Daily Archives: November 24, 2010

Active Listening


Active listening is the process by which we communicate to our clients that they are heard and understood.  There are three specific micro-skills included in the text that all serve this purpose, included among them are encouraging, paraphrasing, and summarizing.  Encouraging can be either verbal or non-verbal, although my personal style is mostly non-verbal.  For me, it’s as simple as a head-not or strategically placed “I understand.”  Restatements are a form of encouraging that I will definitely need to work on, although it is evident to me that restatement is a valuable skill and one that will most certainly be used often.  “Key word encouragers contain one, two, or three words, while restatements are longer.”  (Ivey, Ivey, & Zalaquett, 2010, p. 157)

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“The goal of paraphrasing is facilitating client exploration and clarification of issues.”  (Ivey et al., 2010, p. 158)  Paraphrasing represents an opportunity for the therapist to verify that they have heard and understood what the client has said, as well as to focus (or refocus) conversation on a specific element of the dialogue.  I well designed paraphrase utilizes key word that were used by the client previously, captures the essence of what they client has communicated, and gives the therapist an opportunity to ‘check out’ and verify that they did in fact understand the dialogue correctly.

Summarizing can be employed at the beginning, the end, or during the course of a topic transition.  Summarization is a form of selective attending in which the therapist picks out multiple key points and attempts to restate them as accurately as possible.  (Ivey et al., 2010, p. 159)  The bottom line is that it is absolutely necessary that we continue to be ‘active participants’ in the conversation and that we attend to the details of said conversation so that we are better able to detect slight movement in mood or affect.

 

Reference

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

 

Observation Skills


(Pfäfflin & Adshead, 2004) suggest that from a neurobiological perspective the process of affect regulation inexorably links nonverbal and verbal representational domains in the human brain.  This relationship may serve to facilitate the transfer of implicit information in the right hemisphere to explicit or declarative systems in the left.  (Pfäfflin & Adshead, 2004, p. 136)  One might deduce that it would be subsequently impossible to separate verbal behavior from nonverbal behavior.  Recognizing this connection, in my opinion, is the key to improving our observational skills.  No action, verbal or nonverbal, should go un-scrutinized… every action (no matter how small) means something.

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Despite our recognition that nonverbal communication is as important, or more important, than verbal communication; “there is no dictionary of nonverbal communication.”  (Riggio & Feldman, 2005, p. xiii)  There is no standard by which we can judge the inherent meaning of an averted gaze.  Even basic facial expressions that convey emotion are subject to the trials of context and individual differences.  And so, we would be well served to recognize that individual and multicultural issues are paramount in the interpretation of behavior.  Furthermore, the interpretations of those expressions are governed by our own selective attention.  (Ivey, Ivey, & Zalaquett, 2010, p. 124)  “Be careful not to assign your own ideas about what is ‘standard’ and appropriate nonverbal communication.”  (Ivey et al., 2010, p. 125)

I would suggest that we be cognizant of the perceived deficits that our potential clients bring to the table, especially if they have a history of interpersonal problems.  We should approach our observations with a healthy scientific skepticism and mindful that we can not always trust what we see.  Furthermore, we would be well served to approach the perspectives of our clients with the same distance and objectivity.  Take the case a client whom demonstrates deficits in decoding facial expressions…

One can speculate that many interpersonal problems might result from a deficit in decoding facial expression… the most obvious problem is the difficulty in identifying the internal states of others: their desires, emotions, or intentions.  Such information is essential for the understanding of others, of the meaning of their behavior in general as well as during social interaction.  Relating to someone whose intentions and emotions are obscure is virtually impossible.  (Philippot, Douilliez, Pham, Foisy, & Kornreich, 2004, p. 18)

Furthermore, research suggests that both nonverbal and paralinguistic communication play an important role in the retrieval of knowledge in trans-active memory systems.  (Borman, Ilgen, & Klimoski, 2003, p. 348)  Almost invariably, it seems as though individuals will “look up and to their left” when they are retrieving information from long-term memory.  Although I do not recall the specific source, I recall that left handed people actually do the opposite (look up and to their right).  When interpreting the memory retrieval of our clients, we would be well served to know which hand they write with.

You mentioned note taking… which is important not only for our benefit of reviewing previous sessions, but for our ability to self access and determine if we have left a stone unturned.  Process notes really are an art, not a science.  In his blog, Bowden Mcelroy (2005) suggests a couple of different formats for process notes that you may find helpful in your practice.  He terms the first one ‘BIRP.’

