This post was originally published on August 16, 2016, and updated on July 1, 2019.
When you’re starting your work as a therapist, whether during graduate training or as a brand-new master’s-level therapist, it’s natural to feel anxious and unprepared at times (or all the time!). You’ve spent several years learning a ton of information, and now you, naturally, want it to all make sense, so that you can do effective therapy.
Well, there’s good news: You've learned and assimilated a lot more than you think, and it will "show up" when you need it.
There are a few simple verbal skills that can guide your initial work as a beginning therapist; mastering these is a much better use of your time than worrying about using a theory perfectly or finding the right intervention. These skills are necessary for conducting successful therapy, because they establish a firm foundation for having therapeutic conversations, and they will help you in the moment with clients; they include: summarizing, attending, interrupting, empathizing, and reflecting from an "I" position.
Summarizing is re-stating, in your own words, the therapeutically significant points a client has made during a brief period of time. Summarizing is not merely paraphrasing; it involves sifting through the information, so that when you relay it, you are highlighting information that is useful for the session, or the overall therapeutic goals. Summarizing helps the client feel heard and allows the therapist to prioritize therapeutic information (process over content).
Generally, in the therapy field, attending refers to giving the client your full attention. This is accomplished by listening in order to summarize or repeat, rather than in order to respond. The former requires that you wait until the client is finished speaking, and you have processed the information, to comment. This often requires moments of silence and, as a result, comfort with silence.
Attending is also a verbal and non-verbal skill used to let clients know that you are listening and mentally following their story. Attending skills can be as simple as a head nod, an “mm hmm,” or an “Oh!” These non-verbal and verbal responses come more naturally to some people than others. Either way, it’s useful to notice how and how often you are attending in this way, because it communicates to clients that you are present with them and focused on their needs.
Interrupting is difficult for most beginning therapists, because they have been socially trained not to interrupt, and as a result are concerned about being rude, or they don’t want to be too directive. Interrupting is a skill that isn’t intentionally taught in most graduate training, but is often required for productive therapy.
Although clients want to tell us the details of their lives, or their latest frustration, they also want to accomplish goals. Along with listening to the details of our clients' stories, it is our responsibility as therapists to manage therapy time, so that it is productive, and clients are able to accomplish their goals. As a result, we must balance clients’ desire to accomplish specific goals with their particular communication style. In order to be useful in this process, sometimes, we will need to interrupt. The frequency varies with each client and type of client (i.e., individual vs. couple vs. family).
One way to make interrupting more comfortable is to establish rules for interrupting in the initial session, or make sure to explain your reason for interrupting when you interrupt. You can use the time-out hand signal to interrupt. You can use a bell. You can wave, simply start talking, --find your best option. Anything that helps you get into the conversation, in order to ensure it remains therapeutic, is worth it.
Empathizing is a verbal, emotional reaction to what the client has said; for example, “Wow. That sounds exciting!”, or “I’m sorry. I can’t imagine how it must feel to go through that experience.” When empathizing, you are communicating that you have listened to and understood the client’s experience from an emotional perspective. If you empathize by using an emotional descriptor that doesn’t fit for the client, then the hope is that the client will expand your interpretation. You can ensure s/he feels comfortable doing so by empathizing in a way that allows for collaboration; for example: “That sounds exciting! Was it exciting for you? How did you feel?” In other words, as an attachment to your empathizing statement, you can invite the client’s varied emotions.
Reflecting from an "I" Position
Typically, reflecting means sharing your thoughts about what the client has said. This is a useful therapeutic skill, but it varies slightly from reflecting from an “I” position. In reflecting from an “I” position, the focus of the reflection is you--the therapist, not the client. This type of reflecting is a way to reveal your therapeutic thinking as well as explain your interactions. Here are a few examples: “You said X a few minutes ago, and it made me wonder if . . .”, or “Okay. I’m about to ask a question that may seem off topic, but I am asking it because it will connect to X goal.” Practicing this type of therapeutic self-disclosure creates an environment of transparency, and as a result, helps your clients feel included in the therapeutic process. It also models this type of communication, so that clients can use it in therapy and in their relationships.
For more on essential therapy skills, see the following posts on systemic therapy microskills:
Let me know, in the comments below:
Which essential skill stands out to you the most, or which one would you like to implement more regularly in your sessions?
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