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 , 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.  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.  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.
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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.
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."
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.
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.
Encyclopedia of Personality and Individual Differences pp 4344–4346 Cite as
Reflection (Therapeutic Behavior)
- Kathryn N. Schrantz 3 &
- Alicia Lyon-Limke McLean 4
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- First Online: 01 January 2020
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.
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.
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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 .
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Kathryn N. Schrantz
University of Central Oklahoma Edmond, Edmond, OK, USA
Alicia Lyon-Limke McLean
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Correspondence to Kathryn N. Schrantz .
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Todd K. Shackelford
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Department of Educational Sciences, University of Genoa, Genoa, Italy
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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
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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
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.
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.
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.
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One of the simple and memorable descriptions of this I’ve read, thanks so much!
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How Parroting Is Used in Therapy
An Effective Conversational Technique
Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.
Karen Cilli is a fact-checker for Verywell Mind. She has an extensive background in research, with 33 years of experience as a reference librarian and educator.
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How to Use Parroting
- Role in Talk Therapy
Goals of Therapy
What is parroting in therapy.
Parroting is a conversational technique used in therapy. The therapist loosely repeats, or "reflects," what the client has just said.
Parroting is an effective tool in therapy. Its goals are to ensure that the therapist has heard what was said correctly, to encourage the client to clarify their thoughts, and to help the client feel heard and validated.
When parroting, don't go too far. It is much better to repeat only the last few words than to attempt to repeat several sentences. Additionally, repetitive parroting can become annoying. It can also make the client feel nervous or edgy.
When used properly, parroting can help encourage the client to talk through all sides of an issue and come to their own logical conclusion.
Parroting's Role in Talk Therapy
Parroting is used in talk therapy, also known as psychotherapy. Talk therapy is based on the core idea that talking about the things that are bothering you can help clarify them and put them in perspective. Some talk therapists follow a specific school of thought, such as cognitive theory or behaviorism. Others use a more eclectic approach , drawing techniques, and principles from several different theories.
If you're seeking therapy , develop a few goals to have in mind. For example, if you're a phobia sufferer, your goal likely is to be freed of your irrational fears. Other goals of therapy are:
- Learn to deal with the disorder. The ultimate goal of any type of therapy is to help the client deal more successfully with a disorder or a situation.
- Make goals specific. The specific treatment goals depend on the individual client, the therapist’s theories, and the situation at hand. The goal may be concrete, such as quitting smoking, or more abstract, such as anger management.
- Overcome and manage fear. When talk therapy is used for phobia treatment, there are generally two goals. One is to help the client overcome fear. The second goal is to help the client learn to manage any remaining fear so that he or she is able to live a normal, functional life.
- Resolve underlying issues: Some forms of talk therapy have a third goal. In psychoanalysis and related therapies, the goal is to discover and resolve the underlying conflict that caused the phobia or other disorder. In interpersonal therapies, the goal is to resolve problems in interpersonal relationships that have resulted from or contributed to the phobia or other disorders.
A Word From Verywell Mind
Parroting is a way for a therapist to make sure they've heard and understood what the client has said, to encourage the client to share thoughts, and to help validate the client. It's also a helpful tool in personal relationships, helping the other person feel heard and cared for.
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Lord SP, Sheng E, Imel ZE, Baer J, Atkins DC. More than reflections: Empathy in motivational interviewing includes language style synchrony between therapist and client . Behav Ther . 2015;46(3):296-303. doi:10.1016/j.beth.2014.11.002
American Psychological Association. Understanding psychotherapy and how it works .
By Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics.
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- 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
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
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 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.
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.
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.
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.
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).
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.
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.
What Does Summarizing Mean In Counseling
Table of Contents
What does summarizing mean in counseling?
In a summary, the therapist unites two or more of the client’s thoughts, emotions, or behaviors into a overarching theme. In a counseling interview, summarizing is typically used as a skill during the choice points when the counselor wants to make connections between two or more topics. To fully comprehend the passage, read it again. Make notes on the main idea and any arguments you believe should be included in your summary. Include the author’s terminology and keywords in your paper, and consider how the source’s ideas relate to the argument(s) you are making.When you summarize, you take a longer passage—anywhere from a few sentences to several paragraphs or even more—and restate its key ideas in your own words. You write much fewer words than the original source after summarizing.Outlines, abstracts, and synopses are the three main categories of informative summaries. Outlines display the structure or skeleton of a piece of writing. Outlines display the relationship and order of the various parts of a text. An outline for a chapter on summarization.In-depth, succinct, coherent, and independent are all qualities of a strong summary. The following descriptions of these attributes are given: A summary must be thorough: You should identify all of the crucial ideas from the original passage and list them all.
