CH. 3. Attending and Empathy Skills

Question 1

Attending behavior

Answer 1

ATTENDING BEHAVIOR – Actively paying attention and listening.

• Listening is the core skill of attending behavior and is central to developing a relationship and making real contact with our clients.
• Attending focuses on the counselor’s verbal and nonverbal behavior, which is targeted toward supporting the client with culturally appropriate words, visuals, vocal quality, and body language.
• Observable behavior is the first thing that immediately affects the client. First impressions and welcoming body language are critical.

Question 2

Attending (3V + B)

Answer 2

ATTENTION – is the connective force of conversations and of empathic understanding. It is the first and most critical skill of listening.

• Sometimes listening carefully is enough to produce positive change in a client. Sometimes people simply need to be heard to work out their issues.
• “3 V’s + B” To maximize Attending:
  
  • ​VISUAL/EYE CONTACT – Look at people when you speak to them.
  • VOCAL QUALITIES – Communicate warmth and interest with your voice.
    
    • Think of how many ways you can say, “I am really interested in what you have to say,” just by altering your vocal tone and speech rate.
  • VERBAL TRACKING – Track the client’s story. Don’t change the subject; stay with the client’s topic (Keep them on track).
  • BODY LANGUAGE – To show interest, face clients squarely, lean slightly forward with an expressive face, and use encouraging gestures. Especially critical, smile to show warmth and interest in the client.
    
    • Be yourself – authenticity is essential to building trust.
    • Smiling, listening, and a respectful and understanding vocal tone are things that “fit” virtually all cultures and individuals.
• Attending behavior and listening are essential for human communication, but we need to be prepared for and expect individual and multicultural differences.
  
  • Slow down, relax, and attend to client stories and look for themes in their narratives.

Question 3

Visual: Patterns of Eye Contact

Answer 3

VISUAL: PATTERNS OF EYE CONTACT – Don’t glare but maintain eye contact with a healthy dose of breaks in eye contact so you don’t look creepy.

• Clients look away when thinking carefully or discussing topics that particularly distress them.
  
  • The counselor also reacts physically, showing indicating to their clients whether the current topic is comfortable for them.
• Cultural differences in eye contact – if a client from any culture is uncomfortable talking about a topic, it is likely better to avoid too much direct eye contact.
  
  • Some cultural groups (for instance, certain traditional Native American, Inuit, or Aboriginal Australian groups) generally avoid eye contact, especially when talking about serious subjects. This itself is a sign of respect.

Question 4

Attending Behavior and People with Disabilities

Answer 4

ATTENDING BEHAVIOR AND PEOPLE WITH DISABILITIES – If you are working with people who are disabled. It is your role to learn their unique ways of thinking and being, for these clients will vary extensively in the way they deal with their issues.

• EX: Expect clients with limited vision to be more aware of your vocal tone.
• Focus on the person, not on the disability.

Question 5

Body Language: Distance

Answer 5

BODY LANGUAGE: Distance – What determines a comfortable interpersonal distance is influenced by multiple factors.

• GENDER – Women feel more comfortable with closer distances than men.
• PERSONALITY – Introverts need more distance than extroverts.
• AGE – Children adopt closer distances.
• TOPIC OF CONVERSATION – Difficult topics such as sexual worries or personal misbehavior may lead a person to more distance.
• PERSONAL RELATIONSHIPS – Harmonious friends tend to be closer.
  
  • With disagreements, harmony disappears. (This is also a clue when you find a client suddenly crossing the arms, looking away, or fidgeting.)
• A person may move forward when interested and away when bored or frightened.
  
  • As you talk, notice people’s movements in relation to you. How do you affect them?

Question 6

Verbal Tracking or Change the Topic

Answer 6

VERBAL TRACKING – staying with your client’s topic to encourage full elaboration of the narrative.

• Verbal tracking is especially helpful when lost or puzzled about what to say next in response to a client.

