Exploring Thoughts and Narratives Empathy, Restatements, and Summarizing: Developing a Narrative

Purpose of Restatements: Paraphrase Skills and Action Help clients talk in more detail and depth. Check on the accuracy of what you hear by saying back to clients the essence of their comments and providing periodic summarizations. Develop cognitive empathy and facilitate client cognitive understanding for clearer decision making and more effective action.

Creating the Narrative Encouraging, paraphrasing, and summarizing are active listening skills key to an empathic therapeutic relationship When we attend and clients sense their story is heard, they open up and become more ready for change. Leads to more effective executive brain functioning, which in turn improves understanding of issues and decision making.

Examples of Reflections Adult Client: “Can you believe it? My job just fired me without ever mentioning any issue about my job!” Therapist: “It sounds like you were shocked that you were fired.” Adult Client:” Ever since I broke up with her, I just mope around. I am just at a loss.” Therapist: “So in a way you are grieving your relationship.” Adult Client: “It is no fun watching football games since Bob passed away.” Therapist: “So before Bob died, the two of you used to watch football together and now you feel sad and really miss him especially when you watch football.”

Examples of Reflecting Meaning Adult Client: “I really enjoy spending time with the person I am dating, but my job is so demanding these days that I am feeling stressed and worried about getting everything done.” Reflecting content: “So you are really worried about how you can get your job done and find time for your relationship.” Reflecting meaning: “It sounds like you want to spend time with George and you also want to do a good job at work.” (frames a conflict)

Introduction: Encouraging, Paraphrasing, and Summarizing (slide 4 of 6) Paraphrasing (also known as reflection of content): Shorten or clarify the essence of what has just been said, but be sure to use the client’s main words when you paraphrase. Paraphrases are often fed back to the client in a questioning tone of voice. Anticipated Client Response: Clients will feel heard. They tend to give more detail without repeating the exact same story. They also become clearer and more organized in their thinking. If a paraphrase is inaccurate, the client has an opportunity to correct the interviewer. Paraphrasing of client statements is important in cognitive empathy.

Introduction: Encouraging, Paraphrasing, and Summarizing (slide 5 of 6) Summarizing: Summarize client comments and integrate thoughts, emotions, and behaviors. Similar to paraphrasing but used over a longer time span. Anticipated Client Response: Clients will feel heard and often learn how their complex and even fragmented stories are integrated. A summary helps clients make sense of their lives and will facilitate a more centered and focused discussion. Secondarily, a summary also provides a more coherent transition from one topic to the next or a way to begin and end a full session. As a client organizes the story more effectively, we see growth in brain executive functioning and better decision making.

Examples of Summarizing Therapist: “As I remember our last meeting, we focused on how distressed you felt about your wife’s roller coaster behavior toward you. When she is being friendly, you feel good and get more work done, and when she is distant, you worry and have trouble sleeping and focusing at work. Is this how you remember it? Therapist: (family therapy) “ John and Mary, you seem to be ready to take charge of some of the family’s problems. It has been hard to disagree with your children and feel their disappointment towards you. I can imagine that your children might be upset because its been effective in getting what they want.”

Introduction: Encouraging, Paraphrasing, and Summarizing (slide 6 of 6) Checkout/Perception Check: Periodically check with your client to discover how your statement received. “Is that right?” “Did I hear you correctly?” “What might I have missed?” Anticipated Client Response: Statements such as these give clients a chance to pause and reflect on what they have said. If you indeed have missed something important or distorted their story and meaning, they have the opportunity to correct you. Without an occasional checkout, it is possible to lead clients away from what they really want to talk about.

Class Exercise: Meaningful Restatements A client, Jennifer, enters the room and starts talking immediately. I really need to talk to you. I don’t know where to start. I just got my last exam back and it was a disaster—maybe because I haven’t studied much lately. I was up late drinking at a party last night and I almost passed out. I’ve been sort of going out with a guy for the last month, but that’s over as of last night. . . . [pause] But what really bothers me is that my mom and dad called last Monday and they are going to separate. I know that they have fought a lot, but I never thought it would come to this. I’m thinking of going home, but I’m afraid to. . . . Jennifer continues for another 3 minutes in much the same vein, repeating herself somewhat, and seems close to tears. At times, speech is so fast that it is hard to follow her. Finally, she stops and looks at you expectantly. Question: Formulate possible meaningful restatements for Jennifer. What effect are you intending?

Basic Techniques in Paraphrasing Paraphrasing is the most important cognitive empathic listening skill. An accurate paraphrase usually consists of four dimensions: A sentence stem that may include the client’s name. The key words used by a client to describe the situation or person. The essence of what the client has said in briefer and clearer form. A checkout for accuracy.

Basic Techniques in Summarizing Summarizing pulls together and organizes client conversation, supporting the brain’s executive functioning. Summarizing is key to Theory of Mind, that is, your ability to “mentalize” the world of the client. Attend to client’s verbal and nonverbal comments. Selectively attend to key concepts. Restate key concepts to the client accurately. Check for accuracy at the end.

Exploring Feelings Defenses Against Feelings Emotional Experience necessary for Change Therapist Role: Clarify Feelings and Identify Unexpressed Feelings Therapist Use of Self: to understand the client’s experience, to establish empathy, trust, rapport

Exercise: Intensifying or Accessing Emotions Therapist: Directs client to close eyes, instructs on diaphragmatic deep breathing. “Continue to focus on sensations of breathing. Be open to whatever thoughts and feelings that arise.” Pause. “Ask yourself what is going on right now” pause “Don’t rush, just see whatever comes to mind, just let it come.” Client: Write down the words or images that come to mind. What feelings and sensations came up for you? Try not to filter out feelings or images.

Class Exercise: Constructing the Client’s Narrative Therapist: Use exploring, reflective, and summarizing skills to identify your client’s current life narrative. What challenges do they face, anticipate in the future, what role to they play in the challenge now and expect to play in the future? Summarize their narrative after gathering their story. Observer: Identify what was effective/ineffective. Client: Share your thoughts about your achievement/academic challenges, as elicited by the therapist in your group.