What distinguishes paraphrasing from summarizing in counseling?
Summarizing entails expressing an idea succinctly, whereas paraphrasing entails expressing an idea fully in your own words while retaining the majority of the original source’s information and the meaning of the original. A summary only presents the main idea of the original source and is much shorter than a paraphrase, which completely repeats the original material. The method for taking notes and incorporating what you have learned from sources into your own writing that you will probably use the most frequently is summarizing.To paraphrase is to restate someone else’s ideas in your own language at roughly the same level of detail; when to paraphrase and when to summarize. To summarize is to condense into a briefer form the key ideas of someone else’s work.The primary distinctions between summarizing and paraphrasing can be boiled down to their respective purposes. A summary restates the main ideas while condensing a concept to make it simpler for the reader to understand. Writing summaries allows you to be selective, so you don’t have to include everything the author said.The main distinction between a précis and a summary or paraphrase is that in a précis you use the language and organization of the original, especially key terms and phrases. You must use as few words from the original as you can in your paraphrases and summaries.
How can I make my counseling summaries better?
Ask the client, If you were to summarize what occurred in our session today, what would you say? Pay close attention to how they respond, and then draw connections between what they say and what happened during the session. Academic writing requires the ability to summarize and paraphrase. They entail taking the main ideas from a source text, condensing these ideas into a condensed version (a summary), and, most importantly, communicating this information in your own words.When: When establishing context or providing an overview of a subject. The knowledge you want to describe comes from various sources. The main points of a single source should be identified.Summarizing is similar to outlining a play’s plot. For instance, if someone asked you to sum up the plot of Shakespeare’s Hamlet, you might respond, It’s the tale of a young prince of Denmark who discovers that his uncle and his mother have killed his father, the former king.In addition to letting the client know that the counsellor has heard and understood, summarizing helps the client organize their thoughts and determine what is most crucial. Observing the client’s words alone is not enough; it’s also critical to pay attention to what is absent.
What does summarizing entail?
Write down the main points of the text’s conclusion and rephrase them in your own words and writing style. In comparison to the original, the summary ought to be shorter (roughly one-third the size). The two main kinds of summaries are descriptive and evaluative.Students learn how to identify the key concepts in a text, how to discard unimportant details, and how to coherently combine the key concepts through summarizing. Students’ reading retention is improved when they learn how to summarize.A strong summary should be thorough, succinct, coherent, and independent. These characteristics are described below: A summary must be thorough: You should identify all of the crucial ideas from the original passage and list them all.Key Features of a Summary Summaries are written chronologically and follow the progression of the original text. The opinions and judgments in summaries are absent. Most often, direct quotations are not used in summaries.
What is the primary goal of summarizing?
Summarizing is a technique used to provide context for an argument or thesis by quickly outlining the main ideas of a theory or work. Read the piece first to comprehend the author’s purpose. This is an important step because a faulty reading could result in an incorrect summary. What, then, is the difference between paraphrasing and summarizing? Paraphrasing entails rewording text in a distinctive way while maintaining the original meaning, whereas summarizing offers a concise summary of any written work by distilling the information to the key ideas.Students learn how to identify the most crucial ideas in a text, how to filter out unimportant information, and how to coherently combine the key ideas through summarizing. Improved reading retention results from teaching students how to summarize. Nearly all content areas allow for the use of summarization techniques.Simply identifying the key points from a text is summarizing it. Without even realizing it, you probably summarize every day. Although a summary always contains fewer words than the original text, effective summaries involve more than just paraphrasing a few sentences from a source and omitting others.If you want to rephrase text or speech without changing its meaning, you must use your own words. Reducing something to its bare minimum means summarizing it. To make complex information or ideas simpler or clearer, you can combine the two techniques.
