CHAPTER 3

Listening and Relationship

Development
• We all know a good listener when we meet one.
• However, it’s less easy to figure out exactly what good listeners do to
make it easier for others to talk openly and freely.
• This chapter analyzes the mechanics of effective attending and
listening skills:
• *The difference between positive and negative attending behaviors.
• *How ethnocultural background can affect how clients respond to
attending and listening behaviors.
• *How and why therapists use nondirective listening behaviors,
including: silence, paraphrasing, clarification, reflection of feeling, and
summarization.
• *How and why therapists use directive listening behaviors, including:
interpretive reflection of feeling, interpretation, feeling validation,
and confrontation
ATTENDING BEHAVIOR

• Good therapists consciously engage in specific behaviors that most

clients interpret as signs of interest and concern.
• These behaviors are referred to in the interviewing and counseling
literature as attending behaviors.
• Ivey, Ivey, and Zalaquett (2010) described attending behavior as the
foundation of interviewing.
• To be successful, therapists must pay attention to clients in overt ways
that communicate respect and interest.
• To be successful, therapists must pay attention to clients in overt
ways that communicate respect and interest.
• If therapists fail to look, sound, and act attentive, they won’t have
many clients.
• Most clients drop out of counseling if they don’t think their therapist
is listening.
• The importance of positive attending behaviors to successful therapy
is recognized across disciplines and theoretical orientations; it is
spectacularly uncontroversial
• Attending behavior is primarily nonverbal.
• If verbal and nonverbal messages are in conflict, ???

• WE will believe the nonverbal message.

• This is why being aware of and effectively using nonverbal channels is

so important when communicating with clients.
Positive Attending Behavior
• Positive attending behaviors open up communication and encourage
free expression.

• In contrast, negative attending behaviors inhibit expression.

• Ivey, Ivey, and Zalaquett (2010) have described four categories of
attending behavior that have been studied, to some extent, cross-
culturally.

• These behaviors are described

• 1. Visual/eye contact
• 2. Vocal qualities
• 3. Verbal tracking
• 4. Body language: Attentive
• 1. Visual/eye contact:
• There is considerable variation in what different cultures define as
appropriate eye contact. Individuals also vary greatly in their eye-
contact patterns.
• For some therapists, sustaining eye contact during an interview is
natural.
• For others, it can be difficult; there may be a tendency to look down
or away from the client’s eyes because of respect, shyness, or cultural
dynamics.
• The same is true for clients; some prefer more intense and direct eye
contact; others will prefer looking at the floor, the wall, or anywhere
but into your eyes
• With most clients, it’s appropriate to maintain more constant eye
contact as they speak and less constant eye contact when you speak
Body Language:

• Positive body language includes the following (derived from Walters, 1980):
• • Leaning slightly toward the client.
• • Maintaining a relaxed but attentive posture.
• • Placing your feet and legs in an unobtrusive position.
• • Keeping your hand gestures unobtrusive and smooth.
• • Minimizing the number of other movements.
• • Matching your facial expressions to your feelings or the client’s feelings.
• • Sitting approximately one arm’s length from the client.
• • Arranging the furniture to draw you and the client together, not to erect a
barrier
Vocal Qualities

• I advise you:
• first ask your friends or your lecturer to listen to you and get
feedback on the tone of your voice.

• Remember chapter 2…..

• Interpersonal influence is often determined not so much by what you

say, but by how you say it
• Effective therapists use vocal qualities to enhance rapport,
communicate interest and empathy, and emphasize specific issues or
conflicts.

• As with body language, it’s often useful to follow the client’s lead,
speaking in a volume and tone similar to the client.
• Meier and Davis (2011) refer to this practice as “pacing the client” (p.
9).
• The therapist should adjust the pace according to the client…………
• On the other hand, therapists can use voice tone and speech rate to
lead clients toward particular content or feelings.

