look at your studies to become a counsellor or psychotherapist, you paraphrase in class. Maybe your lecturer brings a body of work, and you list and make notes: you’re paraphrasing as you distil this down to what you feel is important.

The Power of Paraphrasing:

The speaker feels heard.
Helps the listener to adjust frame of reference.
Highlights areas of high importance.
Acts as an invite to explore deeper.
Can indicate an end to the current discussion.

How Paraphrasing Builds Empathy

How does paraphrasing affect the client-counsellor relationship? First of all, it helps the client to feel both heard and understood. The client brings their material, daring to share that with you, and you show that you’re listening by giving them a little portion of that back – the part that feels the most important. You paraphrase it down. If you do that accurately and correctly, and it matches where the client is, the client is going to recognise that and feel heard: ‘Finally, somebody is really listening, really understanding what it is that I am bringing.’

This keys right into empathy, because it’s about building that empathic relationship with the client – and empathy is not a one-way transaction. Carl Rogers (1959, pp. 210-211) defines ‘empathy’ as the ability to ‘perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto as if one were the person, but without ever losing the “as if” conditions’. In other words, we walk in somebody’s shoes as if their reality is our own – but of course it’s not our reality, and that’s where the ‘as if’ comes in. I’ve heard this rather aptly described as ‘walking in the client’s shoes, but keeping our socks on’!

Empathy is a two-way transaction – it’s not enough for us to be 100% in the client’s frame of reference and understanding their true feelings; the client must also perceive that we understand. When the client feels at some level that they have been understood, then the empathy circle is complete.

For example, if you watch a TV programme in which somebody achieves something that is really spectacular, you may find yourself moved for this person. You’re almost there with them on this journey, and as they’re receiving their award or their adulation, and the audience is clapping for what they’ve done, you may even be moved to tears. But the person on the TV cannot perceive your reaction – the empathy is empty, because it’s one-way.

So empathy is effective only if your client feels heard and understood – i.e. they sense that empathic connection. Using paraphrasing is a way of completing the empathy circle – a way of letting them know that we see and hear them.

Other Benefits of Paraphrasing

Paraphrasing also highlights issues by stating them more concisely. This is focusing down: it invites the client to go and delve deeper into part of what they have said. We can also use paraphrasing to check out the accuracy of our perception as a counsellor.

Below is an example of my use of paraphrasing to clarify my understanding of what was brought. This shows how paraphrasing affects the therapeutic relationship; because the paraphrase fits well for the client, she feels heard and understood. As this happens, the material deepens.

I really have a battle with doing things for the impression that others will have of me, or the approval that I will get from other people for what it is that I do. So much so that I will very often override myself, my family, so that I can gain the acceptance, I guess, of other people, whether friends, family or clients in a work situation. I will always favour what the action would be that would gain that acceptance, that would not bring up any sort of confrontation or maybe have a conflict situation arise from it.

So, I guess, I’m eager to please, wanting to make sure that all things are well and smooth – and that I’m liked and accepted with whatever the transaction or situation may be.

Counsellor:

As you’re saying that, it really feels like a lot of hard work. A lot of hard work, pre-empting whatever it is that they would have expected of you, and then ‘sacrificing’, I guess, is a word that came up for me – sacrificing your own wants/needs to be able to meet what you perceive is expected of you. Have I understood that correctly?

Yeah, the word ‘sacrifice’ really captures the feeling that comes up for me when I sort of reflect and look over that kind of situation. So often, I will sacrifice my own wants and my own desires…

In this example, the client really resonated with the word ‘sacrifice’, which the counsellor introduced as a paraphrase; she really felt understood. And it’s interesting to note that throughout the rest of this stimulated session, the word ‘sacrifice’ became almost a theme.

Another paraphrase in this example was ‘hard work’. Although the client hadn’t used this phrase herself, she was presenting visually as weighed down. Her shoulders looked heavy as she was bringing the material. So the counsellor was paraphrasing, not only the words of the narrative, but digging deeper, looking for the feelings and paraphrasing the whole presence of that client within that relationship.

Listening for ‘the Music behind the Words’

Here is another example of paraphrasing, from the same skills session. Try to see if you can hear, as Rogers would put it, ‘the music behind the words’, where the counsellor looks deeper than just the words the client is bringing, paraphrasing back their whole being.

Out of my own will or my own free choice, I would put that aside and favour what would be accepted – or what I think someone else would rather I do. And sometimes it’s hard. It leaves me with a situation of not knowing if they actually really realise what it is that I sacrificed, that I’ve given up, so that it can fall into what I think they would prefer in that situation.

It feels confusing to you in that situation of whether they even perceive what it is that you are sacrificing, what you’re giving up. That it almost feels like you’re giving up part of yourself to match what you think they may want or need from you. And I kind of got the feeling, as you were saying that you wonder if they even see that.

Yeah. As I was sort of verbalizing and talking through that, I actually realised that even within that sacrifice, it’s all my perception of what I think they might want me to do. And just saying that is actually a bit ridiculous. Because how am I to know what it is that they want or need to do? So here I am – disregarding my own desires, for lack of a better word – to do something I assume someone else would want me to do instead.

I thought it was really interesting that this client started off in what felt to me like an external locus of evaluation. She was confused, and wondering whether the people she refers to understood what she was giving up to meet their perceived expectations. Immediately after the counsellor’s paraphrase, this client experienced a moment of movement from an external to an internal locus of evaluation, where she realised it was all about her own perceptions and responsibility. In this way, she went from being powerless to having the power to change this situation.

Next Steps in Paraphrasing

Paraphrasing is so much more than just repeating the client’s words back to them using your own words. Although it might feel very simplistic – and there’s often a tendency to paraphrase the narrative/story that the client brings, rather than their feelings/process – there’s so much more to it than that and so much deeper that we can go. There’s real power in paraphrasing.

I suggest that you:

Practice active listening and paraphrasing in your day-to-day life.
Practice paraphrasing in your own stimulated skills sessions.
Try to look for the full person when paraphrasing, e.g. not just the client’s words, but also their body language, facial expressions, and way of being within the counselling relationship.
Record these sessions (with your peer’s consent) and listen back to them.
Speak to your peers about paraphrasing.
Evaluate each other’s skills and explore how you might paraphrase more effectively.
Look whether you’re getting empathic connection within your paraphrasing.
Search out moments of movement when you paraphrase.
Ask how paraphrasing affects both the client and you, as a counsellor.

Paraphrasing is definitely something that should be debated. I hope that this chapter will encourage you to go out there with a new passion for – and a new way of looking at – paraphrasing!

Alternatives to Questions

What else can we use when we’re not sure what exactly a client means? For example, if a client was speaking about his brother and father, he might say: ‘I really struggle with my brother and my father. They don’t get on, and at times he makes me so angry.’ Who does the client mean by ‘he’: the brother or the father? Not knowing who makes him angry means I cannot be fully within the client’s frame of reference.

I could ask: ‘Sorry, just so I can understand, who it is that you’re angry at – your father or your brother?’ This risks ripping the client out of that emotion (the anger). Instead, we could use reflection: ‘He makes you so angry.’ This invites the client to expand on what he has said. He might say: ‘Yes, ever since I was a young boy, my dad was always…’ In this case, I didn’t need to ask a question – we’re still in the feelings, and I’ve got what I needed in order to be fully in the client’s frame of reference.

Of course, the client might not reveal the information I need in his answer – for example, if he responded to my reflection: ‘He does. He makes me really angry – in fact, so angry that I don’t know what to do about it anymore.’ In that case, I would still need to put in a question: ‘Is this your dad or your brother that you’re referring to?’

Rogers, C, 1959. ‘A Theory of Therapy, Personallity, and Interpersonal Relations, as Developed in the Client-Centered Framework’, in S Koch (ed.), Psychology: A Study of a Science (Vol.3), New York: McGraw-Hill, 184-256.

Sign up for your FREE e-newsletter

You’ll regularly recieve powerful strategies for personal development, tips to improve the growth of your counselling practice, the latest industry news and much more.

We’ll keep your information private and never sell, rent, trade or share it with any other organisation. And you can cancel anytime.

Encouragers, Paraphrasing and Summarising

A counsellor can encourage a client to continue to talk, open up more freely and explore issues in greater depth by providing accurate responses through encouraging, paraphrasing and summarising. Responding in this way informs the client that the counsellor has accurately heard what they have been saying. Encouragers, paraphrases and summaries are basic to helping a client feel understood.

Encouragers, also known as intentional listening , involve fully attending to the client, thus allowing them to explore their feelings and thoughts more completely. Paraphrasing and summarising are more active ways of communicating to the client that they have been listened to. Summarising is particularly useful to help clients organise their thinking.

The diagram below shows how encouragers, paraphrases and summaries are on different points of a continuum, each building on more of the information provided by the client to accurately assess issues and events.

Encouragers – Encouragers are a variety of verbal and non-verbal ways of prompting clients to continue talking.

Types of encouragers include:

Non-verbal minimal responses such as a nod of the head or positive facial expressions
Verbal minimal responses such as “Uh-huh” and “I hear what you’re saying”
Brief invitations to continue such as “Tell me more”

Encouragers simply encourage the client to keep talking. For a counsellor to have more influence on the direction of client progress they would need to make use of other techniques.

Paraphrases – To paraphrase, the counsellor chooses the most important details of what the client has just said and reflects them back to the client. Paraphrases can be just a few words or one or two brief sentences.

Paraphrasing is not a matter of simply repeating or parroting what the client has stated. Rather it is capturing the essence of what the client is saying, through rephrasing. When the counsellor has captured what the client is saying, often the client will say, “That’s right” or offer some other form of confirmation.

Example: I have just broken up with Jason. The way he was treating me was just too much to bear. Every time I tried to touch on the subject with him he would just clam up. I feel so much better now. Paraphrase: You feel much better after breaking up with Jason.

Summaries – Summaries are brief statements of longer excerpts from the counselling session. In summarising, the counsellor attends to verbal and non-verbal comments from the client over a period of time, and then pulls together key parts of the extended communication, restating them for the client as accurately as possible.

A check-out, phrased at the end of the summary, is an important component of the statement, enabling a check of the accuracy of the counsellor’s response. Summaries are similar to paraphrasing, except they are used less frequently and encompass more information.

July 21, 2009
Communication , Counselling Process , Encouraging , Microskills , Paraphrasing
Counselling Theory & Process

Comments: 23

Yeah,must say i like the simple way these basic counselling skills are explained in this article. More of same would be most welcome as it helps give a better understanding of the counselling process and the methods and techniques used within the counselling arena

I really find this information helpful as a refresher in my studies and work. Please keep up the excellent work of ‘educating’ us on being a better counsellor. Thank you!

Wonderfully helpful posting. Many thanks!

Thankyou so much. I am doing a assignment at uni about scitzophrenia and needed to clarify what paraphrasing truly meant. Cheers

So helpful to me as a counselor.

Thankx so much for these post. I’m doing Counselling and Community Services and I need to clarify what summarising and paraphrasing really meant. Once again thank you, this information it’s really helpful

Hello Antoinette friend and doing guidance and counselling need uo help about this question With relevent examples explain the following concepts as used in communicating to clients. (I;listening to verbal messages and using encouraged minimal prompts. 2)making use of non verbal communication and exhibiting attending behaviours using Gerald Eganis macro skill SOLER/ROLES. 3.paraphrasing 4.identifying and reflecting feelings and emotions from the clients story 5.summarizing 6.confrotation 7.counsellor self disclosure 8.asking open and close open ended concept 9.answering questions 10.clarifying

thanks I am doing a counselling community services at careers Australia

Really love the explanations given to the active listening techniques it was really useful and helpful good work done.

Helpful. Thanks!

I really like hw u explain everything in to simple terms for my understanding.

Hai ,thanks for being here .Am a student social worker,i need help an an able to listen to get the implied massages from the client.and to bring questions to explore with them .I love to do this work .What shall I do.how do i train my self in listening.

really appreciate.

You explanation of these three basic intentional listening are very helpful. Thank you for remained us.

very helpful indeed in making the client more open and exploring the issues more deeply

Very important cues.thanks

the article was helpful .thank you for explaining it in more clear and simple words.appreciate it alot .

I need to write about what counselling words mean ie I understand summarising and paraphrasing any more would be useful as I’m near the end of my course

I have a role play exam tomorrow on counselling and find above explanation very useful. thanks for sharing.

This explanation is clear and precise. Very easy to understanding than the expensive textbook. Please keep posting as this helps a lot. Thanks and God bless.

Pingback: Summarising In Counseling (a Comprehensive Overview) | OptimistMinds

One of the simple and memorable descriptions of this I’ve read, thanks so much!

Reflecting Skills

Ensuring that you understand your clients, and that your clients feel understood by you is foundational to the counseling relationship. The skills on this page are particularly useful for building the counseling relationship by helping your clients to know that you are hearing and understanding what they are saying.