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Definition of paraphrase
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When we paraphrase, we provide a version that can exist beside the original (rather than replace it). We paraphrase all the time. When you tell a friend what someone else has said, you're almost always paraphrasing, since you're not repeating the exact words. If you go to hear a talk, you might paraphrase the speaker's main points afterward for your friends. And when writing a paper on a short story, you might start off your essay with a paraphrase of the plot. Paraphrasing is especially useful when dealing with poetry, since poetic language is often difficult and poems may have meanings that are hard to pin down.
Examples of paraphrase in a Sentence
These examples are programmatically compiled from various online sources to illustrate current usage of the word 'paraphrase.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.
Noun and Verb
Middle French, from Latin paraphrasis , from Greek, from paraphrazein to paraphrase, from para- + phrazein to point out
1548, in the meaning defined at sense 1
1598, in the meaning defined at transitive sense
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“Paraphrase.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/paraphrase. Accessed 19 Feb. 2024.
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Basic skills for counselling (paraphrasing).
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/
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Table of Contents
How to Use Summarizing in Counseling? (9+ Important Benefits)
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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 brief guide, we will be discussing the topic: summarising in counseling. We will be exploring the meaning of summarising, its difference from paraphrasing, the steps involved in summarising, the need, and the way to summarise the beginning and end of a session. By the end, we will also be answering some questions related to summarising and counseling skills.
Summarising in counseling
Summarising is one of the skills in counseling used by the therapist to accommodate the feelings, emotions, and thoughts of the client in a nutshell. In other words, summarising is used when the therapist wants to condense, crystallize, the main points that the client conveyed through his words and body language.
Summarising is almost like a recap of a lesson that is already taught. The therapist provides the client with a chance to reflect on their last session and the lessons they might want to take away front their previous sessions, before continuing with the following sessions. Summarising is carried out at the beginning and the end of a session, mostly.
If one is to give an accurate definition for summarising, then it would be best to choose the one by Feltham and Dryden. According to Feltham and Dryden, “summarising is accurately and succinctly reflecting back to the client, from time to time, within and across sessions, the substance of what she has expressed.
The importance of summarising
th e summarising skill used by the therapist in a counseling session helps both the therapist and client to move forward sans confusions and misunderstandings. It reveals the current standing position of the process of therapy and allows the client to explore the varied dimensions of their progress to the given point.
In summarising, the therapist aims to “reflect” to the client, the important and desirable points of a session. It makes the client feel understood and encourages them to open up and talk about their issues comprehensively and with clarity to the therapist in the further sessions. Summaries of any kind are useful for anyone, to gain clarity and insight into the subject matter of concern.
In counseling, summarising aids in the following ways:
- Accurate and efficient clarification of the emotions for both the counselor and the client. This helps both the parties to understand the underlying emotional state involved in each session and its influence on the progress of the session.
- A complete review of the work done so far, especially by the client himself/herself. The client is the core element of the process of counseling , who has to take a major effort in facing their issues at hand and coming to terms with them. Hence, summarising comes as a great aid for the clients for the required progress in each session.
- Summarising help in bringing each session to a closure, without leaving loose ends or unnecessary assumptions. It helps in drawing together the main threads of the discussions between the client and the therapist.
- Summarising also helps in initiating a subsequent session, if the situation and timing are appropriate.
- Usually, clients arrive in counseling with a series of scattered and vague thoughts and emotions. However, as the sessions proceed, the process of summarising helps the client in bringing about order and understanding of their vague emotions and thoughts which they could not comprehend in the beginning. It helps them to prioritize these thoughts and emotions and make their way through them, slowly.
- Most importantly, summarising is the skill that enables the counseling process to move forward. It provides a wholesome meaning to the counseling relationship and the nature of each session.
- It enables the client to open up to new perspectives. When the therapist summarises each session, it’s put forward in a slightly different manner, to allow the client to reflect on their words and emotions expressed in the session.
- Summarising helps the therapists to provide a specific structure to the counseling process that is especially important for those clients who find it difficult to keep their focus on one topic or area of issue.
- Summarising gives a good orientation towards the type of homework that needs to be given to the client and also an idea about the future sessions and what they will comprise.
How to summarize
The following steps can be followed to summarize a session:
- Try to summarize at the end of a session
- Confirm the authenticity of the summary with the client and once that is done, decide the focus of the next session, and assign homework for the client for the next session
- Ask the client to give their version of the summary for the session to make them feel more involved and eager in the process of summarising.
- Jot down the points added by the client during the process of summarising.