• For example, speaking in a soft, slow, and gentle tone encourages

clients to explore feelings more thoroughly, and speaking with
increased rate and volume may help convince them of your credibility
or expertise.
Verbal Tracking:

• Although eye contact, body language, and vocal quality are

important, they do not, by themselves, represent effective listening.
• YOU NEED MORE……………
• Therapists also demonstrate they are tracking the content of their
clients’ speech by occasionally repeating key words and phrases
• Ivey, Ivey, and Zalaquett (2010) consider verbal tracking to have three
major functions.
• 1. To maintain the focus on what clients are talking about. This can
help clients continue to elaborate their personal narrative.
• 2. For therapists to self-reflect on what they’re choosing to verbally
track. This is important because therapists and counselors tend to
listen to some things and ignore others, and observing yourself can
help you develop awareness of your own patterns.
• 3. To selectively attend or not attend to client verbal content.
• Sometimes, by not verbally monitoring negative comments,
therapists can encourage clients to talk about positive qualities rather
than negative experiences OR VERSE
Negative Attending Behavior
• It’s possible to get too much of a good thing. This is equally true with
regard to positive attending behaviors. It can be disconcerting when
someone listens too intensely.
• Therapists should avoid overusing the following behaviors:
• Head nods.
• Saying “Uh huh.”
• Eye contact.
• Repeating the client’s last Word
• Mirroring. ………..Mirroring, as an aspect of body language, involves
synchrony or consistency between therapist and client.
• Additionally, research suggests that clients perceive the following
therapist behaviors as negative (Cormier et al., 2012; Smith-Hanen,
1977):
• • Making infrequent eye contact.
• • Turning 45 degrees or more away from the client.
• Crossing legs away from the client.
• Folding arms across the chest
 Individual and Cultural
Differences
• Many individual and cultural differences affect the interview. These
differences include, but are not limited to:
• (a) gender,
• (b) social class,
• (c) ethnicity,
• (d) sexual orientation,
• (e) age, and
• (f ) physical disabilities

• Keep in mind that there are both individual and cultural differences when
conducting interviews
MOVING BEYOND ATTENDING
• Differences among clients make it impossible to reliably predict their
reactions to various interviewing responses.
• Some clients react positively to therapist behaviors that might seem
inadequate or awkward;
• others react negatively to what might be considered a perfect
paraphrase
• Meier and Davis (2011) advised:
• “When you don’t know what to say, say
nothing”
• Margaret Gibbs (1984) expressed the distress many new therapists experience:

• Once I began my work as a therapist ...I began to have ... doubts.

• Certainly my supervisors seemed to approve of my work, and my patients
improved as much as anybody else’s did. But what was I actually supposed to be
doing?
• I knew the dynamic, client-centered and behavioral theories, but I continued to
read and search for answers. I felt there was something I should know,
something my instructors had neglected to tell me, much as cooks are said to
withhold one important ingredient of their recipes when they relinquish them
• AND NOW,
• We begin with therapist behaviors that are considered to be more
nondirective and proceed along a continuum toward increasingly
directive or therapist-centered behaviors.
• Therapist behaviors are categorized into three groups:
• 1. Nondirective listening behaviors (e.g., paraphrase; see Table 3.1).
• 2. Directive listening behaviors (e.g., interpretation; see Table 3.2).
• 3. Directive action behaviors (e.g., advice; see Table 4.2).
NONDIRECTIVE LISTENING
BEHAVIORS
Silence
• Silence is the most nondirective of all listening behaviors.
• silence is also a powerful therapist response.

• BUT;
• It takes time for most therapists and clients to get comfortable with
silence.
• Silence can frighten both therapists and clients.
• Most people feel awkward about silence in social settings and strive
to keep conversations alive.

• On the other hand, when used appropriately, silence can be soothing.

• Although the primary function of silence is to encourage client talk,
silence may also allow clients to recover from or reflect on what
they’ve just said.