Summarizing, Paraphrasing, & Reflecting

Summarizing, paraphrasing, and reflecting are probably the three most important & most commonly used microskills. These skills can be used by counselors to demonstrate their empathy to clients, make the counseling session go "deeper", & increase clients' awareness of their emotions, cognitions, & behaviors. All three methods involve repeating back, in your own words, what the client has said. Counselors often go beyond simple repetition and include their own interpretations of the client's emotions or existential meaning to increase the "depth" of the session. These techniques can often be used in place of questions, as, like questions, they prompt the client to reflect or talk more. However, these techniques often have additional benefits of questions as they also demonstrate that the counselor empathizes with and understands each client. Summaries, paraphrases, and reflections can be described as:

Broadest of the three methods for repeating information.
Useful at the end or beginning of session. For example, summarizing the session to the client or reorienting the client to the previous session.
Summaries can include condensed paraphrases & reflections.
Not as broad as a summary, yet more broad than a reflection.
Useful for pacing counseling sessions and for demonstrating empathy to clients.
Paraphrases can contain condensed reflections.
There are three broad types of reflection: Reflections of content, reflections of feeling, & reflections of meaning.
Counselors can strengthen their reflections by constructing a reflection that integrates content, process, affect, and meaning. For example, "While talking about the loss of your dog (content) I experience you as alternating between anger and sadness (affect). That makes a lot of sense to me (self-disclosure), since you told me that seeing your dog at the end of a stressful day kept you grounded (meaning)".

Types of Reflections

Counselors can reflect a wide range of information, but reflections typically include one or more of the following:

Reflecting content involves repeating back to clients a version of what they just told you. Reflecting content shows the client you understand and are listening to them. Typically, reflecting content alone is not as powerful as reflecting content with emotions and/or meaning.
Reflecting a client's emotions is often useful for heightening the client's awareness of and ability to label their own emotions. It is important that counselors have a wide emotional vocabulary, so they can tailor their word choice to match a level of emotional intensity that is congruent with a client's experience. Feeling word charts are useful for reviewing a wide range of feeling words.
As existential theorists observe, humans are meaning making creatures. Reflecting a client's meaning can increase the client's self-awareness while encouraging emotional depth in the session.

Emotional Heightening

Counselors can intentionally use language to increase or decrease the emotional intensity of their reflections, thereby altering a client's emotional arousal. Using evocative language and metaphors (e.g., "walking on eggshells") encourages clients to go deeper into a particular experience or emotion, which can heighten awareness and understanding. Conversely, a counselor might support a client in containing their emotions toward the end of the session, so the client is prepared to leave the session.

It is important that counselors attempt to match their reflections to the emotional intensity of the client's experience. Thus, intentionality is important when counselors reflect more or less emotion than the client expresses, as doing so can result in the client feeling misunderstood and not listened to.

An example of emotional heightening is:

Client: "My wife and I can't stop fighting with each other, and things are really escalating."
Counselor: "Your fights are becoming more explosive and hostile."

Encyclopedia of Personality and Individual Differences pp 4344–4346 Cite as

Reflection (Therapeutic Behavior)

Kathryn N. Schrantz 3 &
Alicia Lyon-Limke McLean 4
Reference work entry
First Online: 01 January 2020

960 Accesses

Active listening techniques ; Affirmation statements ; Directive techniques ; Feelings interpretation ; Feelings validation ; Nondirective techniques ; Psychotherapy ; Reflective statements

Therapeutic reflections are statements used by psychotherapists to restate, paraphrase, or uncover therapy clients’ emotional reactions to situations, thoughts, behaviors, or interpersonal interactions.

Introduction

Verbal and nonverbal reflections are a major component of psychotherapy. Considered as an active listening technique, reflections serve as an important therapeutic tool. Often, reflections paraphrase or restate clients’ feelings and emotions. Therapists also use reflections to help clients examine previously undiscovered or misunderstood emotional reactions. There are various types of reflections that are used to elicit different reactions from clients. Reflections impact the therapeutic relationship and play a significant role in many therapeutic approaches.

Types of...

This is a preview of subscription content, log in via an institution .

Buying options

Available as PDF
Read on any device
Instant download
Own it forever
Available as EPUB and PDF
Durable hardcover edition
Dispatched in 3 to 5 business days
Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Arnold, K. (2014). Behind the mirror: Reflective listening and its Tain in the work of Carl Rogers. The Humanistic Psychologist, 42 (4), 354–369. https://doi.org/10.1080/08873267.2014.913247 .

Article Google Scholar

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford Press.

Google Scholar

Brammer, L. M. (1979). The helping relationship . Englewood Cliffs: Prentice Hall.

Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48 (1), 43–49. https://doi.org/10.1037/a0022187 .

Article PubMed Google Scholar

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55 (4), 316–340. https://doi.org/10.1037/pst0000172 .

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.

Rogers, C. R. (1951). Client-centered therapy . Boston: Houghton, Mifflin.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2009). Clinical interviewing (4th ed.). Hoboken: Wiley.

Download references

Author information

Authors and affiliations.

Sam Houston State University, Huntsville, TX, USA

Kathryn N. Schrantz

University of Central Oklahoma Edmond, Edmond, OK, USA

Alicia Lyon-Limke McLean

You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn N. Schrantz .

Editor information

Editors and affiliations.

Oakland University, Rochester, MI, USA

Virgil Zeigler-Hill

Todd K. Shackelford

Section Editor information

Department of Educational Sciences, University of Genoa, Genoa, Italy

Patrizia Velotti

Sapienza University of Rome, Rome, Italy

Rights and permissions

Reprints and permissions

Copyright information

About this entry

Cite this entry.

Schrantz, K.N., McLean, A.LL. (2020). Reflection (Therapeutic Behavior). In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3_841

Download citation

DOI : https://doi.org/10.1007/978-3-319-24612-3_841

Published : 22 April 2020

Publisher Name : Springer, Cham

Print ISBN : 978-3-319-24610-9

Online ISBN : 978-3-319-24612-3

eBook Packages : Behavioral Science and Psychology Reference Module Humanities and Social Sciences Reference Module Business, Economics and Social Sciences

Share this entry

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Publish with us

Policies and ethics

Find a journal
Track your research

Open Access is an initiative that aims to make scientific research freely available to all. To date our community has made over 100 million downloads. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. How? By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers.

We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too.

Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective

Want to get in touch? Contact our London head office or media team here

Our team is growing all the time, so we’re always on the lookout for smart people who want to help us reshape the world of scientific publishing.

Home > Books > Counseling and Therapy

Introductory Chapter: Counseling and Therapy

Published: 09 September 2020

DOI: 10.5772/intechopen.92133

Cite this chapter

There are two ways to cite this chapter:

From the Edited Volume

Counseling and Therapy

Edited by Simon George Taukeni

To purchase hard copies of this book, please contact the representative in India: CBS Publishers & Distributors Pvt. Ltd. www.cbspd.com | [email protected]

Chapter metrics overview

1,253 Chapter Downloads

Impact of this chapter

Total Chapter Downloads on intechopen.com

Total Chapter Views on intechopen.com

Author Information

Simon george taukeni *.

University of Namibia, Namibia

*Address all correspondence to: [email protected]

1. Introduction

Counseling and therapy are concepts central to nearly all academic disciplines and serve as an interdisciplinary area of study. The field of counseling and psychotherapy represents a synthesis of ideas originated from science, philosophy, religion, and the arts [ 1 ]. The book covered the most practical counseling and therapy basic skills, different counseling approaches, and problem-based techniques. This book is written by specialists in the fields of counseling, psychology, health, and other related fields. University students, academics, researchers, life skills teachers, school and community counselors, and other community practitioners would find this book very useful in their professions.

2. Counseling and therapy

Counseling has been playing a pivotal role in the lives of many people who experienced a wide range of psychological, social, emotional, academic, spiritual, health, and physical issues for many years in memorial. For instance, counseling made considerable breakthroughs by meeting the needs of individuals who experience traumatic or sudden interruptions to their life development and social roles [ 1 ]. The concept of developing an individual’s potential through counseling is identified in the early Grecian societies, with their emphasis on developing and strengthening individuals so that they could fulfill their roles, reflecting the greatest potential for themselves and their societies [ 2 ]. Many of such developmental testimonies and breakthroughs are what make this book a useful source.

3. Individual and group counseling

Counseling is being delivered through one-to-one contact, in groups, with couples and families, over the telephone, and even through written materials such as books and self-help manuals [ 1 , 3 ]. It is also possible in the era of technology to conduct counseling via video calls, Skype, and livestreaming platforms. Individual counseling is a one-to-one helping relationship which focuses on a single person’s growth, adjustment, and problem-solving and decision-making needs [ 2 ]. Group counseling is the routine adjustment or developmental experiences provided in a group setting. Group counseling focuses on assisting clients to cope with their day-to-day adjustment and development concerns including behavior modification, developing personal relationship skills, concerns of human sexuality, values or attitudes, or career decision-making [ 2 ].

4. Basic counseling skills

It has long been established that counseling is a daunting and complex process. It is therefore paramount that basic counseling skills are required to have effective and successful counseling sessions. Examples of these skills are minimal responses, paraphrasing, reflective comments, questioning, clarification, silence, body language, summarizing, and evaluation. Even though these skills are well integrated in the entire book, the author has exemplified them briefly below.

4.1 Minimal responses

In most counseling situation, a counselor should know how to use the minimal responses as technique to encourage the client to open up more and as an indication that the counselor is actively listening. While the examples of minimal responses are many to single out, the most common ones are yes, uh, oh, really, mmh, and, so, yeah, and many others.

4.2 Paraphrasing

Paraphrasing is simply to restate what the client has said in order to make sure the counselor understood the issue/issues correctly. At times, the counselor would need to confirm from the client the meaning of what was said in order to have the mutual understanding on the issue. It is important to note however that paraphrasing can be categorized into simple paraphrasing and advanced paraphrasing. The meaning of the latter is that, in simple paraphrasing, the counselor restates what the client has said by using the same exact words. Meanwhile, advanced paraphrasing means that the counselor uses different words than what the client has used with the same meaning. The main purpose with paraphrasing is simply to confirm to whether the counselor got the client correctly and what he or she meant. It is the search for meaning and mutual understanding between the counselor and the client.

4.3 Reflective comments

In addition to paraphrasing, the counselor may also use what is known as reflective comments during counseling process to ensure that information shared with the client are clear and accurate. Amis [ 3 ] notes that reflection is a skill that helps regulate the pace of the session as it allows both client and counselor to think back over what has been said previously and to consider any impact that it has on the present issue.

4.4 Questioning

A good counselor is one who knows how to ask questions and the type of questions during counseling process. The types of questions that are commonly useful to counseling process are open-ended questions and hypothetical questions. Also important but not commonly useful are closed-ended questions, why questions, leading questions, and either/or questions.

4.5 Clarification

In most counseling situations, the counselor would need to make use of clarification skills when the client’s information are vague, confusing, and incomplete [ 4 ]. It is therefore very important that the counselor may ask the client to clarify certain information during the session.

4.6 Silence

The counselor needs to practice listening to the client’s silences in order to try and find out what the reason for the silences are [ 4 ].

4.7 Body language

In order for a counselor and therapist to be effective and successful, he or she should be able to understand the clients’ body language. The examples of body language are as follows: body posture, body movement, facial expressions, eye contact, voice, general appearance, advanced empathy, and distance.

4.8 Summarizing

Importantly, the counselor needs to be a good listener to be able to get the whole picture of the client’s situation at hand. The summarizing skill enables the counselor to focus on the main points of a session.

4.9 Evaluation

Evaluation is believed to come nearer the end of the counseling relationship when the counselor encourages the client to reflect back over a change or development that has occurred and assess its value in the context of their life [ 3 ].

5. Counseling needs

Counseling needs are issues or situations that an individual may experience due to external factors and internal factors. Amis [ 3 ] asserts that external factors are situations that the client is in, the world and people around them, whereas the internal factors refer to the client’s inner world, their thoughts, feelings, perceptions, and fears. The counseling usually attempts to address some of the following common issues, namely, addiction, loss, managing feelings, relationship difficulties, study methods, medical conditions, coping memories, financial difficulties, poverty, unemployment, career choices and self-development, and many others [ 3 ]. The role of counseling has also been well documented in terms of helping people to better deal with addiction problems related to drug and alcohol abuse, food addiction, and smoking. It has also played an important role toward people with particular health conditions such as HIV or AIDS, cancer, and various genetic disorders [ 1 ].

6. Counseling approaches and therapies

Several counseling approaches can be employed by counselors, therapists, and other educators. The common ones are humanistic counseling, psychodynamic counseling, cognitive-behavior counseling, and other contemporary counseling approaches. Each of these approaches has a different view of understanding behavior and how to change unwanted behavior [ 4 ] (see Figure 1 ).

