CH. 7. Reflecting Feelings The Heart of Empathic Understanding Flashcards
1
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Reflecting Feelings
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REFLECTING FEELINGS – Is recognized by many as the most significant listening skill after attending behavior and is central to emotional regulation.
- Cognitive behavioral therapy by itself can change underlying emotions.
2
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Reflection of Feeling
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REFLECTION OF FEELINGS – Identify the key emotions of a client and feed them back to clarify affective experience. With some clients, the brief acknowledgment of feelings may be more appropriate. Affective empathy is often combined with paraphrasing and summarizing. Include a search for positive feelings and strengths.
AFFECTIVE – Relating to emotion.
Compare emotional reflection of feeling with cognitive paraphrasing/summarizing:
- Reflection of feelings involves observing emotions, naming them, and repeating them back to the client.
- More cognitively oriented, paraphrasing and summarizing focus primarily on words and concepts.
- The critical distinction is how much one emphasizes cognitive content (paraphrase) or emotion (reflection of feelings).
- Coupled with this, supported by positive psychology and therapeutic lifestyle changes, we need to look for strengths and resources from the past and present. These are important to build Thomas’s resilience and emotional regulation as he finds new ways of thinking, feeling, and behaving. The positive language of hope and gladness needs encouragement. As we work with client indecision and the many confusing things we face daily, understanding underlying emotions will enable better decisions and personal satisfaction.
3
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Observing the Verbal and Nonverbal Language of Emotions
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OBSERVING THE VERBAL AND NONVERBAL LANGUAGE OF EMOTIONS:
- First step toward naming and understanding emotions.
- Seek to establish and increase your vocabulary of emotions and your ability to observe and name them accurately.
- Counseling and therapy traditionally have focused on four primary emotions—emotions—sad, mad, glad, scared.
- Two more need to be added—disgust and surprise.
- PRIMARY EMOTIONS – Commonality, in terms of facial expression and language, has been validated throughout the world in many cultures.
4
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Expanding Emotional Vocabulary
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EXPANDING EMOTIONAL VOCABULARY:
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Sadness can lead to depression, which leads to a cycle of inaction.
- Although anger sometimes motivates people toward positive ends and against oppression, bullying, and harassment are four situations in which client anger is suitable.
- But all too often it leads to impulsive behavior that is destructive of self and others. Anger appears in spousal abuse, those who bully, oppositional defiant children and teens, and sociopathic behavior.
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Fear is related to anxiety, phobias, and an avoidant personality style.
- Fear in the face of danger is protective.
- Protective fear enables you to short-circuit the time it takes to think and swerve to save your life.
- When a woman fears abuse, it can serve as a motivator to find safety.
- Anger often leads us to action. Emotional regulation of anger leads to impulse control and less acting out.
- Anger is often useful in motivating us to combat unfairness, bullying, and other forms of oppression.
- Fear in the face of danger is protective.
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Disgust is thought to have evolved as a way to ensure avoidance of unhealthy objects
- If you are counseling a couple thinking of separation or divorce, you likely will see anger. However, if the word “anger” turns to “disgust,” saving the relationship is a larger challenge.
- RECOGNITION RESPONSE – Sometimes with an embarrassed look. You likely have reminded them of something they know is right.
5
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Limbic Brain Structures Central in Affective(Emotional) Empathy
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LIMBIC BRAIN STRUCTURES CENTRAL IN AFFECTIVE (EMOTIONAL) EMPATHY:
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AMYGDALA – Our emotional (and cognitive) driver.
- Closely related to the total limbic system and has close connections with the prefrontal cortex.
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PREFRONTAL CORTEX (PFC) – Very close connections to the amygdala, the PFC labels emotions as feelings and, regulates action.
- Those with impulse control issues are often ruled by regions associated with the amygdala, and the PFC follows—in effect, actions are now regulated by the emotions, a failure of emotional regulation.
- HIPPOCAMPUS – Memory center that holds and distributes information throughout the brain.
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HYPOTHALAMUS, PITUITARY, and ADRENAL GLANDS (HPA) – Understanding the physical role of emotion, they produces the hormones for our brain and body.