• silence allows therapists time to consider and intentionally select a

response, rather than rushing into one
• Silence is a major tool used by psychoanalytic psychotherapists to
facilitate free association.
• Effective psychoanalytic therapists, however, explain the concept of
free association to their clients before using it.
• AND SO;
• Before the sessions, you should explain the reason of your silence. If
yo dont do that, when you are silent, great pressure is placed on
clients to speak and client anxiety begins to mount.
• ***When silence comes, sometimes wait for the client to speak next
and other times break the silence yourself.
• ***If you feel uncomfortable during silent periods, use attending
skills and look expectantly toward clients and be relax.
• ***Remember to monitor your body and face while being silent.
There is a vast difference between a cold silence and an accepting,
warm silence… maintaining eye contact, keeping the body close to
the client.
• ***Avoid using silence if you believe your client is confused,
experiencing an acute emotional crisis, or psychotic
Paraphrase / Reflection of
Content
Several types of paraphrases
• 1) The Simple Paraphrase:

• The simple paraphrase doesn’t add meaning or direction.

• The therapist rephrases, rewords, and reflects what the client just
said.
Some examples include:
• Client 1: Yesterday was my day off. I just sat around the house doing
nothing. I had some errands to run, but I couldn’t seem to make
myself get up off the couch and do them.

• How do you paraphase this sentence?

• …………………………………………………
• Client 1 : Yesterday was my day off. I just sat around the house doing
nothing. I had some errands to run, but I couldn’t seem to make
myself get up off the couch and do them.

• Therapist 1: yesterday was your day off and you had trouble getting
going on your day off
• Client 2: I do this with every assignment. I wait until the last minute
and then whip together the paper. I end up doing all-nighters. I don’t
think the final product is as good as it could be.
• ………………………………………..
• How do you paraphase this sentence?
• Client 2: I do this with every assignment. I wait until the last minute
and then whip together the paper. I end up doing all-nighters. I don’t
think the final product is as good as it could be.

• Therapist 2: Waiting until the last minute has become a pattern for
you and you think it makes it so you don’t do as well as you could on
your assignments
• ****Simple paraphrases also don’t include
therapist opinion, reactions, or
commentary, whether positive or negative..

• ****Each of these preceding paraphrase

examples is relatively simple and
straightforward.
• ***As clients talk more, reflective listening can grow
increasingly complex.
• ***Although it’s important to do the best you can to stay
accurate, sometimes reflective listening feels like a verbal
dance
• If you miss something important, the client will move to
make a correction. Or if you include something the client
didn’t say, the client will make a clarification.
• Client 3: If my goal is to lose weight, even though I don’t like going to
bed early, I should, and then wake up early in the morning and then I
don’t have an excuse to avoid exercising.
• Therapist 3: So you think it would be better for you to get up earlier in
the morning.
• Client 3: But I’m a night person.
• Therapist 3: You like to stay up.
• Client 3: Yeah. I like to stay up and talk on the phone and go online
and do Facebook.
• In the next two examples, the therapists are using paraphrasing, but
are including specific language with their particular theoretical
orientation.
• Guess !
• Therapist 4……………………

• Therapist 4 is operating from a cognitive perspective

• Therapist 5 ………………………………………..
• Therapist 5 is using a psychodynamic approach.
• 2) The Sensory-Based Paraphrase:

• It depends on NLP---neurolinguistic programming.

• NLP emphasized a concept referred to as representational systems
THAT refer to the sensory system—usually visual, auditory, or
kinesthetic—that individual clients use when experiencing their
world.
• If you listen closely to your clients’ words, you’ll notice that some
clients rely primarily on visually oriented words (e.g., “I see” or “it
looks like”), others on auditory words (e.g., “I hear” or “it sounded
like”), and others on kinesthetic words (e.g., “I feel” or “it moved
me”).
• Client 1: My goal in therapy is to get to know myself better. I think of
therapy as kind of a mirror through which I can see myself, my
strengths, and my weaknesses more clearly.
• Therapist 1:………………………
• Client 1: My goal in therapy is to get to know myself better. I think of
therapy as kind of a mirror through which I can see myself, my
strengths, and my weaknesses more clearly.
• Therapist 1: You’re here because you want to see yourself more
clearly and believe therapy can really help you with that.
• *** Client 2: I just got laid off from my job and I don’t know what to
do. My job is so important to me. I feel lost.
• Therapist 2:…………………………….
• *** Client 2: I just got laid off from my job and I don’t know what to
do. My job is so important to me. I feel lost.
• Therapist 2: Your job has been so important to you, you feel adrift
without it
The Metaphorical Paraphrase
• Therapists can use metaphor or analogy to capture their client’s
central message.