The main counseling approaches (adopted from [ 3 ]).

7. Counseling session

A counseling session is structured nearly in the same way for various problems/issues facing the client/s. Therapies and interventions can vary considerably from client to client [ 5 ]. Before embarking on regular sessions, a contract is agreed between those involved that covers areas such as timing, venue, and confidentiality [ 3 ]. In general terms, counseling session is divided into three phases, namely, the beginning phase, middle phase, and end phase.

During the beginning phase, the counselor starts building relationship with the client and assessment of the problem. He or she would need to work together with the client to identify and define the problem. In the middle phase, the counselor starts working with the client to set up counseling goals and plan of action. The end phase is where the counselor would assess the progress made by the client and to terminate the counseling process after an evaluation of the initial goal of the counseling.

8. Conclusion

The importance of counseling and therapy cannot be overemphasized in the world that is facing numerous challenges as a result of technological advancement, educational needs, social-economical factors, and personal developmental needs. In order to addressing students’ needs such as study methods, student retention, dropout, peer pressure, relationship skills, and other academic activities, there should be a well-functioning and comprehensive guidance and counseling program in place. It is important to note that not every counseling approach can yield the best results; that is one of the reasons this book provided many different counseling approaches and therapies.

1. McLeod J. An Introduction to Counseling. Buckingham: Open University Press; 1993
2. Gibson RL, Mitchell MH. Introduction to Counseling and Guidance. New Jersey: Pearson Prentice Hall; 2008
3. Amis K. Becoming a Counselor. London: Sage; 2011
4. Mostert ML. Guidance and Counseling/Guidance and Counseling 2: Study Guide. Windhoek: UNAM Center of External Studies; 2014
5. Beck JS. Cognitive Behavior Therapy: Basics and beyond. New York: The Guilford; 2011

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Continue reading from the same book

By Mohd Zarawi Mat Nor

1762 downloads

By Hector Chiboola

2071 downloads

By Livingstone Malinge Gqeba and Nokuzola Gloria Gqeb...

734 downloads

Pleasefireme.com

Your good mood for every day

What is paraphrasing and Summarising in counselling?

Table of Contents

Difference between paraphrasing and summarising in counselling. Using summaries is different from using paraphrasing, as a summary usually covers a longer time period than a paraphrase. Thus, summarising may be used after some time: perhaps halfway through – or near the end of – a counselling session.

What are encouragers in counseling?

Encouragers – Encouragers are a variety of verbal and non-verbal ways of prompting clients to continue talking. Types of encouragers include: Non-verbal minimal responses such as a nod of the head or positive facial expressions. Verbal minimal responses such as “Uh-huh” and “I hear what you’re saying”

What is an example of summarizing in counseling?

Summarization is also used as a way to close a session. For example: Client: “I really feel guilty about marrying her in the first place. It wasn’t really for love.

How is Summarising used in counselling?

Summarizing lets the client know that the counsellor has heard and understood, and also enables the client to clarify thoughts, identifying what is most important. It is not sufficient just to notice what the client has said; it is also important to notice what is missing.

What is an example of paraphrasing in counseling?

The following are some examples of accurate paraphrasing: One moment she’s really friendly, and the next time 1 see her she’s totally cold.” Counselor: “You haven’t experienced her as being very consistent.” Client: “Every moment there is something new to do.

Why paraphrasing is important in counseling?

What is an encourager?

Encouragernoun. one who encourages, incites, or helps forward; a favorer.

How can counselling improve paraphrasing skills?

let the client know that you are listening and understand what they are saying, 2. clarify confusing content, 3. highlight issues by stating them more concisely, and 4. check out the accuracy of your perceptions as the counselor.

What is paraphrase in counseling?

Paraphrasing or active listening (coined by Carl R. Rogers in Client-Centered-Therapy) is a form of responding empathically to the emotions of another person by repeating in other words what this person said while focusing on the essence of what they feel and what is important to them.

How is paraphrasing used in counselling?

Why paraphrasing is important in counselling.

What is Summarising paraphrasing?

Paraphrasing means rephrasing text or speech in your own words, without changing its meaning. Summarizing means cutting it down to its bare essentials. You can use both techniques to clarify and simplify complex information or ideas. To paraphrase text: Read and make notes.

How would you explain summarizing and paraphrasing?

A paraphrase must also be attributed to the original source. Paraphrased material is usually shorter than the original passage, taking a somewhat broader segment of the source and condensing it slightly. Summarizing involves putting the main idea(s) into your own words, including only the main point(s).

What is the role of an encourager?

Encouragers see people as storehouses of untapped potential because they don’t see you where you are, but have a vision of where you can go. By looking at people as a work-in-progress they provide coaching, feedback and mentoring that enables the discovery and development of your unique gifts and talents.

What type of word is encourager?

verb (used with object), en·cour·aged, en·cour·ag·ing. to inspire with courage, spirit, or confidence: His coach encouraged him throughout the marathon race to keep on running.

Why is Summarising and paraphrasing important?

Summaries leave out detail or examples that may distract the reader from the most important information, and they simplify complex arguments, grammar and vocabulary. Used correctly, summarizing and paraphrasing can save time, increase understanding, and give authority and credibility to your work.

How do you teach paraphrasing and summarizing?

Key strategies for paraphrase

Read the portion of text you want to paraphrase.
Make sure you understand it.
After you’ve read the text, make notes of what you read, without using the author’s words or structure.
Using only your notes, write all of the important ideas of the text using own words.

What is the meaning of encourager?

1. To inspire with hope, courage, or confidence. 2. To give support to; foster: policies designed to encourage private investment. 3.

What makes a good encourager?

Encouragers actively listen with empathy. Meaningful encouragement is grounded in understanding—being able to accurately interpret what other people are saying. Great encouragers consistently seek to understand people. They are as comfortable with your fears and failures as they are with your hopes and dreams.

What music is used in ballroom dancing, what size is the electra townie 7d.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
v.39(1); 2018 Feb

Teaching and Improving Clinical Counseling Skills

Teaching counseling microskills to audiology students: recommendations from professional counseling educators.

1 Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania

Jamie Kulzer

To provide the highest quality services, audiologists incorporate counseling into their professional practice. This article, written by professional counselors, highlights the distinction between services provided by professional counselors (i.e., psychotherapy) and counseling microskills used by all health and rehabilitation professionals. Effective application of counseling microskills facilitates a strong therapeutic alliance, which research shows contributes to positive therapeutic outcomes. Counseling microskills should be taught early in graduate programs, because they serve as the foundation for the therapeutic alliance and allow for more effective application of other therapeutic interventions. The four most critical counseling microskills for audiologists are active listening, nonverbal communication, silence, and empathy. These skills should be taught using experiential learning activities (i.e., classroom role-play and use of simulated patients) that incorporate practice, repetition, and feedback. Students should be evaluated on their ability to perform counseling microskills using a detailed grading rubric. Instructors should deliver feedback on these skills with care to reduce potential negative reactions. Ultimately, effectively teaching counseling microskills in graduate programs can improve students' ability to facilitate the therapeutic alliance and facilitate better health outcomes for patients.

Learning Outcomes: As a result of this activity, the participant will be able to (1) identify and explain four counseling microskills essential for audiologists and (2) describe effective methods for teaching counseling microskills to Au.D. students.

Patient outcomes are influenced by the therapeutic alliance. Patients who report a positive, trusting relationship with their clinicians are more likely to demonstrate treatment compliance and improved health outcomes compared to patients who do not report a strong relationship with their clinicians. All clinical health and rehabilitation professionals could benefit from training on developing the therapeutic alliance with patients. Professional counselors learn basic counseling skills (i.e., microskills) early in graduate programs as a foundation for developing the therapeutic alliance with clients. This article proposes that counseling microskills fit into the audiologist's scope of practice and should be taught to audiology graduate students (Au.D. students). Four counseling microskills necessary to successfully provide services related to preventing, diagnosing, and treating hearing and balance disorders are identified and described. This article concludes with recommendations on how to most effectively teach counseling microskills to Au.D. students.

The authors of this article are professional counselors and counselor educators, not audiologists. We have 10 years of combined experience teaching masters-level counseling students in the clinical rehabilitation and mental health counseling program at the University of Pittsburgh. We teach clinical courses that focus on counseling techniques, group counseling, clinical interviewing, and evidence-based interventions. We value interdisciplinary teamwork and appreciate this opportunity to share our unique expertise, knowledge, and skills as counseling educators, in the hope of achieving the shared goal of providing the highest possible quality of patient care.

Scope of Practice: Counseling and Audiology

Professional counseling.

It may be helpful to begin with a definition and overview of the scope of professional counseling. Counseling is defined as “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.” 1 (p.368) Professional counselors have at a minimum a master's graduate degree in counseling. Broadly speaking, they assess, diagnose, and treat mental disorders using evidence-based interventions. Professional counselors assist individuals struggling to cope with typical life stressors (e.g., birth of a child, relationship issues, midlife career change) and individuals in crisis (e.g., death of a loved one, natural or human-caused disasters). Professional counselors, often with a certification specialty in rehabilitation counseling, also assist individuals with disabilities with adjustment, secondary and comorbid mental health symptoms, and case management. 2 Professional counseling is grounded in a holistic philosophy of mental health, with a focus on proactive wellness, empowerment, and self-actualization. 3

Professional counselor education programs are accredited by the Council for Accreditation of Counseling and Related Educational Programs. 4 Professional counselors abide by the American Counseling Association code of ethics. 5 6 They are certified nationally by the National Board for Certified Counselors or Commission on Rehabilitation Counselor Certification. Licensure is required to practice professional counseling. Requirements for licensure vary slightly by state, (e.g., in Pennsylvania, professional counselors are licensed by the Pennsylvania State Board of Social Workers, Marriage and Family Therapists, and Professional Counselors). Licensure boards require that professional counselors complete a 60-hour accredited graduate program in counseling and complete a required number of postgraduation supervised clinical hours (ranging from 1,000 to 4,000 depending on state licensing board). 7

Professional counselors are trained in both basic counseling skills, also known as microskills and evidence-based psychotherapy. The therapeutic process has many influencing factors that are difficult to learn and execute in practice. The counseling profession found that graduate students were not able to practice evidence-based psychotherapy effectively without basic skills (e.g., what to say, how to say it, how to behave in session). 8 9 Thus, counseling and counseling psychology fields developed a microskills training approach to break down the therapeutic process into basic skills that facilitate a therapeutic alliance. 8 9 Microskills are basic counseling skills that assist rapport building and begin the therapeutic process. They include listening, nonverbal communication, silence, empathy, and responding (i.e., reflections, questioning, summarizing, and paraphrasing). Students refine these skills before learning ways to conceptualize primary problems and provide treatment with theory-driven, evidence-based practice. Microskills are necessary but not sufficient for conducting professional counseling and facilitating therapeutic change; assessment, techniques, and evidence-based interventions are also necessary. 8 9

Psychotherapy involves the application of higher-level evidence-based counseling interventions to treat individuals with various mental health issues and diagnoses. Professional counselors are trained to evaluate the needs of the client, the evidence available, and their personal skill set to develop individualized treatment plans. The amount of training that is required to provide psychotherapy varies depending on the intervention, but typically requires training above the rigorous requirements for professional counselors. Training often involves a minimum of (1) education (i.e., a minimum of a master's degree in a counseling or related field) and (2) supervised clinical experience. For example, much evidence in the counseling field supports cognitive and behavioral interventions. The criteria for becoming a certified cognitive-behavioral therapist are: (1) a masters or doctoral degree in counseling or a related field, (2) 6 years of postgraduate experience providing cognitive behavioral therapy (CBT), (3) three letters of recommendation from mental health professionals who are familiar with the applicant's cognitive-behavioral skills, and (4) successful completion of a certification program in CBT recognized by the National Association of Cognitive-Behavioral Therapists. 10 Training standards for other evidence-based treatment interventions, such as mindfulness-based stress reduction and dialectical behavioral therapy, are comparable to CBT in time and rigor. These evidence-based interventions are powerful, and to avoid causing harm, clinicians should be well trained.