- Hypothalamus controls release of hormones as stimulated by the amygdala.
- Pituitary stimulates the adrenals at the top of the kidney.
- Adrenals produce cortisol, which in a balanced amount is essential for learning. But with stress and trauma, too much cortisol is delivered with harm to both brain and body.
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Limbic system received information from the senses first, it operates ahead of the structures in the prefrontal cortex, which seeks to regulate emotions.
- Thus, many of our decisions are made before we are cognitively aware of what we are about to decide.
6
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Building Solid Positive Emotions
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BUILDING SOLID POSITIVE EMOTIONS:
- Enable clients to bring out stories of positive emotions and thoughts; this is particularly valuable when you work with clients who have a cognitive style of primarily negative thinking.
- Left prefrontal cortex is the primary location of positive emotional experience (e.g., glad/happy) and is also where our executive decision-making functions lie.
7
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Confusion, Frustration, and Mixed Feelings
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CONFUSION, FRUSTRATION, and MIXED FEELINGS:
- Puzzled, sympathy, embarrassment, guilt, pride, jealousy, gratitude, admiration, indignation, and contempt are social emotions that come from primary emotions.
- Basic emotions appear to be universal across all cultures.
- Social emotions appear to be learned from one’s community, culture, family members, and peers.
- Help them become aware of what is occurring in the body along with their emotions and cognitions. That knowledge will help strengthen emotional regulation.
- Confusion, frustration, and indecision need to be treated as emotional reactions to a literally confusing and often overwhelming world.
- As you listen to the cognitive content of the story, you encourage, paraphrase, and summarize, and the underlying basic emotions will appear.
- With cognitive understanding, emotions also become better defined.
8
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Skill Dimensions of Reflection of Feeling
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SKILL DIMENSIONS OF REFLECTION OF FEELING:
- First task, is constant awareness and observation of emotions and feelings as clients show them explicitly through words in their conversation and nonverbally through their patterns of eye contact, facial expression, and body language.
- Vocal tone, speech hesitations, and variations in loudness are also useful clues to underlying feelings.
At the most basic level, reflection of feelings involves the following set of verbal responses:
SENTENCE STEM – Choose a sentence stem such as “I hear you are feeling . . .,” “Sounds like you feel . . .,” “I sense you are feeling . . .”
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FEELING LABEL – Add an emotional word or feeling label to the stem (“Angelica, you seem to feel sad about . . .,” “Looks like you’re happy,” “Sounds like you’re discouraged today;
- For mixed feelings, more than one emotional word may be used (“Miguel, you appear both glad and sad . . .”).
- Note that if you use the term “you feel . . .” too often that you may sound repetitious.
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CONTEXT OR BRIEF PARAPHRASE – Add a brief paraphrase to broaden the reflection of feelings.
- The words about, when, and because are only three of many that add context to a reflection of feelings
- (“Angelica, you seem to feel angry about all the things that have happened in the past two weeks”; “Miguel, you seem to be excited and glad when you think about moving out and going to college
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TENSE AND IMMEDIACY – Reflections in the present tense (“Right now, you look very angry”) tend to be more useful than those in the past (“You felt angry when. . .”).
- However, Some clients have difficulty with the present tense and talking in the “here and now.” “There and then” review of past feelings can be helpful and may feel safer for the client.
- CHECKOUT – Check to see whether your reflection of feelings is accurate. This is especially helpful if the feeling is unspoken (“You really feel angry and frustrated today—am I hearing you correctly?”).
- BRING OUT POSITIVE EMOTIONAL STORIES AND STRENGTHS – Employ positive psychology and bring out strengths close to the time we discuss serious concerns and issues,
9
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Acknowledgment of Feelings
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ACKNOWLEDGEMENT OF FEELINGS – A simple, brief recognition of feelings can be as helpful as a full reflection.
- With a harried and perhaps even rude busy clerk or restaurant server, try saying in a warm and supportive tone, “Being that rushed must make you tense.” Often this is met with a surprised or relaxed look with an implicit thanks of appreciation.