• For instance, often clients come for therapy because of feeling stuck
and not making progress in terms of personal growth or problem
resolution.
• In such a case, a therapist might reflect, “It seems like you’re spinning
your wheels” or “Dealing with this has been a real uphill battle.”
• 4) Intentionally Directive Paraphrases:
• Rogers considers this technique as a means of showing empathy and
compassion, while at the same time helping clients move beyond
their negative or traumatic feelings from the past
• Examples:
• Client 1: I feel like cutting myself.
• Therapist 1: You’ve felt like cutting yourself.
• [In this example the therapist is validating the client, but shifting to
past tense.
• Client 2: I have flashbacks all the time.
• Therapist 2: So you have flashbacks a lot of the time.
• [In this example the therapist transforms the client’s verbal
disclosure from a global to a partial perception.]
• Insoo Kim Berg was famous for her ability to focus on, magnify, and
paraphrase back a small positive client statement—even if the
statement was surrounded by or covered up with negative content.
• For Berg, the decision regarding what to paraphrase back to her
clients was simple.
• She believed all therapists lead their clients and so they may as well
intentionally lead their clients in positive directions
• The basic belief:
• Since we cannot avoid leading, the question becomes, “Where shall
we lead our clients?”
• Let ‘s remember this example:
• original nondirective listening example
• We didn’t have much money when I was growing up, and I suppose
that frustrated my father. He beat us five kids all the time. He’s dead
now, but to this day, my mom says we needed the discipline. But I
hated it then and swore I’d never be like him. Now that I’m grown
and have kids of my own, I’m doing okay, but sometimes I feel I need
to discipline my kids more ... harder... do you know what I mean?
• Your answer please?
• Take a moment and try to imagine what positive part of this statement
Berg might choose to paraphrase. Perhaps Berg would have said
something like:

• “Now that you’re grown and have your own kids, you see yourself as
doing okay!” or “So, you swore that would never be like your father and
clearly, you aren’t!” Similar to Carl Rogers with a twist, these solution- or
strength-focused reflections intentionally lead clients toward the
positive. There are many different names for these intentionally leading
responses, including: positive reconstruction, finding the exception, or
focusing on sparkling moments
Clarification
• There are several forms of clarification and they all serve a common
purpose: to make clear for yourself and the client precisely what has
been said.
• 1) The most basic fom:
• It’s used when you don’t quite hear what a client said and you need
to recheck.
• I’m sorry, I didn’t quite hear that. Could you repeat what you said?
• 2) The second form of clarification consists of a restatement
imbedded in a double question.
• A double question is an either/or question including two or more
choices of response for the client.

• For example: • Do you dislike being called on in class—or is it

something else?
• 3) The last form consists of a restatement of what the client said and
a closed question.
• There are two main factors to consider when deciding whether to
use clarification.
• First, if the information appears trivial and unrelated to central
therapeutic issues, it may be best to wait for the client to move on to
a more productive area.
• It can be a waste of time to clarify minor details that are only
remotely related to interview goals.
• For example:
• a client says, “My stepdaughter’s grandfather on my wife’s side of the
family usually has little or no contact with my parents.”…….

• You need just listening..

• If you use clarification technics, this can lead to a conversation full of
unnecessary details.
•
Reflection of Feeling
• Nondirective feeling reflections also encourage further emotional
expression.