SELECTIVE ATTENTION – focusing on what is essential to accomplish the tasks at hand, while ignoring other potentially useful information.

• Selective attention is central to interviewing, counseling, and psychotherapy.
• Observe the selective attention patterns of both you and your clients.
  
  • What do your clients focus on?
  • What topics do they seem to avoid?
    
    • You want to draw out client stories from their own language perspective, not yours.

REDIRECTING ATTENTION – Changing the topic. Though verbal tracking is important to keep the client on track and on topic, there are times when it’s time to move on.

• EX: ​A client may talk insistently about the same topic over and over again.
  
  • In such cases, what seems to work best is paraphrasing or summarizing the client’s story so far, followed by questions for relevant details or a deliberate topic jump.
    
    • But remember that clients who have been traumatized (e.g. by hospitalization, a breakup, accident, or burglary) may need to tell their story several times.
• We need to hear that client’s story and understand it, but eventually, we also need to move on to a more positive message.
• Clients grow from strengths.
  
  • Redirect the conversation to focus on positive assets when you observe a strength, a wellness habit (running, spirituality, music), or a resource outside the individual who might be helpful.

USEFULNESS OF SILENCE – Sometimes the most useful thing you can do as a helper is to support your client silently.

• The best support may be simply being with the person and not saying a word.
  
  • Consider offering a tissue, as even this small gesture shows you care.
• When you feel uncomfortable with silence, look at your client with a supportive facial expression. If the client appears comfortable, draw from her or his body language and join in the silence. If the client seems disquieted by the silence, rely on your attending skills. Ask a question or make a comment about something relevant mentioned earlier in the session.

TALK TIME – With most adults, the percentage of client talk time should generally be more than that of the counselor.

• Clients can’t talk while you do.
• With less verbal clients or young children, the counselor may need to talk slightly more or tell stories to encourage conversation.
  
  • read a children’s book on feelings
  • Play therapy

Question 7

Training as Treatment: Social Skills, Psychoeducation, and Attending Behavior

Answer 7

TRAINING AS TREATMENT** – **Social skills training involves educational methods to teach clients an array of interpersonal skills and behaviors that help them deal with others and issues in everyday life.

• These skills and behaviors include listening, assertiveness, dating, drug refusal skills, mediation, and job interview procedures.

Consider the following steps:

1. Determine the desired skill area for learning with the client.
2. Discuss the behaviors involved in the skill.
3. Practice the skill with the client.
4. Plan for use of the skill in daily life.

​Teaching listening skills can be most helpful to many clients – particularly the 3V’s & B which is always helpful for them to communicate with others and make friends.

• Instruction in ATTENDING BEHAVIOR is one of the foundations of social skills training.
  
  • Teaching active listening and empathic skills builds closer relationships
• When you are attending to someone else, it becomes much more difficult to think negatively about yourself.

Question 8

Empathy

Answer 8

EMPATHY – Experiencing the client’s world and story as if you were that client; understanding his or her key issues and saying them back accurately, without adding your own thoughts, feelings, or meanings. Putting yourself “in another person’s shoes” or viewing the world “through someone else’s eyes and ears”

• This requires attending and observation skills plus using the important keywords of the client, but distilling and shortening the main ideas.
• Three types of empathic understanding:
  
  • SUBJECTIVE EMPATHY – (AVOID THIS) Counselor responses give back to the client LESS than what the client stated, and perhaps even distort what has been said. In this case, the listening or influencing skills are used inappropriately.
  • BASIC EMPATHY – (DO THIS AT A MINIMUM) Counselor responses are roughly interchangeable with those of the client – shows that you are listening and keeps the flow of the interview moving forward.
    
    • You will find this the most common counselor comment level in interviews
    • listening in itself is necessary and sufficient to produce positive client change.
  • ADDITIVE EMPATHY – (THIS IS OPTIMAL) Counselor responses that add something beyond what the client has said often are additive.
    