B: Behavior. What did the client do?

I: Intervention. How did the therapist intervene?

R: What was the client’s Response to the intervention?

P: What is the Plan? Where does treatment go from here?

A second suggestion, one that is in relatively wide use in the field, is called ‘SOAP.’  (As a sidebar, this is also a great method for self-assessment) (Mcelroy, 2005)

S: Subjective: What did the client say?

O: Objective: What did the therapist observe?

A: Assessment (or, Analysis): What does the therapist think is going on?

P: As always, P stands for Plan.

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References

Borman, W. C., Ilgen, D. R., & Klimoski, R. J. (Eds.). (2003). Handbook of psychology (Vols. 1-12). Hoboken, NJ: John Wiley & Sons.

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

Mcelroy, B. (2005, Nov. 10). How to write counseling notes [Web log message]. Retrieved from http://mcelroycounseling.com/how-to-write-counseling-notes/

Pfäfflin, F., & Adshead, G. (Eds.). (2004). A matter of security: The application of attachment theory to forensic psychiatry and psychotherapy. New York, NY: Jessica Kingsley Publishers.

Philippot, P., Douilliez, C., Pham, T., Foisy, M., & Kornreich, C. (2004). Facial expression decoding deficits in clinical populations with interpersonal relationship dysfunctions. In R. E. Riggio & R. S. Feldman (Eds.), Applications of nonverbal communication (pp. 17-37). Mahwah, NJ: Lawrence Erlbaum Associates.

Riggio, R. E., & Feldman, R. S. (Eds.). (2005). Applications of nonverbal communication. Mahwah, NJ: Lawrence Erlbaum Associates.

The Secret Sales Sauce


The best question ever asked (or proposed to me) should be credited to Derrick Pick, President and Founder of Delaine Consulting Inc.  Delaine Consulting designs and implements skills development programs for sales and customer service organizations.  I had the pleasure of taking a 3 day relationship course with Derrick while employed at Compaq Computer Corporation (now Hewlett-Packard).  His question is a variant on the “why” question.  This question is the cornerstone of a program that led to a 516% sales increase over the course of 9 months at Compaq.  (Pick, n.d.)

“Obviously you have a good reason for saying that, do you mind if I ask what it is?”


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Why is it such a great question?  The very nature of the word “why” is confrontational.  “Why questions most often lead to a discussion of reasons.  (Ivey, Ivey, & Zalaquett, 2010, p. 103)  However, the word “why” invokes a response that is often defensive and will often “trigger an alarm” in most people.  “Remember: Many clients associate why with a past experience of being grilled.”  (Ivey et al., 2010, p. 103)  The purpose is to reaffirm what the client has told you, and then get more detail into the specifics without saying the word “why.”  Typically this statement is used during the sales process to overcome an objection.  For example: Someone says “I’m not interested.”  A good salesperson will drive deeper to see what the real objective is.  Of course it’s possible that the individual simply isn’t interested, but we can’t accept that for an answer… quite simply, WHY are you not interested?

Intonation is the key to the use of this question.  If you raise the pitch or tone of your voice at the end of the question it becomes a command.  If you instead lower your pitch or tone at the end of the question, you have inadvertently given the client non-verbal permission to say “no” or “it’s none of your damn business” or “because I said so.”  When I say the sentence, I start very “low and slow” with the acknowledgement portion… and then gradually raise the tempo, pitch, and tone of my voice as I say the portion after the comma.  It’s the secret that has driven me to the heights of an award winning sales career, and one aspect of my sales background that I intend to modify and carry forward into my clinical counseling career.

Conversely, the best question I have ever asked is best described as “an A or B” closing question.  It is a “checkout with purpose.”  A good example would be “Would you like to try the basic cable or the digital cable?”  There is an implied assumption in the question… you are going to buy cable from me… right here, right now.  There is no “C” in which you hang up the phone and buy nothing.  As soon as the client makes a choice at the A or B close.  Another suitable example would be “So, would you prefer to try Cable and Internet, or would you like to bundle them both with phone for just 5 dollars more?”

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References

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing & counseling (7th ed.). Belmont, CA: Brooks/Cole.

Pick, D. (n.d.). Results: Some quantified highlights from our track record…. Retrieved June 28, 2010, from http://www.delaineconsulting.com/flinks.htm