• Consider the following example of a 15-year-old male talking about

his teacher:
• Client 1: That teacher pissed me off big time when she accused me of
stealing her watch. I wanted to punch her lights out.
• Counselor 1: So you were pretty pissed off.
• Client 1: Damn right
• If you’re tentative in your feeling reflection, your client may quickly
correct you.
• For example:
• Client 2: That teacher pissed me off big time when she accused me of
stealing her watch. I wanted to punch her lights out.
• Counselor 2: Seems like you were a little irritated about that. Is that
right?
• Client 2: Irritated, hell, I was pissed.
• Counselor: You were more than irritated. You were pissed
• There are many ways to explore and enhance your feeling capacity
and vocabulary. Carkhuff (Carkhuff, 1987) recommended the
following activity. Identify a basic emotion, such as anger, fear,
happiness, or sadness, and then begin associating to other feelings in
response to that emotion.
• For instance, state, “When I feel sad ... .” and then finish Chapter 3
Basic Attending, Listening, and Action Skills 81 the thought by
associating to another feeling and stating it; for example, “I feel
cheated.” An example of this process follows: When I feel joy, I feel
fulfilled. When I feel fulfilled, I feel content. When I feel content, I feel
comfortable. When I feel comfortable, I feel safe. When I feel safe, I
feel calm. When I feel calm, I feel relaxed.
• Conduct this exercise individually or in dyads using each of the 10
primary emotions

• Interest-excitement Distress
• Disgust Shame
• Joy Anger
• Contempt Guilt
• Surprise Fear
Summarization
• Summarization demonstrates accurate listening, enhances client and
therapist recall of major themes, helps clients focus on important
issues, and extracts or refines the meaning behind client messages.
• Depending on how much your clients talk, summarization can be used
intermittently throughout a session and then at the end.
• Therapist 1: You’ve said a lot in the past 10 minutes and so I want to
make sure I’m tracking your main concerns. You talked about the
conflicts between you and your parents, about how you’ve felt angry
and neglected, and about how it was a relief, but also a big
adjustment, to be placed in a foster home. And you also said you’re
doing better than you thought you’d be doing. Does that cover the
main points of what you’ve talked about so far?
• Client 1: Yeah. That about covers it.
• Although summarization is conceptually simple, coming up with a
summary can be difficult. Your memory of what your client said
sometimes may fade quickly, leaving you without an accurate or
complete recollection.
• Sometimes, therapists take on too much responsibility.
• For example: You’ve mentioned four main issues today. First, you said
your childhood was hard because of your father’s authoritarian style.
Second, in your current marriage, you find yourself overly critical of
your wife’s parenting. Third, ……………………………And fourth, uh, fourth
[long pause], uh, sorry, I forgot the fourth one—but I’m sure it will
come to me !
• In general, you should use an interactive summary.
• First, doing so takes pressure off your memory. Second, it places
responsibility on clients to state what they think is important. Third,
an interactive approach models a collaborative relationship
Guidelines for Summarizing
• Overall, when summarizing content from an interview, be informal,
collaborative, supportive, and hopeful:
• • Informal
• Instead of saying, “Here’s my summary of what you’ve said,” say
something like, “Let’s make sure I’m keeping up with the main things
you talked about.” Instead of numbering your points, simply state
them one by one. That way you won’t be embarrassed by forgetting a
point.
• • Collaborative
• Instead of taking the lead, ask clients to summarize (e.g., “What seemed most
important to you during our meeting?”).
• This allows you to hear your client’s view before offering your own. You can always
add what you thought was important later.
• If you do take the lead in summarizing, pause intermittently so your client can
agree, disagree, or elaborate.
• At the end of your part of the summary, ask if what you’ve said seems accurate
(e.g., “Does that seem to fit with what you recall?”).
• Using a collaborative approach can feel empowering to clients. You might say, “I’m
interested in what you feel has been most important of all you’ve covered today.”
• • Supportive
• It can be very supportive to acknowledge your client’s efforts.
• For example, “You’ve said a lot” or “I appreciate your openness with
me” are reassuring and supportive statements that help clients feel
good about what they’ve shared.
• Of course, you should only make these supportive statements when
you believe them
• Hopeful
• When summarizing, it’s important to consciously or intentionally
decide how positive or hopeful you want your message to be.
Although it’s fine to be neutral and reflective, therapists who adhere
to a solution-focused perspective will avoid summarizing anything
negative
THE PULL TO REASSURANCE
• Reassurance, too, is a technique.
• Clients may behave in ways that tug on your impulse to say
something reassuring. They want to know if they’re good parents, if
they did the right thing, or if their sadness will lift.
• At some point you’re likely to feel the pull to tell them they’re doing
just fine.
DIRECTIVE LISTENING BEHAVIORS
• * Feeling Validation:
• The purpose of feeling validation is to help clients accept their
feelings as a natural part of being human. Feeling validation can be
ego boosting; clients feel supported and more normal because of
their therapist’s validating comments.