- Acknowledging and naming feelings may be especially helpful with children, particularly when they are unaware of what they are feeling.
- Children often respond well to the classic reflection of feelings, “You feel . . . [sad, mad, glad, scared] because . . .”
10
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Nonverbal Language of Emotion: Micro and Macro Feelings
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NONVERBAL LANGUAGE OF EMOTION: MICRO AND MACRO FEELINGS:
MACRO NONVERBALS – Are those that are relatively easy to see.
- Fairly clear indication of some difficulty in talking about an issue.
MICRO NONVERBALS – Subtle behaviors that may be revealing.
- for the most part we don’t notice them—and if we do, we don’t say anything.
- Micro nonverbals may be minor parts of a larger story.
MICROEXPRESSIONS – are fleeting expressions of concealed emotion, sometimes so fast that they happen in the blink of an eye—as fast as one-fifteenth of a second. . . . This results from the individual’s attempt to hide them. . . .
- [They are] a powerful tool for investigators because facial expressions of emotion are the closest thing humans have to a universal language”
- they can be as reliable indicators of underlying feelings as macro nonverbals—and they can be even more valuable than more overt, easily observable client behavior.
- While observing micro nonverbals is valuable, reflecting them needs to be done carefully, as often the client will not be aware of these underlying feelings.
- Facial expressions are considered the most important, as the clearest indication of underlying feelings. And the fleeting, quick micro nonverbals may be most easily noted in the face.
Nonverbal Examples of Underlying Emotions:
- SAD – A raise of the inner brows is considered one of the best indications of sadness.
- MAD – “Anger grin,” which may indicate a desire to hide underlying feelings.
- GLAD – Open gestures with the palms up.
- SCARED – The fear grin, which is closely related to the anger grin (i.e., not real).
- DISGUST – Nose tends to be wrinkled and the upper lip raised as the lips are pursed.
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CONTEMPT – Attitude of disdain and disrespect toward another person.
- The chin is raised, which gives the appearance of looking down one’s nose at other. One lip corner may be tightened and slightly raised. A slight smile is often interpreted as a sneer.
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SURPRISE – Surprise may show as a fleeting micro nonverbal when you have helped the client discover a new insight.
- Surprise can lead to cognitive and emotional change.
11
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Diversity and Reflection of Feeling
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DIVERSITY AND REFLECTION OF FEELING:
- Do not expect all Chinese or other Asians to be emotionally reserved, however. Their style of emotional expression will depend on their individual upbringing, their acculturation, and other factors.
- Generally speaking, citizens of the United States more freely express opinions and emotions than do those from other countries.
- Thus, Americans may be seen as rude and intrusive, while they may see other groups as cold and indifferent. English and German people are generally seen as reserved, while those of Italian or Latino/a background deal more easily with their emotional world. In turn, they may see the United States as “uptight” and remote.
National and International Perspectives on Counseling Skills:
- In much of Asia, the cultural rationale is that the social order doesn’t need extensive consideration of personal, inner feelings.
- One might understand why the Chinese student was resistant when the counselor showed interest in his feelings and addressed that issue directly.
- People with lower emotional awareness are more likely to make errors than those who are in touch with their emotions.
- Using questions oriented toward affect increased client expression of emotion. However, once a client has expressed emotion, continued use of questions may be too intrusive and the more reflective approach will be more useful.
- “Several studies have shown that between 30% and 60% of patients in general practice present health problems for which no firm diagnosis can be made” (Bensing, 1999a). Be ready to look to emotions in clients who have medical issues. Older persons tend to manifest more mixed feelings than others.
- That the reflection of feelings is useful cross-culturally.
12
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Reflecting Feelings in Action
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REFLECTING FEELINGS IN ACTION:
- Reflection of feelings is used in all theories of counseling and therapy.
- The cognitive behavioral theories (e.g., CBT) use the skill, but their focus is on changing cognitions, which in turns often leads to emotional change.
- We suggest you start by first simply noting emotions and then acknowledging them through short reflections indicating that the emotions have been observed.