Counseling in Audiology

It can be difficult to differentiate the scope of practice for professional counselors versus rehabilitation professionals who utilize counseling in their specialty, such as audiology. This can be a problematic distinction due to ethical requirements to practice within one's scope of practice and expertise. The word counseling appears five times in the American Speech-Language Hearing Association (ASHA) scope of practice. 11 It is referred to as a method and essential role in audiology practice. 11 In the rehabilitation section, the ASHA indicates that audiologists are to develop treatment plans that include counseling related to psychosocial problems or adjustment to “hearing loss and other auditory dysfunction.” 11 It also refers to using counseling as a method for the “assessment and non-medical management of tinnitus.” 11 Similar to ASHA, the American Academy of Audiology references counseling six times in the published scope of practice. 12 The referenced use of counseling is similar to the ASHA scope of practice. It mentions “the audiologist determines the appropriateness of amplification systems for persons with hearing impairment, evaluates benefit, and provides counseling and training regarding their use” and “counseling regarding hearing loss, the use of amplification systems and strategies for improving speech recognition is within the expertise of the audiologist.” 12 It is clearly in the audiologist's scope of practice to provide education, instruction, and advice about audiologic conditions and treatment services. However, the more difficult distinction is counseling related to problematic psychosocial issues presented by the patient.

To make a suggested distinction, these scope of practices were compared with counseling specialty scopes of practice. 2 It is important to note that there is overlap between the Scope of Practice for Rehabilitation Counseling and the reviewed audiology scope of practices. 2 11 12 Both fields indicate that it is an essential role of audiologists and rehabilitation counselors to counsel related to psychosocial adjustment to disability. 2 11 12 Patients are best served by clinicians who are well trained and specialized in the disability or condition. Here, counselors are well trained and specialized in counseling but not all audiologic conditions, whereas audiologists are specialized in audiologic conditions but not counseling. It is reasonable and necessary for audiologists to become trained in basic counseling methods so that they may provide counseling for adjustment and psychosocial aspects specific to a patient's condition. Although overlapping, this is a useful practice of counseling for practicing audiologists.

It is, however, important to begin to make a distinction between psychosocial aspects of audiologic conditions and comorbid mental health conditions, as the line is often unclear in real-life clinical practice. In the cases of complex audiologic problems with presenting mental health symptoms (e.g., severe cases of tinnitus), it is necessary to have both a counselor and audiologist providing treatment to the patient. 13 It is outside the scope of practice for audiologists to determine if presenting mental health problems (anxiety, depression) are solely attributed to the audiologic condition (i.e., tinnitus) or impacting other areas of life as well. Thus, a minimum of a referral to a counselor or psychologist is necessary for a formal mental health assessment in those situations. Individuals with prolonged disability and pain conditions often develop significant comorbid mental health conditions that require the previously mentioned evidence-based psychotherapy interventions. 13 Although the criteria for provision of evidence-based psychotherapy mentioned previously (CBT, mindfulness-based stress reduction, dialectical behavioral therapy ) does not necessarily exclude audiologists, the level of training required is typically above and beyond what Au.D. students and professionals experience in their formal education and postgraduation experiences.

Counseling Microskills for Audiologists

Establishing rapport and a trusting therapeutic relationship is necessary for all clinical relationships and not reserved for professional counselors utilizing psychotherapy. Often, clinicians focus on mastering therapeutic techniques or interventions. Yet, we now know that the delivery of services and relationship between the clinician and client is as or more important than the technique itself. 14 15 In 1957, Carl Rogers, father of client-centered therapy, hypothesized that if there is relationship between the therapist and client in which the therapist experiences and communicates unconditional positive regard and empathy, that relationship alone may be capable of producing positive change in the client. 16 Several decades later, researchers have found that more than 50% of treatment effects result from the therapeutic relationship, as opposed to only 10% of effects resulting from therapeutic techniques. 15 Further research confirms that in the patient-doctor relationship, patient expectations, patient comfort, and patient optimism regarding treatments can all impact health-treatment outcomes. 17 Thus, it is necessary for audiologists to establish rapport and trusting relationships with patients.

Establishing rapport and a trusting relationship with patients is also referred to as developing a therapeutic alliance. 18 19 Given the importance of the therapeutic alliance, it is a counseling skill that is crucial for counselors and audiologists alike. 18 19 The counseling profession utilizes microskills training as the foundational education method for facilitating a therapeutic alliance and strong working relationships with patients. 8 9 Counseling microskills are taught in counseling graduate programs as the first step and prerequisite to delivering a therapeutic intervention. 20 Counseling microskills training is then followed by more advanced coursework in case conceptualization, treatment planning, and advanced psychotherapy courses.

There are countless microskills required by counselors. Some counseling microskills are specific to the process of psychotherapy; others are universally practiced by all health and rehabilitation professionals. Active listening, nonverbal communication, silence, and empathy are the core counseling microskills that should be taught to Au.D. students. We will provide a rationale and overview of each of these counseling microskills followed by suggestions for teaching these skills to Au.D. students. It should be noted that we purposefully excluded the microskills domain of responding (i.e., reflections, questioning, paraphrasing, summarizing, challenging). The use of responding microskills are dependent on the goal of treatment, which is different between audiologists and professional counselors. Thus, we highlighted the crucial importance of accurate responding in the empathy section later in this article but suggest audiology educators tailor responding microskills training to audiology.

Active Listening

Active listening is the foundational microskill required to foster a therapeutic alliance with patients. 21 This skill is often overlooked as easy or self-explanatory; however, active listening is one of the most challenging microskills both to learn and maintain as a new or experienced professional. 22 Evidence also suggests that active listening is one of the most influential microskills for improving clinical outcomes and patient/clinician relationships. 21 Active listening is dependent on the clinician being fully present to the patient and situation. This requires that the clinician is able to manage internal thoughts, dialogue, and distractions to fully concentrate on the patient. 22 Full presence requires advanced concentration and self-monitoring of metacognition. 18 Active listening is not simply accurate repetition of the words, though that is a component of demonstrating listening. It requires that clinicians also simultaneously note nonverbal messages, affective messages, expressed thought processes, and patterns of behavior. 22 For example, a client shares the following statement with their clinician: “I am just really frustrated with my teacher asking me to repeat myself over and over. I get that repeating is better than pretending to understand me when they don't, but I am sick of it. So, I have stopped participating in class.” The clinician must be actively listening on the specific affective messages expressed (“frustration,” “sick of it”), the scenario described (interaction with teacher in likely group setting), the nonverbal behaviors (in this example eyes watering with slumped posture), and patterns of behavior (withdrawal from class participation). The clinician must observe, listen, and note all of these things prior to expressively responding to the patient. 22

When considering active listening, it is helpful to consider the opposite of active listening. Gerard Edgan presented several forms of “inactive or inadequate listening” that are commonly used by helping professionals, including the following: (1) nonlistening or no presence; (2) partial listening or incomplete presence; (3) tape-recorder listening, or simply repeating words without conveying understanding of feelings or meanings behind the words; and (4) rehearsing, or when the professional stops listening to plan their response. 22 These forms of inactive listening are habitual, and health and rehabilitation professionals can easily fall into them, especially in high-stress and time-limited situations. In these situations, clinicians may listen to react and respond, when they should be listening to understand the patient's perspective, problem, emotions, and opinions before considering the appropriate response. 22

Errors in listening or inadequate listening have countless etiologies. Graduate students and new professionals often lack confidence in their skills and knowledge base. 23 This can cause novice clinicians to be preoccupied with how to respond or to make a clinical judgment rather than listening to the patient. 24 Novice clinicians also have difficulty integrating patient messages that are being communicated through various channels. Experienced clinicians are often more proficient in active listening and gathering the necessary information through verbal messages, nonverbal messages, thought processes, patterns of behavior, and so on. However, clinicians are at risk for burnout, high stress, and limited time. 25 These stressors can lead to working on autopilot without being fully present to the patient. 24 Thus, active listening is a microskill that requires constant monitoring once mastered.

Learning to refine active listening skills can be broken down into a few steps for Au.D. students. First, students must learn to listen and remember the words another individual is sharing. Accuracy is crucial for rapport building and clinical decision making. 24 Clinicians can learn to accurately identify the situation, key details shared, and specific emotion words used. It can also instantly build rapport if a clinician is able to listen and remember names that the patient shares. Listening to verbal messages with accuracy can require weeks of practicing listening. The best way to develop this skill is to check for accuracy with the other individual (including the situation described, key details, names shared, and emotion words/affective messages). It can be helpful to eliminate any nonverbal input while refining this microskill (e.g., not looking at the other person). It can also be helpful to start with short time lengths (2 to 3 minutes) and build to longer time periods (15 minutes), as it is an exercise in concentration and memory. Following mastery of listening accurately to verbal communication, students can add nonverbal input into the skill-building exercises. The types of nonverbal communication are covered in detail in the next section. Ultimately, students must train themselves to become fully focused and concentrated to actively listen to a patient.

Nonverbal Communication

Receiving nonverbal communication from patients is critical for active listening and building therapeutic alliance. 22 26 However, clinicians also are sending nonverbal messages to patients, which can significantly impact the development of therapeutic rapport. 24 27 Thus, developing the microskill to both read nonverbal messages from patients and monitor personal nonverbal output is critical for Au.D. students.

Nonverbal communication is a broad concept; it encompasses a range of skills that are worth differentiating. 28 Nonverbal communication skills include: facial expressions, eye contact, physical gestures, paralanguage, posture, proximity, and autonomic display. 28 Paralanguage includes voice tone, pacing, and volume. Posture includes body angle and orientation, back posture, hand placement, leg placement, and position in a chair. 18 28 Proximity refers to the body positioning and physical space between two individuals (i.e., the clinician and the patient). 26 28 The physical setting and space also impacts proximity. For instance, is there a table between the clinician and patient? Is the patient across from the clinician or diagonally opposite? Finally, autonomic display is also a nonverbal message that impacts the therapeutic relationship. 26 27 29 Common autonomic displays that negatively influence therapeutic relationships include sweat production, flushed face, blotchy skin, shallow breathing, stomach noises, tear production, and so on. These physical reactions occur automatically when the autonomic nervous system engages, often under pressure or stress.

All of the nonverbal behaviors and messages mentioned are culturally dependent and influenced by personal preferences, norms, and abilities. Some individuals may be uncomfortable with too much or too little eye contact, as this is a culturally dependent form of communication. 18 Nonverbal communication can be influenced by physical or cognitive conditions. Clinicians should be cognizant of disability conditions that influence nonverbal behaviors. For example, individuals with autism spectrum disorder might have very limited facial expressions directed to the examiner. Thus, nonverbal communication must be interpreted on an individual basis within the cultural context of the patient.

It is important for clinicians to not only recognize the patient's nonverbal message, but evaluate the congruence of the nonverbal behavior with verbal expressions of the patient. 18 For instance, a patient who describes tinnitus by saying he “cannot stand the pain anymore,” but smiles at the clinician. In this scenario, the patient may smile when under extreme distress because it is not culturally acceptable to display negative emotions. This nonverbal incongruence is worth recognizing in a therapeutic setting, because it could influence assessment, treatment plan, and future clinical interactions.

Clinicians also must monitor nonverbal messages communicated to the patient. Most clinicians are used to monitoring their own facial expressions and physical gestures. Paralanguage can be difficult for clinicians to monitor, as it is due to a lack of awareness or a clinician's tendency to automatically mirror nonverbal messages. The former can be remedied with focused monitoring and feedback. The latter, unconscious mirroring, is more difficult to control. For instance, a patient who is in pain may loudly express anger regarding unpleasant symptoms, and a clinician may unconsciously mirror this with a loud and fast-paced response. In this instance, mirroring of nonverbal affect does not serve to help the therapeutic alliance or environment. 18 At the same time, mirroring nonverbal messages can be effective and appropriate in many clinical situations, such as during grieving, when mirroring paralanguage can build rapport, trust, and the therapeutic alliance. 18 Clinicians should be cognizant and reflective of the clinical utility of mirroring nonverbal messages in varying situations. 18 Finally, clinicians' autonomic display is a very challenging aspect of nonverbal communication that is difficult to manage in a clinical setting. This is particularly common and difficult for graduate students experiencing anxiety in new clinical experiences. 24 27 Stress management and relaxation techniques can be helpful to manage visible distress.

A simple nonverbal microskills framework, S-O-L-E-R, is often taught in professional counseling graduate programs. 22 This framework can serve as a beginning for graduate students learning to master nonverbal communication in a clinical setting. 22 S constitutes body posture and positioning of the clinician, specifically “facing the client squarely.” This body posture communicates engagement and is best without a table or desk between client and patient. 22 O , or “adopt an open posture,” also refers to postural positioning of the clinician. Specifically, a clinician should avoid crossing legs and arms, as this is often viewed as an unwelcoming posture in American culture. 22 Leaning toward a client, or L , is another postural behavior that can be beneficial for the therapeutic relationship. 22 However, this should be monitored for cultural preferences, because too much engagement can overwhelm some patients. Egan's framework also includes E , or “maintain good eye contact,” as a clinician nonverbal behavior to monitor. 22 Direct eye contact is often an indicator of engagement in American culture; however, similar to leaning, this can fluctuate between individuals for cultural and personal reasons. Finally, the S-O-L-E-R framework suggests that clinicians remain “relaxed and natural” in clinical interactions. 22 Nervous behaviors such as fidgeting, twirling hair, postural collapse, paralanguage suggesting discomfort, and shaking legs communicates discomfort to patients, which fails to create a safe environment for the patient. 22 This framework can serve as a starting point for Au.D. students when learning nonverbal microskills.