• All approaches to feeling validation give clients the message: “Your

feelings are acceptable and you have permission to feel them.” In
fact, sometimes feeling validations suggest that clients should be
having particular feelings
• Client 1: I’ve just been so sad since my mother died. I can’t seem to
stop myself from crying. (Client begins sobbing.)

• Therapist 1: It’s okay for you to be sad about losing your mother.
That’s perfectly normal. Go ahead and cry if you feel like it.
• Therapists can also validate or reassure clients by using a concept
Yalom and Leszcz (2005) refer to as universality.

• Client 3: I’m always comparing myself to everyone else—and I usually

come up short. I wonder if I’ll ever really feel confident.
• Therapist 3: You’re being too hard on yourself. Everyone has self-
doubts. I don’t know anyone who feels a complete sense of
confidence
• Feeling validation is common in interviewing and counseling.
• Potential effects of feeling validation include:
• • Enhanced rapport.
• • Increased or reduced client exploration of the problem or feeling
(this could go either direction).
• • Reduction in client anxiety, at least temporarily.
• • Enhanced client self-esteem or feelings of normality (perhaps only
temporarily).
• • Possible increased likelihood of client-therapist dependency
Interpretive Reflection of
Feeling
• Interpretive feeling reflections can have many effects, but some of
the most prominent include the following:
• • If offered prematurely or without a good rationale, they may feel
foreign or uncomfortable to clients; this discomfort can lead to client
resistance, reluctance, or denial.
• • When well stated and used within the context of a positive therapy
relationship, interpretive feeling reflections may feel very good to
clients because the therapist is “hearing” the client on a deeper level;
this can lead to enhanced therapist credibility and further
strengthening of the therapy relationship
• Keep in mind the following principles when using interpretive feeling
reflections.
• • Wait until: ◦ You have good rapport. ◦ You have shown your clients,
using active listening skills, that you’re able to accurately hear what
they’re saying. ◦ You have evidence (e.g., nonverbal signals, previous
client statements) that provide a rational foundation for your
interpretation.
• • Phrase your interpretive statement: ◦ Tentatively (e.g., “If I were to
guess, I’d say ... ”) ◦ Collaboratively (e.g., “Correct me if I’m wrong,
but ... ”)
• Many different phrasings can be used to deliver interpretive
statements in ways that make them more likely to be accepted.
• For example: • I think I’m hearing that…………..
• Correct me if I’m wrong, but it sounds like…………
Interpretation
• The purpose of an interpretation is to produce client insight or to help
clients perceive reality more accurately.

