CEWE: Chapter 5: Empathic Attunement to Affect

Question 1

What is empathic attunement affect?

what level does it function at?

Answer 1

A Kinesthetic and emotional sensing of another’s inner world

knowing the rhythm, feeling, and experience by methaphorically being in their skin

Functions on a level beneth conscious awareness

Question 2

How is empathic attunement to affect different from empathic understanding?

Answer 2

It goes beyond understanding of the content and focuses on affect and affect mirroring and creating a felt sense of affective understanding and connection.

Question 3

How is empathic attunement to affect implemented?

Answer 3

Not deliberately, but rather as an automatic response that results from being fully present, interested, fully absorbed, and curious

Question 4

Define Therapeutic Presence?

Answer 4

Bringing one’s whole self into the encounter by being completely in the moment on multiple levels
- physically
- emotionally
- cognitively
- spiritually

Question 5

What does Therapeutic presence involve?

Answer 5

1. Being integrated with one’s integrated and healthy self while
2. being open and receptive to what is poignant in the moment and immersed in it, with
3. a larger sense of spaciousness and expansion of awareness and preception and with
4. the intention of being with and for the client in service of their healing process

Question 6

What does reflection of empathic attunement look like

Answer 6

not just reflecting the feeling “you are sad”

but capturing the whole state and felt meening and sense of direction, including putting into words the want or need embedded in the emotion (even if not explicitly stated by the client)

“you are sad about missing or losing X, and you want or need Y”

Question 7

List 6 skills that therapists can work on to help them become more empathic and attuned to emotion?

Answer 7

1. Practicing being present
2. Creation of an alliance to work on emotion
3. Internal tracking
4. Perceptual skills
5. Fluency in different types of empathic responses
6. Compassion

Question 8

What are the 2 main objections that are raised to working with emotion?

Answer 8

1. How can feeling bad lead to feeling good?
2. It’s all in the past, you can’t change the past so what’s the point of going into it?

Question 9

What are some examples of rationales and metaphors to motivate clients to overcome emotional avoidance?

Answer 9

1. Emotions as a check engine light alerting you to things that neeed attention
2. Emotions as a type of GPS or “EPS” that provide us with information about whether we are meeting our needs
3. Emotions are like a wave, and experienced surfers know that if a wave is coming at you, it’s better to dive into and under the wave than to try and swim away from it. If you try to swim away it upends you, but if you go through it, you come out on the other side into calm

Question 10

What are some examples of rationales and metaphors to motivate clients to overcome resistance to the past?

Answer 10

1. Past memories affect the present. The majority of emotion memories were formed at a young age when they couldn’t be adequately processed, and they pop up and affect us in the present.
2. Evidence shows that by going into a memory and working on it, how one experiences the past can be changed (memory reconsolidation). The events from the past won’t change, but the way that we think and feel about them, and the way we see ourselves in relation to the events, and how our bodies react can all change

Question 11

What is a rationale for going into past memories?

Answer 11

They impact the present and they were formed at a young age when they could not be adequately processed

by going into a memory and working on it, it can change how we experience the past. The events cannot be changed, but the way that we think and feel about them does

Question 12

Within the narrative coding system, what are the three catagories of client narratives?

which are the external vs internal tracks?

Answer 12

1. the landscape of action (what happened)
2. the reflexive landscape (what it meant)
3. the landscape of feeling (what it felt like)

1 and 2 are external
3 is internal

Question 13

When being empathically attuned, what track should a therapist respond with?

Answer 13

Respond with the internal track

If you empathically reflect what happened or what it meant, the client is likely to continue on that track, but if you reflect what the emotions must have been like, the client will shift their focus to their affective experience

Question 14

A client says “my husband is never there for me. he doesnt pat attention to what I say. At dinner he looks at his phone and barely looks at me and now I handle it by having another glass of wine”

What would a reflection of the external track be?

What would a relection of the internal track be?

Answer 14

External track: “so your husband is just so inattentive, looking at his phone, barely looking at you, and all you can do to manage this is to turn to drinking”

Internal track “It must leave you feeling so unimportant, so lonely, and terribly hurt, and maybe kind of angry too”

Question 15

Describe a technique that can be used by a therapist to help them stay focused on the client’s internal track?

Answer 15

To see the client as providing a movie of what happened, a description of events and behaviours

The therapist listens to the “music” of the movie, the tone of voice, body langauge, in order to figure out what that must have been like for the client, what they were feeling.

Question 16

What is it important to be mindful of when focusing the client on their internal track

Answer 16

that they are experts in their own experience and our job is to help them focus on their internal track and follow along with it, rather than impose a direction on it

Question 17

What are the 4 types of vocal quality?

Answer 17

1. Focused
2. External
3. Limited
4. Emotional

Question 18

What is a focused voice and what does it indicate?

Answer 18

Clients a turned inwards, trying to symbolize their internale experience in words

Question 19

What is an external voice and what does it indicate?

Answer 19

Pre rehersed, “talking at”, or lecturing quality

it lacks sponteneity and has an even rhythmic tone and enegery that is turned outwards

indicates that it is unliekly the content is being freshly experienced

Question 20

What is a limited voice and what does it indicate?

Answer 20

Low enegry, often high pitched, anxiety leads to tightening of the throat

affect is being strangled, difficult for the client to trust

Question 21

What does an emotional voice indicate?

Answer 21

Emotion breaking through the voice as the client speaks

Question 22

Which two vocal qualities are have been found to predict good outcomes?

Answer 22

focused and emotional

Question 23

What are the 4 speech patterns that combine in different ways to make up the different voices?

Answer 23

1. accentuation pattern
2. regularity of pace
3. terminal contours
4. disruptions in speech patterns

Question 24

What is an accentuation pattern?