Silence occurs when neither the clinician nor patient are speaking in a clinical encounter. 30 31 Silence can be used for different purposes. One purpose of silence is for counselors to organize their thoughts and identify an appropriate response. 30 31 This can be a helpful complimentary microskill to active listening. Active listening requires full attention and presence, which can lead to breaks in conversation while a counselor thinks about how to best respond. A second purpose of silence is to deepen therapeutic insight, facilitate the client's internal reflection, and solicit a response from the client. 30 31 Although audiologists may not need to use silence to deepen insight, silence is a useful microskill to honor emotional moments in a clinical encounter, not rush the client, and give the patient time to generate responses. 30 31 Audiologists will likely use silence for this purpose often when delivering difficult news to a patient. Silence allows a patient to process, react, and understand the difficult news. For instance, many individuals find it jarring and invalidating for a helping professional to move too quickly from difficult news (e.g., learning their child is deaf) to suggestions for treatment. In this scenario, silence is a useful therapeutic microskill to allow patients appropriate time for processing difficult news.

Not only are the purposes or intentions of silence complicated, silence is a difficult microskill to execute properly. Effective use of silence in a therapeutic manner requires that the clinician is comfortable and fully present while using silence. 30 31 Silence is uncomfortable or awkward when clinicians are anxious, internally distracted, or uncomfortable. 30 This is difficult for students, because students often report distress and discomfort during silences. Students tend to be unsure of themselves during a clinical encounter, which causes them to be internally distracted or anxious during lapses in conversation with the patient.

Silence is a controversial microskill due to the variability in patient responses. Silence can convey empathy and facilitate positive change, but can also be detrimental to the therapeutic alliance. 30 31 Research has found that some individuals view silence as a display of empathy, respect, active listening, and comfort. 30 31 However, research also found that other individuals view silence as anxiety provoking, abandonment, and agitating. 30 31 Similar to nonverbal communication, silence is culturally dependent and individualized. This, along with the clinician's comfort and presence, contributes to the variable reactions to silence. 30 Many experienced counselors report to use silence only once a strong working therapeutic alliance is established and avoid this microskill with extremely agitated clients. 30 31

Silence is not typically covered in basic microskills training resources. 18 22 However, we suggest that this microskill is taught in audiology graduate programs precisely due to its controversial nature. It is necessary for beginning clinicians to, at a minimum, understand the varying implications of using silence in a clinical encounter. Graduate students and new clinicians are often uncomfortable with silence in a clinical encounter, causing them to become internally distracted, anxious, and preoccupied with the correct response. Silence is a useful and necessary microskill for delivering difficult news, which is a common scenario in audiology clinical practice. Thus, it is necessary for Au.D. students to understand the varying purposes of silence, controversial responses to silences, and establish comfort with using silence clinically when appropriate for the patient. Comfort with silence often comes with exposure, experience, and confidence. Repetitive practice of using silence in simulated clinical sessions increases exposure and allows students to receive feedback regarding their visible comfort while using silence.

Conveying Empathy

Experiencing and conveying empathy are central to developing a strong therapeutic alliance with patients. 32 33 There is little consensus on the definition of empathy; however, it is understood to be a process in which a person understands the experience of another person while still maintaining their own point of view. 33 34 35 Empathy consists of cognitive and affective processes, because an individual conceptually understands another's point of view (cognitive) and has emotional reactions to the other person (affective). 33 34 35 The first step is for therapists to understand their patient's experience, feelings, and cognitive state. 33 35 36 Errors in this step will prevent therapists from conveying empathy and establishing a strong relationship. The second step is for therapists to convey this understanding and empathy to the patient in a genuine way. 33 34 35 36 This section will discuss the microskill of conveying empathy rather than discussing the cognitive, emotional, and biological processes of accurately understanding another's point of view. Graduate students and new clinicians often have natural abilities for step 1 but have difficulty conveying empathy (step 2).

Conveying empathy refers to a clinician communicating their understanding of the patient's point of view with accuracy and unconditional positive regard. 33 35 To convey empathy, clinicians use all of the previously covered microskills (i.e., listening, nonverbal communication, silence) in addition to verbal microskills not covered in this article (e.g., paraphrase, emotion reflections, simple reflections, encouragers, questioning, summarizing). Perhaps most important to conveying empathy is the clinician's accuracy. 23 33 A clinician must accurately communicate an understanding of the patient's experiences, reported problems, and feelings. To do this, clinicians can start with verbal reflections of the patient reported problems and experiences to express understanding. 35 It can be helpful for clinicians to use phrases such as “Correct me if I'm wrong . . . ,” “Let me make sure I understand . . . ,” or “Is that right?” so that the patient is given an opportunity to correct the clinician if he or she is off. 35

Conveying empathy also requires that clinicians communicate an understanding of the patient's emotional valence and intensity. 23 33 Thus, clinicians should utilize accurate verbal reflections (i.e. matching the emotional language of the patient). For instance, a patient explains that they are feeling frustrated and furious about their situation. A clinician would not be conveying empathy if they later referenced or summarized the patient's feelings of anger and stress, because these are different feelings with less intensity. Using the wrong emotion words with a patient can be invalidating and harmful to the therapeutic relationship, especially if the word used is of lesser intensity, whereas matching emotion language has been shown to predict the feeling of empathy. 23 35

Finally, clinicians' expressive nonverbal messages influence conveyed empathy and the therapeutic relationship. Matching nonverbal messages and behaviors of a patient can convey understanding of a patient's emotional state. 23 For instance, a clinician matches their patient's quiet, slow-paced paralanguage while discussing the limited treatment options for their child. It would detract from empathy to talk quickly and loud during visible patient distress. A clinician can also display empathy through visible engagement, warmth, and attitudes of acceptance during a clinical encounter. This microskill can be difficult for graduate students and new clinicians, because nerves and lack of confidence can cause students to display incongruent nonverbal behaviors. 23

Conveying empathy becomes more natural and genuine with experience; however, graduate students can benefit from learning appropriate and inappropriate empathetic statements. First, it is important to distinguish empathy from sympathy, because students often confuse the two. 37 Empathetic statements should serve to convey understanding of the patient's perspective and feelings. 37 Sympathy refers to “heightened awareness of another's plight as something to be alleviated.” 37 (p.314) Though slight, this distinction between understanding and awareness of suffering is crucial for establishing a therapeutic alliance. Particularly in rehabilitation settings and populations, clinicians should attempt to avoid conveying that conditions need to be fixed or alleviated. Statements that reflect understanding are empathetic, such as “I can see that is really difficult for you,” “That sounds very frustrating,” or “How terrible.” Statements that reflect sympathy are slightly different, such as “I'm sorry that happened to you” or “I can't even imagine how difficult that is.” The first set of examples indicates that the clinician is joining with and understanding the patient whereas the second set of examples suggests pity and a lack of understanding. Students can be taught to conceptually understand and use basic empathetic statements and then master genuine delivery of these statements.

Teaching Methods

Orientation to teaching counseling microskills.

Clinical educators are tasked not only with imparting knowledge, but with facilitating and monitoring students' clinical performance as well. It is important to acknowledge the difference between learning information and developing skills. Skills are not learned or mastered through traditional forms of teaching content (i.e., didactic instruction and examinations). 38 Clinicians develop skills through practice, repetition, feedback, and evaluation. Thus, it is necessary to utilize experiential and performance-based learning in clinical rehabilitation graduate training programs. 38

We subscribe to constructivist learning theory and believe in the importance of experiential learning. Research supports the use of constructivist teaching over teacher-centered classrooms in counseling graduate programs. 38 Constructivist learning theory can be conceptualized through the differentiation between student/learner-centered and teacher-centered classrooms. 38 39 Teacher-centered classrooms tend to utilize didactic- and lecture-based instruction. 39 Student-centered learning, a form of constructivist learning, consists of collaborative learning between the teacher, student, and peers. Student-centered learning tends to be more individualized, because classroom activities and projects are tailored to each students' needs and require active involvement of the students. 39

Constructivist learning also strives to assess student performance in realistic contexts and address relevant problems. 28 This teaching philosophy is congruent with the task of developing clinical skills with experiential activities. We find that students conceptually understand a skill but falter with the execution. For instance, an entire class will be able to discuss the importance of the microskill, anticipate scenarios to utilize that skill, and discuss hypothetical problems or barriers to utilizing the skill. However, upon engaging the class in a role-play evaluation, less than a third of students are able to effectively demonstrate the skill. Thus, our courses have been modified to have minimal didactic instruction or conceptual discussions (less than 20 minutes per 3-hour course) and instead consist of several hours of structured role-plays and classroom group activities to demonstrate skills. We find that students learn through doing as opposed to though readings, lectures, intellectual discussions, or passive observations. It is often students' insecurities or nerves that prevent them from effectively demonstrating a counseling microskill, which is only remedied through practice and experience. Evidence supports the use of experiential learning activities in the development of basic and advanced counseling skills. 40 Thus, experiential classroom activities are critical to learning counseling microskills. 40 41 42

We use a variety of experiential learning activities, such as role-play activities, simulated patients, video tape recording, and real-life patients, in our clinical courses to both maximize our students' skill development and best evaluate student progress. We recommend that audiology instructors utilize these methods to teach and evaluate counseling microskills. The following section details these methods and provides recommendations for those teaching counseling microskills in audiology graduate programs.

Microskill Sequence

We recommend that audiology instructors teach basic counseling microskills to students early in clinical graduate programs. 20 These are foundational skills that facilitate the therapeutic alliance between clinician and patient. In our experience, students need to master counseling microskills (e.g., listening) before learning more complex microskills (e.g., reflection). It is important to note that being proficient at basic counseling microskills is not sufficient for meeting standards of clinical excellence. 9 Basic counseling microskills serve as a foundation for learning more complex clinical interventions that are specific to the profession and clinical context. 8 9 20

Our basic counseling microskills course begins with active listening, the most foundational and difficult microskill. Active listening is the sole focus of the course for 3 to 5 weeks, depending on the students' ability to master the skill. Following demonstration of competence in listening, the course progresses to instruction in nonverbal communication. Students typically require 2 to 3 weeks to learn and demonstrate basic competency in nonverbal communication skills. Up until this point, students are not verbally responding or asking questions during practice activities and recorded evaluations but only focusing on listening and nonverbal accuracy. Following mastery of nonverbal communication, our students are taught silence and verbal responses. Verbal responses include paraphrase, emotion reflections, simple reflections, encouraging, questioning, summarizing, and challenging. However, verbal response curriculum will likely be specific to professional specialty because there are different needs for different professional roles. We teach empathy shortly after introducing verbal responses, because empathy is demonstrated through both nonverbal and verbal communication. Our basic skills course continues on to teach other skills specific to the profession of counseling. This sequence of basic microskills allows students to scaffold their microskills beginning with the most foundational and crucial counseling skill of active listening. It is recommended that the same sequence is utilized in counseling classes for Au.D. students, and microskills necessary for audiology settings are suggested to be taught after empathy (e.g., teaching skills to deliver difficult news or assess risk).

Classroom Role-Play

There are several practical and structural suggestions for instructors teaching counseling microskills through individual or group role-play classroom activities.

Students may initially feel more comfortable practicing in dyads or small groups rather than a full classroom role-play. It is difficult for students to evaluate one another when one student is acting as the clinician and the other as the patient. Thus, we recommend small groups of three or four so that there can be student observers evaluating the role-play. It is helpful if instructors assign roles to each student in the group. For instance: student one acts as the clinician demonstrating the new skill; student two acts as the patient; student three observes the scenario for a previously learned skill; student four observes the scenario for the newly learned skill. Observers are able to focus on providing feedback on the role-play scenario, and this ensures that all group members are involved in the learning process.
We find it helpful for the instructor to spend equal time (even a minute or less) with each group during role-plays. This allows the instructor to evaluate the class's overall understanding and ability to utilize the new skill. This builds in time for formative assessment and each student receives some feedback, if only brief, from the instructor each week. This can help shape their development rather than waiting for feedback on larger assignments.
Timing is critical when managing an experiential classroom. Strict timing structures are necessary to ensure that role-play scenarios are completed and every student is able to practice the skill. We utilize countdown timers to alert the class at the start and end of each role-play. In our experience, microskills are present or absent within the first few minutes of a clinical scenario. Thus, long extended role-plays are not necessary. We typically structure multiple role-plays throughout the class that are only 2 to 10 minutes in length. It is more important for a student to try several times and grow with a skill than have only one extended role-play.
Role-play prompts can be challenging to write for classroom activities. We have found it helpful to write very brief prompts (less than a sentence), because students' acting tends to be disingenuous or preoccupied with the script when the prompt is longer. It can be helpful to give students a single emotion word to role-play so that they are able to act out a scenario that is more real to them. It is also critical that instructors balance role-play activities with both positive and negative situations. It might be helpful to remind students that classroom role-plays are simply to practice microskills rather than practice real-life clinical scenarios and decision making.
When the entire class is having difficulty demonstrating a new skill, having a pair of students practice in front of the class can be an effective classroom activity. Our clinical instructors randomly select students to be the clinician and the client and we provide a brief prompt. This activity can be helpful if the instructor suspects that the majority of students are incorrectly utilizing a skill, because it allows the instructor to structure all of the feedback. This activity can produce a mild amount of distress for students. Thus, it may be helpful to prep students at the beginning of class and allow them to practice in dyads before the full classroom activity.
We recommend that you structure reflection time after each role-play activity. As stated previously, it is helpful to assign roles to students so that they have a specific skill to reflect on following the activity. We find that it can be helpful to structure the self-reflection on performance and internal dialogue rather than skill demonstration, because students tend to give inaccurate or overly positive skill feedback to each other.