Summarising vs paraphrasing
Summarising and paraphrasing are not the same. They differ in their structure, purpose, and timing. A summary is provided for the client to reflect on their words and emotions and to let them take the lead. However, paraphrasing on the other hand is done to clarify and move forward in the session without any kind of assumptions, confusion, or misunderstandings.
A summary usually covers a longer time period than a paraphrase. Summarising is usually used at the end of a session, before winding up the session. paraphrasing , on the other hand, is usually used during the session to move the session forward smoothly.
The end of a session
Summarising is the key process for winding up the session. It brings the session to a clear close, without any misconceptions. It is an opportunity provided to the client for clearing any confusion and to make sense of the happenings of the session. It also provides the counselor with an assurance for their efforts taken and to continue with the subsequent sessions.
The summary at the end of a session must match the material of the session and must help the client feel understood and at peace. It allows the client to deny something if they feel is not right or give a better modulation to the words used by the therapist in the summary, if the need arises. This leads to a complete realignment of the session and also shapes the future ones.
Summarising should begin around five to ten minutes before the session comes to a close. The therapist should hint to the client that the allotted time is nearing a close and start with the process of summarising, once the client is ready to begin. Make sure to include the most relevant thoughts, emotions, and opinions expressed by the client and how they perceive them, int the summary.
The beginning of a session
Summarising can also be used at the beginning of a session. It helps the counselor to gain clarity on the direction of the session and it enables the client to decide on the themes of discussion for the current session. The therapist can put forward a summary comprising the themes of previous sessions and how far have the duo come to manage them.
Summarising at the beginning also allows the client to feel settled before the actual session starts. It gives them an idea of their current standing and what they could expect from the ongoing session. This enhances the strength and consolidation of the therapeutic relationship between the client and the therapist.
While summarising at the beginning of a session, the counselor/therapist must keep in mind to give the client complete freedom to take the lead for the session and decide the key theme of discussion. They should not feel evaluated or judged while the process of summarising is going on. This form of summarising is mostly used by person-centered counselors and therapists since it does not go against any of their core principles.
The counselor can also jot down, in a notepad the points brought up by the client at the end of the summary, which can be used for the next session as well.
In this article, we discussed the topic: summarising in counseling. We looked at the meaning, nature, importance, steps involved, and conduction of the process of summarising during the beginning and end of a session. We also examined the difference between paraphrasing and summarising.
FAQs: summarising in counseling
Why is summarising an important skill.
Summarising is an important skill in the field of academic writing. It allows you to grasp the most relevant points from a source of the text and rewrite them, using your own words. It lets you create a brief version of the original content and for quick reference. A good summary also indicates your ability to evaluate your understanding of the source and to turn it around the way you want it.
What are the five counseling skills?
The core counseling skills are as follows:
Attending( refers to completely attending to the client and their issues without getting lost in thoughts or being in dissonance). Silence(aids in providing control to the content, pace, and objectives of the sessions). Reflecting and paraphrasing (helps the counselor to keep away misunderstandings with the client and to help the client reflect on their words and feelings expressed during the sessions? Clarification and the use of questions (helps the counselor in asking open questions to clarify the feelings of the client) Building good rapport (helps in building a sense of connection with the client) Focusing (helps the client to decide the key theme to be discussed during a session. It helps to filter out the unnecessary or the less important issues) Summarising (provides a meaningful and clarified summary of what the says during the sesion) Immediacy. ( helps to focus on the immediate environment or in other words, the here and now relationship between the client and the therapist) Active listening (the client feels heard and understood by the therapist)
What are some counseling techniques?
Some of the most popularly used techniques are as follows:
Psychodynamic counseling: this is one of the most well-known approaches to counseling and is based on the Freudian theory of psychodynamics. It focuses on the development of strong therapist-client alliances.
Interpersonal counseling: interpersonal counseling is mostly diagnosis based and the disorder of the client is considered as a medical condition that requires appropriate intervention. The focus of this technique is on the attachment of the mental health outcomes to the well-being of the client. It is a time-limited counseling approach that helps the clients to identify the environmental stressors that are causing their issues.
Humanistic counseling: this approach was developed by Carl Rogers and works on the belief that humans have an innate ability and willingness to be self-actualized. It encourages curiosity, humility, intuition, and genuine acceptance. It is also called client-centered therapy, which helps the client realize their full potential.
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