• When therapists provide an interpretation, they’re offering a form of

feedback that links past relationship patterns to current relationship
patterns.
• Psychoanalytic or “Classical” Interpretations
• According to the psychoanalytic tradition, an interpretation is based
on the theoretical assumption that unconscious processes influence
behavior.
• By pointing out unconscious conflicts and patterns, therapists help
clients move toward greater self-awareness and improved functioning.
• This isn’t to suggest that insight alone produces behavior change.
• Instead, insight begins moving clients toward more adaptive ways of
feeling, thinking, and acting
•
• Consider, one last time, our angry 15-year-old student. Client 1: That
teacher pissed me off big time when she accused me of stealing her
watch. I wanted to punch her lights out.
• Counselor 1: So you were pretty pissed off. (Nondirective feeling reflection.)
• Client 1: Damn right.
• Counselor 1: You know, I also sense you have some other feelings about what
your teacher did. Maybe you were hurt because she didn’t trust you.
(Interpretive feeling reflection.)
• Client 1: (Pauses.) Yeah, well that’s a dumb idea ... it doesn’t hurt anymore ...
after a while when no one trusts you, it ain’t no big surprise to get accused again
of something I didn’t do.
• Counselor 1: So when you respond to your teacher’s distrust of you with anger,
it’s like you’re reacting to all those times when your parents haven’t trusted you.
(Interpretation.)
• Classical interpretations work best if you have knowledge of the client
and the client’s past and present relationships.
• In the previous example, the counselor knows from earlier interviews
that the boy perceived himself as being unjustly punished by his
parents.
• The counselor could have made the interpretation after the boy’s first
statement, but waited until after the boy responded positively to the
first two interventions. This illustrates the importance of timing when
using interpretations.
• ,As Fenichel (1945) wrote, “The unprepared patient can in no way
connect the words he hears from the analyst with his emotional
experiences. Such an ‘interpretation’ does not interpret at all” (p. 25)
• Interpretation is an advanced therapeutic technique!
• what to interpret, when to interpret it, and how to interpret it
• They all are very important !
• To a socially anxious client:
• “When people don’t say hello to you, you think they’re rejecting you,
when it could be that they’re having a bad day or have something
else on their minds.”
Confrontation
• For example,
• imagine a client with clenched fists and a harsh, angry voice saying,
• “I wish you wouldn’t bring up my ex-wife. I’ve told you before, that’s
over! I don’t have any feelings toward her. It’s all just water under the
bridge.”

• Obviously, this client still has strong feelings about his ex-wife.
• Perhaps the relationship is over and the client wishes he could put it
behind him, but his nonverbal behavior—voice tone, body posture,
and facial expression—tells the therapist that he’s still emotionally
involved with his ex-wife
• Confrontation works best when ……………………………
• Confrontation works best when you have a working relationship with
the client and ample evidence to demonstrate the client’s emotional
or behavioral incongruity or discrepancy.
• Think about the preceding example
• Any evidence?
• we wouldn’t recommend using confrontation unless there was
additional evidence indicating the client’s unresolved feelings about
his ex-wife
• If there was supporting evidence, the following confrontation might
be appropriate:

• You mentioned last week that every time you think of your ex-wife
and how the relationship ended, you want revenge.
• And yet today, you’re saying you don’t have any feelings about her.
• But judging by your clenched fists, voice tone, and what you said last
week about her “screwing you over,” it seems like you still have very
strong feelings about her.
• Perhaps you wish those feelings would go away, but it sure looks like
they’re still there
• In this case, the therapist is using a reflection of content (or lack of
content) to gently confront the fact that the client was neglecting to
discuss his wife and the relevance of her departure on his mood
• In this case, the therapist is using a reflection of content (or lack of
content) to gently confront the fact that the client was neglecting to
discuss his wife and the relevance of her departure on his mood
• Firmer confrontations are sometimes useful.
• However, when therapists use more aggressive confrontations, they
run the risk of evoking client resistance.

• Many people believe effective confrontations must be harsh and

aggressive.
• BUT… It’s more therapeutic, sensible, and less likely to produce
resistance if therapists begin with gentle confrontations, becoming
more assertive later.
 Summary
• What did we learn?

• 1) Attending behavior is primarily nonverbal and consists of

culturally appropriate eye contact, body language, vocal qualities,
and verbal tracking

• 2) Positive attending behaviors open up and facilitate client talk,

whereas negative attending behaviors tend to shut down client
communication
• 3) To improve communication and and attending skills, therapists
should seek feedback from peers and supervisors.

• 4) therapists employ many different nondirective listening

behaviors, including silence, paraphrasing (or reflection of content),
clarification, reflection of feeling, and summarization
• 5) Nondirective listening behaviors are designed to facilitate client
self-expression. However, even nondirective listening behaviors
influence clients and have some directive qualities
• 6) Directive interviewing behaviors are used for assessment
purposes, to explore issues with clients, and to facilitate insight.
• Directives tend to work best after a therapeutic alliance has been
established.
• 7)Directive listening behaviors include feeling validation,
interpretive reflection of feeling, interpretation (psychoanalytic or
reframing), confrontation, and immediacy.
• These techniques involve therapists identifying particular issues for
clients to focus on during the session.
• The end of the Chapter 3