Best teaching practices in psychology and counseling support the use of role-plays and experiential learning activities in the classroom. 40 41 42 These are effective ways to use classroom time in a productive manner that facilitates skill development and refinement. However, learning and evaluating microskills should not be limited to peer role-plays. Constructivist learning theory highlights the need for relevant and realistic evaluation. Thus, we recommend the use of simulated and real patients for evaluation of microskill demonstration while utilizing peer, group, and classroom role-play for introducing, learning, and practicing new microskills.

Simulated Patients

Utilizing real patients for counseling microskill development has its advantages and disadvantages. Real patients clearly maximize the realistic learning experience. However, it is not expected that students are developmentally ready to work with real patients when learning counseling microskills very early in the graduate training programs. Educators are ethically required to consider the best interest of the patient over students' learning opportunities. If real patients are used this early in students' clinical training, faculty must commit to high levels of supervision and patient outcomes could be negatively impacted.

Simulated patients are an effective alternative to real patients when students are developing basic microskills. 43 In fact, recent comparative research found no significant difference in learning outcomes between students practicing skills with a real patient or simulated patient. 44 Both utilization of real patients and simulated patients facilitated equal student demonstration of required counseling skills. 44 Simulated patients allow students to demonstrate skills under direct supervision without the risk of harm to the client. Our program utilizes simulated clients for the first two counseling courses before students move to working with real clients in practicum settings and classroom evaluation.

There are a few options to consider for utilizing simulated patients during basic counseling microskills courses. One option for the simulated patient is to hire student actors to role-play a standardized script. Another option is to hire student actors to role-play with varying scripts. Finally, the course instructor can serve as a simulated patient, (we use this option primarily for evaluation; see the following section). We do not generally recommend that students use each other for simulated clinical interactions. In our experience, students preplan the session with each other to help facilitate good grading and performance. Even though it is more convenient to have students schedule with each other, this minimizes the learning potential for the activity.

Hiring student actors for simulated clinical sessions can be time-consuming to organize, but our learning outcomes have been very positive and greatly improved from peer role-play sessions. We typically hire psychology and drama undergraduate students to complete several (three to four) clinical sessions across the course of the semester. We recommend that instructors provide actors with a brief group training prior to beginning the simulated clinical sessions with students (1 to 2 hours). The clinical sessions are video recorded. One advantage to utilizing standardized scripts for actors is that it simplifies fair grading across students. Student actor performances still vary between actors, which allows for the class to see minor human behaviors variations within the same case study. Further, developing scripts and training actors is time intensive for instructors and standard scripts can reduce unnecessary workload.

Simulated clinical sessions with actors also allow the use of watching tapes in class, because it does not violate the Health Insurance Portability and Accountability Act or patient confidentiality. Our clinical courses watch student-simulated sessions a minimum of two classes per term. This classroom activity has several benefits: students are able to see different approaches and techniques, it normalizes students' insecurities and doubts, and it allows the instructor to call attention to specific microskills with all students. One useful learning technique while watching student videos in class is to use signs or paddles that students raise when they recognize a microskill being demonstrated (example: nonverbal warmth or empathy). This ensures that students are able to recognize and identify microskills, which can be helpful for their future demonstration of the skill.

Clinical educators have a gatekeeping responsibility. We do our best to ensure that the students who graduate from our program are fit for professional practice. Au.D. students are evaluated on their ability to provide audiology services, and they should, as health and rehabilitation professionals, also be evaluated on their ability to successfully use basic counseling microskills. In this section, we will provide recommendations for instructors on how to evaluate students' counseling microskills, with the goal of ensuring students demonstrate minimal competency to begin clinical practice. We will also comment briefly on evaluation from the students' perspective.

Students cannot demonstrate counseling microskill proficiency through a test or writing assignment, but through skill demonstration. Evaluating counseling microskills is time-consuming. We have found that for a 50-minute session, it takes about 2 hours to watch the session and provide written feedback, and an additional 30 to 60 minutes to meet with the student to review the video and highlight clips that demonstrate areas of strength and areas for growth. Depending on the counseling course structure and class size, it can be difficult for instructors to watch every video recorded simulated clinical session. Our counseling courses typically require students to complete three or four video recorded simulated sessions and a final with the course instructor. Of the three or four recorded sessions, our instructors watch and grade a minimum of two.

We require students to watch their clinical sessions and provide a reflection on their performance and microskill demonstration. This helps the instructor assess the student's insight and ability to self-evaluate. We utilize a transcription assignment for the simulated session that we do not watch in entirety. In this assignment, students are required to transcribe the entire simulated clinical session. Following transcription, they are required to evaluate their responses (verbal and nonverbal) throughout the entire session. Instructors read the transcription and evaluation submitted by the student. Any areas of concern or interest are then watched by the instructor. This significantly reduces the amount of time watching clinical tapes and students report significant growth during this reflective assignment.

Several of our counseling courses require students to conduct a session with the instructor as client for their final examination. There are several advantages to this version of simulated clinical sessions. First, this allows the instructor to control the clinical scenario ensuring that every student encounters key clinical scenarios, decision points, or challenges that are the targets for evaluation. It also reduces workload for the instructor as the instructor can immediately evaluate student performance. Our clinical instructor simulated sessions are typically only 30 minutes in length, because the instructor can more quickly evaluate microskills when receiving them as the “patient.”

Table 1 is a sample counseling microskills evaluation grading rubric similar to those used in our counseling microskills courses. It includes the four microskills highlighted in this article: listening, nonverbal communication, silence, and empathy. A description of each skill is provided. Generally, for each skill, students are considered to exceed expectations if they appropriately demonstrate the skill for at least 90% of the clinical session. This is considered exceptional and means the student is demonstrating skill above and beyond what is expected of a novice clinician. Students meet expectations if they are demonstrating the skill 75 to 90% of the time. For students who demonstrate skills inconsistently, less than 75% of the time, or not at all, they fall into one of the last three columns, and this typically indicates a need for remediation. An advantage to using a rubric like this is that you can see easily where students stand; oftentimes we will see that students generally perform well but need remediation in just one or two specific areas.

Evaluation can be difficult from the students' perspective as well. Anxiety and negative reactions to feedback in counselor training and education is well documented in counseling literature. 23 45 46 47 Counseling and psychology graduate students demonstrate lowest levels in self-efficacy during the beginning terms of clinical training programs. 47 This is likely due to increased awareness in areas that require growth and exposure to clinical feedback. Students are accustomed to receiving feedback on exams or papers and corrections to these types of work are less likely to be taken personally. When evaluating counseling microskills, the way students communicate, interact, and connect with others is being evaluated. This feels more personal than grades on external work (papers, exams) they have completed. Further, counseling interactions are dynamic so there is no one “right” way to execute counseling skills. 45 46 This can cause students to become preoccupied with performance and evaluation. Students may also have unrealistically high expectations or perfectionistic tendencies and constructive criticism or developmental feedback can cause considerable distress. 45 46 We have seen negative students' reactions to evaluation be both external (e.g., anger at faculty, blaming the patient, etc.) and internal (e.g., feelings of guilt, sadness, powerlessness, etc.).

We have found it helpful to prepare students for feedback in our program orientation and the first day of each clinical course. Students also periodically complete self-reflections and self-report assessments on reactions to feedback. 48 Feedback reactions and integration are also topics of discussion with student's academic advisors. Faculty-student discussions on feedback acknowledge that feedback on counseling microskills may feel more personal than feedback on academic work. We continually reinforce to students that counseling microskills are skills that must be learned over time rather than a natural ability. Finally, we strongly recommend that students seek out their own personal counseling if they have negative reactions to evaluation that prevent them from integrating feedback and improving skills. It is essential that clinical educators openly discuss feedback with students in addition to skill evaluation, because student confidence and anxiety directly impact the ability to demonstrate natural and genuine counseling microskills with patients. 23

The patient-clinician relationship and therapeutic alliance influences response to treatment and health outcomes. It is necessary for all clinical professionals to have the skills necessary to build trusting and genuine relationships with patients. Professional counselors learn the fundamentals of building a therapeutic alliance in basic counseling microskills courses early in the graduate curriculum. Audiology graduate programs would benefit from adopting a counseling microskills training approach for teaching Au.D. students basic clinical skills. This article reviewed four universal counseling microskills—active listening, nonverbal communication, silence, and empathy—that contribute to the development of a strong therapeutic alliance. These skills cannot be taught through more traditional, didactic teaching means, they must be taught and evaluated using experiential methods. Suggestions for learning and teaching these skills through role-plays, simulated patients, and regular evaluative feedback were provided. Following mastery of counseling microskills, Au.D. students can focus on learning audiology-specific interventions for patients. Teaching these skills is undoubtedly challenging for both instructors and students. But, as counselor educators, we believe it is worth the time and effort.

Counseling Reviews

Basic skills for counselling (paraphrasing).

3 comments:

When you are rephrasing so you need to think like a paraphrase helper who is always there to help and creativity not for just checking purposes.

Hi, I just wanted some clarification on #4 of Why we paraphrase. I am a little confused with the sentence that states, "With this skill to emphasize content is also useful if attention to affect is premature or counter-productive."

Counselling skills are the tools that counsellors use to help clients. They can be divided into three main categories: communication skills, intervention skills, and assessment skills. Communication skills involve active listening, empathy, and rapport building. Intervention skills involve providing support, guidance, and encouragement. Assessment skills involve identifying client goals and objectives, assessing progress, and making referrals. Counselling skills are important because they provide a framework for helping people achieve their goals. When used effectively, counselling skills can help people overcome challenges, make progress, and improve their lives. Read another amazing blog: https://lead-academy.org/blog/what-is-counselling-skills/

Related Posts Plugin for WordPress, Blogger...

Empathy in Counseling: How to Show Empathetic Understanding

What is Empathy and Why is it Important in Counseling

After all, building a complete appreciation of clients’ experiences, triggers, and behaviors is essential to counseling. Recognizably sharing their feelings encourages them to dig deeper, strengthen the therapeutic alliance, and boost the likelihood of a successful treatment outcome.

And yet, “you must experience empathy before you can express it,” writes counseling experts Jeff and Nancy Cochran (Cochran & Cochran, 2015, p. 48).

This article explores the skills and techniques counselors can adopt in session with their clients to develop and show empathic understanding.

Before you continue, we thought you might like to download our three Emotional Intelligence Exercises for free . These science-based exercises will enhance your ability to understand and work with your emotions and have empathy. It will also give you the tools to foster the emotional intelligence of your clients, students, or employees.

This Article Contains:

Defining empathy in counseling, why is empathy important in counseling, empathy & positive psychology – a good fit, examples of empathic responses, skills & barriers, understanding empathy vs sympathy vs compassion, how to show empathy in therapy, positivepsychology.com’s empathy resources for counseling, a take-home message.

“Providing a therapeutic relationship will always involve deep caring, respect and empathy for the anxiety and suffering of another human being” (Cochran & Cochran, 2015, p. 17).

And yet, expressing empathy within a counseling session involves more than just words; the counselor must communicate a deep understanding and display a personal connection with the client.

It requires more than providing solutions. Focusing too early on what you, as a counselor, can do to address your clients’ problems may get in the way of sharing experiences and showing empathy. If you find yourself searching for a solution as they talk, you may have strayed too far from empathizing and listening (Cochran & Cochran, 2015).

Instead, the client’s emotional pain must be allowed and accepted, as only then will it change. The relationship between counselor and client must be one of empathy, presence, and acceptance (Greenberg, 2011).

And yet they need to experience empathy and acceptance to find the motivation and peace they need to be empowered to make choices and take responsibility (Cochran & Cochran, 2015).