    • Referring back (linking) to something the client has said earlier.
    • Presenting a similar or congruent idea.
    • Present a frame of reference that helps the client see a new perspective.
    • Feedback and your own self-disclosure used thoughtfully, can be addictive.

Use unpredicted and surprising client responses as an opportunity to understand the client more fully. Why did they respond that way? Try to find out.

• It’s not the errors you make; it is your ability to repair them and move on that counts! So if your comment surprises a client, work with that, find out why it was surprising, and move on with that new information and perspective.
• Try to understand clients’ experiences and worldviews as they present their story in a nonjudgmental supportive fashion.
• Seek to communicate that understanding to the client, but avoid mixing “your own thing” in with what you say.

Question 9

Neuroscience and Empathy

Answer 9

NEUROSCIENCE AND EMPATHY – Empathy is identifiable through fMRI.

MIRROR NEURONS – fire when humans or animals act and when they observe actions by another – as though the observer were actually experiencing the act being acted on or by someone they are observing.

• Mirror neurons of people diagnosed with conduct or antisocial personality disorder do NOT activate.
• Verbal communication is a joint activity, and an fMRI study found that this “neural coupling” disappears when story comprehension is not effective.
  
  • Thus, when listening skills are not successfully implemented (i.e., subtractive), empathy falls apart.
• Listening and EMPATHY are not just abstract concepts they are clearly measurable and make a difference in other people’s lives

Question 10

The Samurai Effect, Magic, and the Importance of Practice to Mastery

Answer 10

SAMURAI EFFECT – Focused practicing with the exclusive intent to get better and better (as opposed to simply going through the motions).

• Greatness only happens with extensive practice
• Benefits of PRACTICE:

1. Practice changes your body. Both the brain and the body change with practice.
   
   • EX: Neural Plasticity, Muscle Memory, Muscle Growth.
2. Skills are specific. Each skill must be practiced completely if they are to be integrated into superior performance.
3. The brain drives the brawn. Areas of the brain relating to finger exercises or arm movements show brain growth in those areas. Expect the same in your brain as you truly master communication skills.
4. Practice style is crucial. One can understand attending behavior intellectually, but actually practicing the specific skills of attending is what will make the difference.
5. Short-term intensity cannot replace long-term commitment. If Ted Williams did not continue to practice, his skills would have gradually been lost. You will want to take what you learn about counseling skills and use them regularly.
6. Practice provides a continuous feedback loop, which leads to even more improvement. In addition, feedback from colleagues on your counseling style and skills is especially beneficial.

Question 11

Summary: Action

Answer 11

The goal of Listening is central!

Attending with individual and cultural sensitivity is always a must.

Observation skills will enable you to stay in tune with your clients.

FOUR ASPECTS OF ATTENDING – Attending behavior consists of four simple but critical dimensions (3 V’s 1 B), but all need to be modified to meet individual and cultural differences.

1. VISUAL/EYE CONTACT
2. VOCAL QUALITIES: Your vocal tone and speech rate indicate much of how you feel about another person.
3. VERBAL TRACKING: Don’t change the subject. Keep to the topic initiated by the client. If selectively attend to an aspect of the story or a different topic, realize the purpose of your change.
4. BODY LANGUAGE/FACIAL EXPRESSION: Be attentive and genuine. Face clients naturally, lean slightly forward, have an expressive face, and use facilitative, encouraging gestures.

ATTENDING BEHAVIOR – Attending is easiest if you focus your attention on the client rather than on yourself.

• your ability to be empathic and observe what is occurring in the client is central.
• Note what the client is talking about, ask questions, and make comments that relate to your client’s topics.
• communication skills training has a positive effect on patient outcomes,

EMPATHY – ability to enter the world of the client and to communicate that we understand his or her world as the client sees and experiences it.

• Empathy can be SUBSTRACTIVE, BASIC, or ADDITIVE.