13
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Helping Clients Increase or Decrease Emotional Expressiveness*
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HELPING CLIENTS INCREASE OR DECREASE EMOTIONAL EXPRESSIVENESS:
- Assist your clients to get more accurately in touch with their emotions.
- Ultimately, this awareness will help both overall executive cognitive functioning and their own emotional regulation.
OBSERVE NONVERBALS – Breathing directly reflects emotional content. Rapid or frozen breath indicates contact with intense emotion, note facial flushing, eye movement, body tension, and changes in vocal tone.
- Especially, note hesitations. Attend to these clues and follow up at an appropriate point.
- At times you may also find an apparent absence of emotion when discussing a difficult issue.
- This might be a clue that the client is avoiding dealing with feelings or that the expression of emotion is culturally inappropriate for this client.
- You can pace clients by listening and acknowledging feelings and then gradually lead them to fuller expression and awareness of effect.
PACE AND ENCOURAGE CLIENTS TO EXPRESS MORE EMOTION:
- Say to the client that she looked as though she was close to something important. “Would you like to go back and try again?”
- Discuss some positive resources that the client has. This base can free the client to face the negative. You as a counselor also represent a positive asset.
- Consider asking questions. Used carefully, questions may help some clients explore emotions.
- Use here-and-now strategies, especially in the present tense: “What are you feeling right now—at this moment?”
WHEN TEARS, RAGE, DESPAIR, JOY, or EXHILARATION:
- Allowing room for the client to sob, yell, or shake. You can also use phrases such as these:
- I’m here.
- I’ve been there, too.
- Let it out . . . that’s OK
- These feelings are just right.
- I hear you.
- I see you.
- Breathe with it.
- Seek to keep deep emotional expression within a reasonable time frame; 2 minutes is a long time when you are crying.
- Afterward, help the person reorient to the here-and-now present moment before reflecting and discussing the strong emotions.
REORIENT THE SESSION TOWARD EMOTIONAL REGULATION:
- Help the client use slowed, rhythmic breathing.
- This may be accompanied by a brief acknowledgment of feeling.
- Discuss the client’s positive strengths.
- Discuss direct, empowering, self-protective steps that the client can take in response to the feelings expressed.
- Stand and walk or center the pelvis and torso in a seated position.
- Explore the emotional outburst as appropriate to the situation. Cognitively reframe the emotional experience in a positive way.
- Comment that it helps to tell the story many times.
CAUTION:
- There is the possibility of reawakening issues in a client who has a history of painful trauma.
- Obtain permission for the desired depth of emotional experiencing.
14
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Positive Emotions in Reflecting Feelings and Resilience
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POSITIVE EMOTIONS IN REFLECTING AND RESILIENCE:
- “To become resilient, we must embrace the human experience”
- We grow best and become resilient with what we “can do” rather than what we “can’t do.” Positive emotions, color the ways people respond to others and their environments.
- Positive emotions broaden the scope of people’s visual attention, expand their repertoires for action, and increase their capacities to cope in a crisis.
- Positive emotions produce patterns of thought that are flexible, creative, integrative, and open to information.
- We need more attention to glad words, such as pleased, happy, love, contented, together, excited, delighted, pleasured.
- With positive emotions, reinforcing neurotransmitters such as dopamine and serotonin increase.
- When you feel sad or angry, potentially destructive cortisol and hormones are released.
- Emotions change the way our body functions and thus are a foundation for our thinking experience.
- A resilient affective lifestyle results in a faster recovery and lower damaging cortisol levels.
- Examples of well-being and wellness are located predominantly in the executive prefrontal cortex, with lower levels of activation in the amygdala.
- If you smiled, your body tension would very likely be reduced, and even your blood pressure could lower.
- Positive psychology shows us that attention to strengths lessens the load, takes our mind off our concerns, and empowers us when we recall our strengths and good experiences.
15
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Depression is a biological disease.
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DEPRESSION IS A BIOLOGICAL DISEASE:
- If we only focus on negative, problematic stories and reflect these negative feelings, we are reinforcing depression.
- While it is necessary to hear these stories, ultimately our goal with any client expressing sadness or depression is to find positives.