Indeed, that relationship “is seen as being curative in and of itself in that the therapist’s empathy and acceptance promote breaking of the isolation, validation, strengthening of the self, and self-acceptance” (Greenberg, 2011, p. 68).

And yet, empathy starts outside the session with how we view ourselves.

To have the capacity for empathy, we must not, as counselors, shape who we are based on the person we believe others want us to be. Seeking external validation limits our potential and self-actualization. Valuing ourselves through our being allows us to become who we want and create a therapeutic environment and experience for clients to learn naturally and rediscover themselves (Cochran & Cochran, 2015).

Indeed, research reported by the American Psychological Association confirmed that empathy, defined as a “sensitive understanding of the patient’s feelings and struggles; seeing them from the patient’s point of view,” is one of several factors crucial to a strong therapeutic alliance (American Psychological Association, 2019).

Download 3 Free Emotional Intelligence Exercises (PDF)

These detailed, science-based exercises will help you or your clients understand and use emotions advantageously.

Download 3 Free Emotional Intelligence Tools Pack (PDF)

By filling out your name and email address below.

Positive psychology recognizes the importance of emotional intelligence to our psychological wellbeing and growth and the potential of developing emotional skills and empathy through related interventions. After all, emotional awareness and expression are building blocks for creating that understanding and strengthening our feelings for one another (Lomas, Hefferon, & Ivtzan, 2014).

Empathy is vital for all our valued relationships. Positive psychologist Tim Lomas and colleagues describe it as “the ability to communicate understanding of another person’s experience from that person’s perspective” (Lomas et al., 2014, p. 159).

The Oxford Handbook of Positive Psychology also recognizes its value in making lives worth living, defining empathy as “an other oriented emotional response elicited by and congruent with the perceived welfare of someone else” (Snyder, Edwards, Marques, & Lopez, 2021, p. 418).

While not the easiest of definitions, we can further break down positive psychology’s view of empathy as:

Taking a strong interest in the other person’s positive wellbeing
Experiencing joy at another’s good fortune
Evoking altruistic motivation
Belonging to other-oriented feelings, including tenderness, soft-heartedness, and sympathy
Involving feelings ‘for’ another person

At times, positive psychology appears to distance itself from some of the more populous interpretations of empathy, including inferring another’s psychological state, projecting oneself onto their situation, and feeling what another feels (Snyder et al., 2021).

And yet, the difference is subtle and possibly ‘academic’ for the counselor in session. We may not be undergoing the very same upset, sorrow, or fear as our clients, but by being empathic, we are most likely experiencing our interpretation of such feelings. And in doing so, forming a stronger, more helpful connection, boosting the therapeutic alliance and the potential for a successful treatment outcome.

Empathy skills

Empathy is more than just communication; it is about challenging self-perceptions, finding joy in making connections, and furthering communication. And it requires you as a counselor to become more open to your own and your client’s feelings and to make them visible in your relationship with them (Greenberg, 2011; Cochran & Cochran, 2015).

– Finding ways to express empathy

Empathy can be expressed in many ways, yet is typically a combination of the following (Cochran & Cochran, 2015):

Matching the client’s tone : if they say they feel hurt and show it, then match it with your tone.
Facial expression and body language : don’t maintain a poker face. Let your client see what they have said affects you by indicating it in your face, hand gestures, and how you hold your body.
Naming feelings : words are powerful tools. Use them to name the feelings your client is experiencing. For example:

“You are so angry; you can hardly sit still.” “I can hear the pain and upset in your voice.” “You feel so mad about this.” “It’s like you are battling uphill every day.”

– Self-reflection

Self-reflection can be a powerful way of developing loving-kindness. Indeed, techniques and tools such as gratitude journals and focusing on three good things from the last twenty-four hours encourages us to open up to the positive impact others have had on our lives and create the openness required to develop empathy (Lomas et al., 2014)

– Advanced reflection of feelings

Closely observing and actively listening to clients can help the counselor or therapist become aware of subtle, underlying messages. After all, clients, like the rest of us, may repress, suppress, or otherwise avoid feelings—especially uncomfortable ones.

Deep empathy helps clients articulate what they are experiencing. Richard Nelson-Jones suggests counselors and therapists ask themselves (modified from Nelson-Jones, 2014, p. 184):

What is our client only half telling us? What are they hinting at or toward? What might they be saying in a confusing way? What is hiding behind, or implied by, this explicit message?

Sometimes the therapist acts on ‘hunches,’ intervening to help the client share more than they intended. At other times, they hold back, letting the client’s story unfold uninterrupted.

– Therapeutic listening

A large percentage of the counselor’s time is spent listening – a vital skill for building and maintaining empathy. Demonstrating to each client that the counselor knows and understands them–in increasing depth–must be communicated with feeling.

The following communication skills do’s and don’t’s help improve communication, build on the therapeutic alliance, and develop empathy (modified from Cochran & Cochran, 2015):

Use your body language Listening with empathy is a way of being. When doing so, it is apparent in your body language. For example, leaning in, arms and legs uncrossed, communicates you are interested in what the client is saying and empathizing with their feelings.
Share your perception of their communication You cannot fully know what the client is going through, yet reflecting back how you perceive their emotional position shows empathy.
Show understanding using declarative statements When the client is clear in what they say, make sure that you respond with equally transparent declarative statements, such as “I understand that you are irritated by your partner’s actions.”
Be prepared to accept corrections You are demonstrating empathy if you have decided you have nothing more to learn. Even if your understanding is justified based on what your client has told you, and they later reject your thoughts, showing respect and letting them correct you will create a deeper bond and improve your understanding of their position.
Interrupt your client with care Consider whether your interruption will help your client share how they feel – perhaps by paraphrasing what they have said so they can move forward. Reflections, while often helpful, can harm communication when excessive or if their tone does not signal empathy.
Let your client own their silences Following a reflection, the client may go silent – let them own it. They may be readying themselves to go deeper and share very personal experiences or feelings or may be considering what you have said – having been taken by surprise.
Allow a hierarchy to form Counseling builds on equality – your observations and reflections are not more important than what the client has to share. Only they truly know how they feel.
Ask questions Use questioning only in rare circumstances, and do not end reflections by asking for something. Questions typically focus more on the counselor’s needs than the clients – satisfying their desire not to be misunderstood. Otherwise, when asked something, the client may try to answer whether or not it is something they need to communicate.

Suggested read: Things therapists should not do .

Types of empathy

At least three types of empathy can help you build stronger and healthier relationships with clients. They include (Jeffrey, 2016; Cochran & Cochran, 2015):

Cognitive empathy Improves our ability to communicate because it focuses on what the other person may be thinking.
Emotional empathy Or ‘affective empathy’ is our capacity to share what the other person is feeling. Taking on another’s emotions can help us build stronger emotional connections with them.
Compassionate empathy Or ‘empathic concern’ is about helping the other person take the actions required to move forward. It might be about the client adopting coping mechanisms or working together to set goals .

Cultural empathy

Inclusive cultural empathy is described as having two defining features (Garcia, Yuhwa, & Maurer, 2012):

An “empathic counseling relationship values the full range of differences and similarities of positive and negative features as contributing to the quality of that relationship in a dynamic balance” (Garcia, Yuhwa, & Maurer, 2012, p. 2).
Culture is defined broadly as the client’s ethnographic nationality and ethnicity, demographic (age, gender, lifestyle, etc.), status (educational, economic, and social), and formal and informal backgrounds (Garcia, Yuhwa, & Maurer, 2012).

And while research has shown clinical skills to be essential, cultural empathy ensures counselors understand the factors that influence client identity.

Empathy barriers

Empathy can be as limited by what we do as much as what we do not do:

– Quietening our minds

Unless we quieten our minds during client sessions, our thoughts will impede forming empathic therapeutic bonds. Practicing mindfulness can help us focus on the client’s feelings and experiences rather than our inner chatter and self-doubt (Cochran & Cochran, 2015).

– Inappropriate reflection

Repeating back to your client what you have understood is important. “When you feel strong emotion hit you from your client, let that be the prompt to reflect” (Cochran & Cochran, 2015, p. 43; Nelson-Jones, 2014).

– Worrying if you are liked

The therapeutic bond is vital in counseling. Yet, time spent wondering if the client likes us will not help reach a positive outcome – indeed, it may get in the way of building and maintaining empathy. After all, if your client is eager to share, they most likely already respect and value the bond created (Cochran & Cochran, 2015; Nelson-Jones, 2014).

Empathic responses and the use of silence – Kelly Allison

While empathy, sympathy, and compassion have many different definitions, it is broadly accepted that they have elements shared with other prosocial behavior (modified from Jeffrey, 2016):

Empathy Whether cognitive, emotional, compassionate, or behavioral, empathy involves understanding a person from their frame of reference rather than our own.
Sympathy Sympathy is a broad term that signals experiencing another’s feelings rather than empathizing with them. Sympathy can take a self-oriented perspective.
Compassion Compassion has been described as “a deep awareness of the suffering of another coupled with the wish to relieve it.” Like sympathy, it can arise when something bad happens to another person (Jeffrey, 2016).

Whether empathy is part of compassion or vice versa, they are closely related. Either way, many in social sciences treat them as variations of a broad affective phenomenon and collectively refer to them as empathy (Jeffrey, 2016).

Self-disclosure

While sharing too much as a counselor can move the focus away from the client, a balanced approach to self-disclosure is a valuable empathy skill. Indeed, sharing experiences with the client can help ‘normalize’ their feelings while reminding the counselor they may have walked similar paths (Nelson-Jones, 2014).

Assigning tasks

Between-session tasks help clients practice what they have learned. When they report back on their successes (and failures), the counselor better understands what remains difficult; their growing empathy sheds light on helpful future exercises and techniques to employ (Nelson-Jones, 2014).

Role-playing

Conducting role plays with clients can help them share, even if indirectly, how they feel. For you, as a counselor, it can encourage greater understanding, awareness, and empathy for what they are going through. Alternating roles offer insight into how each ‘player’ feels and why such emotions are important (Nelson-Jones, 2014).

Live observation

During a session, it can be difficult for clients to explore feelings fully regarding situations they find difficult. Taking the clients into environments they find problematic–while maintaining an appropriate degree of control–can help the counselor empathize with their emotional responses and understand what is prompting unwanted behavior (Nelson-Jones, 2014).

17 Exercises To Develop Emotional Intelligence

These 17 Emotional Intelligence Exercises [PDF] will help others strengthen their relationships, lower stress, and enhance their wellbeing through improved EQ.

Created by Experts. 100% Science-based.

We have various resources available for counselors wishing to develop their empathy and use it within counseling sessions:

Free resources include:

Traps to avoid and Tips for Success Use this worksheet to identify traps, avoiding closed thinking, and practice tips for productive, positive and receptive communication.
Empathy Bingo Helps individuals differentiate between empathy and other emotions .
Trading places Encourages reflection on a situation from: our, another person’s, and finally a wise person’s perspective.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

Strength collisions When our strengths collide with others, we may perceive the other person’s strength as a weakness and ours as superior and absolute. We may also believe our behavior is the ‘right’ way to deal with the situation that confronts us. This exercise helps the client consider another person’s perspective by stepping into their shoes and can increase empathy.
Transcending Pain: Using Personal Suffering to Benefit Others Channeling our feelings into compassionate service and helping others who are suffering provides an enhanced sense of meaning that is positively associated with happiness, physical health, wellbeing, and increased prosocial behavior.

This exercise helps clients understand the value of their past emotional wounds, hurts, and disappointments and uses them to help others who are also suffering.

If you’re looking for more science-based ways to help others develop emotional intelligence, this collection contains 17 validated EI tools for practitioners. Use them to help others understand and use their emotions to their advantage.

When someone has decided to seek help, there is most likely no quick fix—attempting to find and implement one in a hurry will not create an environment conducive to empathetic listening.

Instead, showing that you are listening and understanding what the client has to share displays empathy and that you are engaged and invested in them as a person.

And yet, to express empathy in a counseling session, you must have experienced it first-hand. As a counselor, you need to have lived experiences of emotions before communicating a profound understanding and displaying a personal connection with the client.

Experiencing joy at the good times in another’s life and emotional upset at the traumas they face shows a strong interest in their wellbeing. When evident in what we say and how we express ourselves, the client is encouraged to go deeper and share what has so far remained private and hidden.

We hope ‌this article helps counselors, in their professional and personal life, increase awareness of their own and others’ emotions and create stronger relationships.

Don’t forget to download our three Emotional Intelligence Exercises for free .