Answer 24

the pattern of which words are emphasized within sentences
it can have a more regular beat (e.g., in a sermon)
or more irregular

Question 25

What is regularity of pace?

Answer 25

variations in pace within a phrase (e.g., starting out slow then speeding up vs keeping a steady pace)

Question 26

What are terminal contours?

Answer 26

rises or drops in pitch

Question 27

What are disruptions in speech patterns?

Answer 27

All 4 of the speech patterns have a “regular” pattern

Disruptions in speech patterns are the degree to which this regular pattern has been disrupted by emotion

Question 28

What is expressed emotional arousal?

Answer 28

The degree to which you can see emotional arousal in the client indicated by the degree of:
1. intensity in voice and body
2. restriction of expression

Question 29

What are the different types of empathic responses (6)?

Answer 29

1. Empathic Understanding
2. Empathic Affirmation
3. Empathic Evocation
4. Empathic Exploration
5. Empathic Conjectures
6. Empathic Refocusing

Question 30

What is Empathic Understanding?

What is it used for?

Is it mainly leading or following?

Answer 30

Showing understanding by reflecting the main point of the clients message

Used to help build and maintain a safe therapeutic relationship and to confirm whether the therapist’s understanding is accurate

Mainly following the clients lead

Question 31

What is Empathic Affirmation?

What is it used for?

Give and example

Answer 31

Goes beyond showing understanding, and provides validation, support, and confirmation of the client’s experience

Validating that the client’s experience makes sense helps them to cope with the painful experience, which allows the client to feel stronger

E.g., “No wonder you felt that way given what happened”

Question 32

What is Empathic Evocation?

What is its purpose?

Leading or following?

Answer 32

Communicating understanding via metaphor, imagery, connotative language, and expressive speech that help activate experience

Making the clients experience more vivid: It brings the clients emotional experience alive and helps them reenter past memories and reexperience what was felt

Goes beyond following to some degree

Question 33

What is Empathic Exploration?

What is its purpose?

Leading or following?

Answer 33

Making explicit what is implicit and understanding what is at the edge of the client’s awareness

Helps clients become aware of the not yet aware feelings and experience them

In addition to following, the therapist is also leading by guiding the client’s attention to their internal track

Question 34

What are Empathic Conjectures?

What are they used for?

Leading or following?

How do they differ from Empathic Exploration

Give an example

Answer 34

Tentative guesses about the client’s immediate implicit experience

Used to help the client deepen or intensify their experiencing

Increasing proportion of following

Differ from Empathic Exploration because in Empathic Exploration you are making explicit something the client has expressed implicitly, while with empathic conjectures the therapist is making a guess about something that hasn’t been expressed explicitly or implicitly

“When you think of that, you feel a real sense of sadness and loss. My hunch is that you still feel that and its still very much alive. Does that fit?”

Question 35

What is Empathic Refocusing?

Answer 35

Refocusing on something that the client said earlier that seemed important but they veered off course

Therapist is leading

See p 133

Question 36

Which type of empathic response is seen as the fundamental mode of intervention?

Answer 36

Empathic Exploration

Needs to be balanced with empathic understanding (50/50)

see p 133-134

Question 37

Explain how a therapist uses the different types of empathic responses to work with a client

Answer 37

Use a blance of approximately 50% understanding responses with at least 50% exploratory responses that are focused on articulating what is on the edge of the client’s awareness

When an exploratory response ends with a client focusing on what appears to be important/alive in the client’s experience, the clients attention is focused on this aspect of their experience

The client is encouraged to focus on and differentiate the edges of their experience

Question 38

For clients who are more disorganized or alexithymic/don’t have words for emotions or are blocked, what type of response does Les believe is the most helpful?

Answer 38

Empathic conjectures

Discusses how many therapists are uncomfortable with this because they are concerned that they are putting words in the clients mouth or depriving the client of the opportunity to express an emotion themselves

but Les does not think this is true, and that it often helps bring the client into the present moment and helps them get in touch with themselves

Question 39

What is the logic behind conjectures that Les notes?

Answer 39

That they are helpful because recall memory takes more resources than recognition memory

So if you say to a client “you felt ashamed” they can check it against their experience and say “Yes, exactly” or “no, just afraid”

Versus if you ask “how did you feel” it is harder for them to access their experience

Question 40

What are the 7 steps to follow to respond empathically rather than use confrontation for a difficult behaviour?

Answer 40

*Note there are 4 steps described on the previous page (137) that make more sense to me than these so maybe return to that. Try to work through the steps with a different behaviour because I don’t really follow the logic in the example provided on page 138

1. Talk about your own experience
2. Validate the client’s need (what the client really yearns for)
3. Link the unmet need to the maladpative emotion (When your need for validation is not met, it leaves you feeling unimportant)
4. Link the maladpative emotion to the secondary emotion OR the reactive behaviour (and when you feel unimportant you withdraw)
5. Emphasize and validate that the secondary emotion/behaviour does not help get the need met (but somehow, withdrawing doesn’t help me to see you and make you feel understoof)
6. Guide the clients attention to the painful underlying maladaptive emotion that needs to be processed (and therefore we need to help you deal with your feelings of being unimportant in a different way)
7. End by focusing on the unmet need (what you really need is validation)

Question 41

What is a strategy that Les uses to teach his trainees with video review?

Answer 41

he pauses the video and asks them to become the client
“become your client, as your client what are you feeling”

then the trainee attends to what in them responds (reverberates, echos)

identify in themsleves what it might feel like to feel this

search for, grasp, and capture the core painful emotions (while attending to sense of what it might feel like for the client)

put words to the clients feelings, symbolizing them

identify what you might think is at the edge of awareness (put words to this)