American Psychological Association. (2019) What the evidence shows . (2019). Retrieved July 4, 2022, from https://www.apa.org/monitor/2019/11/ce-corner-sidebar.html
Cochran, J. L., & Cochran, N. H. (2015). The heart of counseling: Counseling skills through therapeutic relationships . New York: Routledge, Taylor & Francis Group.
Garcia, B., Yuhwa, E. L., & Maurer, K. (2012). Cultural Empathy: Implications of Findings from Social Work Objective-Structured Clinical Observation for Field Education .
Greenberg, L. S. (2011). Emotion-focused therapy . Washington, DC: American psychological Association.
Jeffrey, D. (2016). Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter? Journal of the Royal Society of Medicine , 109(12), 446-452.
Lomas, T., Hefferon, K., & Ivtzan, I. (2014). Applied positive psychology: Integrated positive practice . Los Angeles: SAGE.
Nelson-Jones, R. (2014). Practical counselling and helping skills . London. Sage.
Snyder, C. R., Edwards, L. M., Marques, S. C., & Lopez, S. J. (2021). The Oxford Handbook of Positive Psychology . Oxford University Press.

Share this article:

Article feedback

What our readers think.

I enjoyed gaining this insight from your article, which I will be referencing in a class discussion on “Empathy” in counseling at Ohio Christian University. There is a lot of thought put into your work in this article, and I do hope to show future clients that I am being empathetic toward their situations. Personally, I have much experience of what most clients might be facing, which, hopefully, will help to empathize with them in an effective manner. I feel that genuine experience makes it much easier to help clients through similar experiences. It allows them to acknowledge that they are not alone in the struggles they face in life. The information you provide in this article has been incredibly helpful for me as a student and my journey towards becoming a counselor for teens and adolescents. Thank you! 🙂

Many Blessings, Lisa Chapman A college student at Ohio Christian University; received access to this article through course instructor: Applying Skills for Helping Professionals, Online Course.

Wow just came at the right time .Am on my last year on counselling .

Please refer to Dr. Peter Breggin and his website and organization International Center for the Study of Empathic Therapy

Hey, So glad you liked our article. Your writing seems balanced and intelligent. The utility of empathy in psychotherapy is, as you suggest, very likely change-inducing from a number of directions. You might take a look at the concept of alliance.

Hi, I am a registered dietitian and was delighted to see your site. I plan to incorporate some of your suggestions in order to be more effective in my counseling sessions. Much success in all you do Ana

Hi, you did a great job of explaining the need of empathy in counseling. Personally, I believe that even just listening simply means you do empathize with and care about them. Emotional support is better than financial support! Thanks for your kindness in sharing this information, you do really care!

Very insightfull and practical!

Let us know your thoughts Cancel reply

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Youth Counseling: 17 Courses & Activities for Helping Teens

From a maturing body and brain to developing life skills and values, the teen years can be challenging, and mental health concerns may arise. Teens [...]

How To Plan Your Counseling Session: 6 Examples

Planning is crucial in a counseling session to ensure that time inside–and outside–therapy sessions is well spent, with the client achieving a successful outcome within [...]

Applied Positive Psychology in Therapy: Your Ultimate Guide

Without a doubt, this is an exciting time for positive psychology in therapy. Many academics and therapists now recognize the value of this fascinating, evolving [...]

No category

Week 5 - Counselling Skills Practice 1 - Paraphrasing

Add this document to collection(s)

You can add this document to your study collection(s)

Add this document to saved

You can add this document to your saved list

Suggest us how to improve StudyLib

(For complaints, use another form )

Input it if you want to receive answer

IMAGES

Paraphrasing in Counselling
paraphrasing therapy techniques
Counseling Techniques: Paraphrase, Self-disclosure, Summarization & Confronting
paraphrasing therapy techniques
PPT
PPT

VIDEO

Paraphrasing as a Scientific Writing
Use of Paraphrasing in Research Writing
What is Paraphrasing? Everything You Need to Know #shortvideo
Writing Center Lessons: Quoting, Paraphrasing, and Summarizing
Yoga Nidra for Protecting Your Energy
The Therapist's Invitation: Equity

COMMENTS

Reflecting and Paraphrasing • Counselling Tutor
Definition of Paraphrasing in Counselling. Paraphrasing is repeating back your understanding of the material that has been brought by the client, using your own words. A paraphrase reflects the essence of what has been said. We all use paraphrasing in our everyday lives. If you look at your studies to become a counsellor or psychotherapist, you ...
How Can Paraphrasing Be Used in Counseling? (3+ Main Indications)
Paraphrasing is a form of acknowledgment that is provided by the counselor. This is done by mindfully restating the words of the client, conveying empathy, acceptance, and genuineness. A therapist's role does not comprise of reading the minds of the clients or assuming their emotional states.
Paraphrasing in Counselling
In essence, paraphrasing is a micro skill that allows counselors to create an authentic bond with their clients Together with encouraging and summarizing, paraphrasing plays a crucial role in therapeutic communication, making the client feel understood and listened to. In other words, paraphrasing in counseling is what makes the client say ...
Effects of Empathic Paraphrasing
Paraphrasing or active listening (coined by Carl R. Rogers in Client-Centered-Therapy) is a form of responding empathically to the emotions of another person by repeating in other words what this person said while focusing on the essence of what they feel and what is important to them. ... define as (1) understanding the patient's situation ...
Paraphrasing
Paraphrasing is repeating back your understanding of the material that has been brought by the client in your own words. A paraphrase reflects the essence of what has been said. We all use paraphrasing in our everyday lives. If you look at your studies to become a counsellor or psychotherapist, you paraphrase in class.
Encouragers, Paraphrasing and Summarising
Encouragers, Paraphrasing and Summarising. A counsellor can encourage a client to continue to talk, open up more freely and explore issues in greater depth by providing accurate responses through encouraging, paraphrasing and summarising. Responding in this way informs the client that the counsellor has accurately heard what they have been ...
Reflecting & Listening Skills
Summarizing, Paraphrasing, & Reflecting. Summarizing, paraphrasing, and reflecting are probably the three most important & most commonly used microskills. These skills can be used by counselors to demonstrate their empathy to clients, make the counseling session go "deeper", & increase clients' awareness of their emotions, cognitions, & behaviors.
PDF Reﬂecting Skills Paraphrase and Reﬂection of Feeling
Paraphrasing is a skill used to address the ﬁrst level (cognitive level) In the beginning of the counseling relationship a client can feel more comfortable if you are able to reﬂect content. In most cases you cannot really understand the deeper layers until later on. Paraphrasing Basic formula for a paraphrase:
PDF Reﬂecting Skills: Paraphrasing
Paraphrasing Paraphrasing is a ski! used to address the ﬁrst level (cognitive level) In the beginning of the counseling relationship a client can feel more comfortable if you are able to reﬂect content. In most cases you cannot rea!y understand the deeper layers until later on. How to create a Paraphrase 1.Choose a sentence stem. •It ...
Basic Counseling Skills: Paraphrase, Reflection of Feeling ...
Paraphrase, reflection of feeling, and summarization are basic counseling skills. What are they and how are they used? Watch Drs. Jim Cook and Laura Harrawoo...
Reflection (Therapeutic Behavior)
Nondirective reflections do not lead or direct clients, but reflect back feelings or messages initially provided by the client. Such reflections include paraphrasing, in which therapists rephrase or reword content stated by clients (Sommers-Flanagan and Sommers-Flanagan 2009).For example, a paraphrasing reflection could be "It sounds like you're having trouble getting out of bed in the ...
Paraphrasing/Tone
Paraphrasing (link to Integrative Counselling Skills in action by Sue Culley, Tim Bond) is when you, the listener, restate succinctly and tentatively what the speaker said - conveying empathy, acceptance and genuineness. Since we cannot read our client's mind and we've been given a lot of extraneous material, it's good to learn how to rephrase briefly and acknowledge that this is what we ...
Active Listening: The Art of Empathetic Conversation
Active and empathetic listening is a vital skill in forming and maintaining relationships within therapy and counseling. ... well-developed paraphrasing skills form part of active listening and show that the listener is engaged and understands what is being said (Nelson-Jones, 2014). ... In APA dictionary of psychology. Retrieved June 19, 2022 ...
Introductory Chapter: Counseling and Therapy
1. Introduction. Counseling and therapy are concepts central to nearly all academic disciplines and serve as an interdisciplinary area of study. The field of counseling and psychotherapy represents a synthesis of ideas originated from science, philosophy, religion, and the arts [ 1 ]. The book covered the most practical counseling and therapy ...
What is paraphrasing and Summarising in counselling?
Paraphrasing means rephrasing text or speech in your own words, without changing its meaning. Summarizing means cutting it down to its bare essentials. You can use both techniques to clarify and simplify complex information or ideas. To paraphrase text: Read and make notes.
Microskills: Paraphrasing vs. Summarizing in Counseling Practice
So paraphrasing and summarizing are similar in that they both involve repeating or restating a client's thoughts and feelings, but they're different in that paraphrasing is about restating a specific message or idea expressed by the client, while summarizing involves condensing several ideas that have been expressed by the client.
Teaching and Improving Clinical Counseling Skills: Teaching Counseling
Professional Counseling. It may be helpful to begin with a definition and overview of the scope of professional counseling. Counseling is defined as "a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals." 1 (p.368) Professional counselors have at a minimum a master's graduate degree in counseling.
APA Dictionary of Psychology
n. in psychotherapy and counseling, the verbatim repetition or rephrasing by the therapist or counselor of a client's statement. The purpose is not only to confirm that the client's remarks have been understood but also to provide a "mirror" in which the client can perceive their feelings and ideas more clearly (see mirroring ). Compare ...
(PDF) Counseling Summarization using Mental Health Knowledge Guided
It encodes dialogue's utterances and uses three modules in the. Counseling Summarization using Mental Health Knowledge Guided U erance Filtering KDD '22, August 14-18, 2022, Washington, DC ...
Counseling Reviews: Basic Skills for Counselling (Paraphrasing)
1. Paraphrasing tells the client that you have understood their concerns and communication. If your understanding is complete and accurate, the client can expand or clarify their ideas. 2. It can encourage client elaboration of a key idea or thought. Clients may talk about an important topic in greater depth.
Empathy in Counseling: How to Show Empathetic Understanding
Displaying empathy shows that you, as the counselor, are listening, understanding, and experiencing what the client is sharing. After all, building a complete appreciation of clients' experiences, triggers, and behaviors is essential to counseling. Recognizably sharing their feelings encourages them to dig deeper, strengthen the therapeutic ...
Week 5
Exercise #1. Read the dialogue between the worker and client (Stacy) below. Then return to think. critically and answer the following questions about using paraphrasing within a Person-Centred. Approach. Tip: Use slides from the lecture of Week 3 and the lecture and seminar of Week 5 to help you. 1) Read the client's story provided on the ...

Reflecting and Paraphrasing

2 FREE Downloads - Get your overview documents that describe reflection and paraphrasing and how they are used in counselling.

Definition of Reflection in Counselling

Using Reflection to Clarify Our Understanding

Definition of Paraphrasing in Counselling

How Paraphrasing Builds Empathy

Clinical psychology

Psychotherapy

How Can Paraphrasing Be Used in Counseling? (3+ Main Indications)

Paraphrasing in counseling

Emphasis on essence

Growth of empathy

A form of acknowledgment

Tone of voice

Alternatives that do not define paraphrasing

FAQs: paraphrasing in counseling

What is the difference between paraphrasing and reflecting in counseling?

How do you reflect in counseling?

How is paraphrasing helpful?

What are some counseling skills?

What is the primary goal of counseling?

Was this helpful?

Related Posts

Paraphrasing in Counselling

What is the difference between reflecting and paraphrasing in Counseling?

Let’s look at a brief example of paraphrasing in counseling:

Now let’s take a look at reflecting:

How do you paraphrase?

Focus on feelings and thoughts rather than circumstances

Capture the essence of the message

Offer a brief version of what has been said

How does paraphrasing help in communication?

Facilitating emotional regulation

What is the role of paraphrasing in listening?

Paraphrasing

Sign up for your FREE e-newsletter

Encouragers, Paraphrasing and Summarising

Comments: 23

Leave a Reply Cancel reply

Reflecting Skills

Summarizing, Paraphrasing, & Reflecting

Types of Reflections

Emotional Heightening

Reflection (Therapeutic Behavior)

Introduction

Types of...

Buying options

Author information

Corresponding author

Editor information

Section Editor information

Rights and permissions

Copyright information

About this entry

Download citation

Share this entry

Introductory Chapter: Counseling and Therapy

Counseling and Therapy

Author Information

1. Introduction

2. Counseling and therapy

3. Individual and group counseling

4. Basic counseling skills

4.1 Minimal responses

4.2 Paraphrasing

4.3 Reflective comments

4.4 Questioning

4.5 Clarification

4.6 Silence

4.7 Body language

4.8 Summarizing

4.9 Evaluation

5. Counseling needs

6. Counseling approaches and therapies

7. Counseling session

8. Conclusion

Continue reading from the same book

What is paraphrasing and Summarising in counselling?

What are encouragers in counseling?

How is Summarising used in counselling?