How to Listen? When to Teach?

I wrote this reflection for our pre-practicum class at the University of Rochester. The professor asked us to reflect on our readings regarding attending, listening and questioning clients.

 This week, I reflected on Chapter 3 ("Basic Attending, Listening, and Action Skills") and Chapter 4 ("Directives: Questions and Action Skills") in Sommers-Flanagan & Sommers-Flanagan's (2015) Clinical Interviewing. Both of these chapters addressed fundamental topics in how a therapist can interact with a client, beginning with simply how to listen. Chapter 3 further elaborates by describing attending, non-directive, and directive behaviors. Attending is how a therapist should simply "be" with a client, in order to listen. Attending includes attributes such as the therapist's presence, body language, eye contact, and even their brief comments in between listening to show they are paying attention. Therapists can attend to their patients well, enabling effective therapy, or they can attend poorly. Moving beyond simple attending, we have non-directive and directive behaviors. Non-directive listening occurs when a therapist responds to a part of what a client is saying. This response can be non-verbal, such as a nod or a conscious silence, but often it is a verbal response. Common non-directive responses include paraphrasing what the client said, reflecting feelings, or even summarizing themes.

 Directive behavior is when a therapist takes more control of a conversation. Directive behavior could be via a judgment, such as "you were justified to feel anger", by inferring feelings, "you must be furious", by interpreting what a client said, or re-framing what they said to offer a different angle. The authors suggest that the most directive behaviors are confronting a client or describing immediate feelings to a client. Chapter 4 focused solely on one very important kind of directive behavior, asking questions. It went through different types of questions, from open to closed and more. The authors also looked at the pros and cons of using questions, advising therapists to use them sparingly and wisely overall. Throughout this material, the authors also emphasized the importance of multicultural sensitivity and ethical awareness.

 I found this reading enjoyable and informative. I did have several questions after completing the reading. From my experience, growth, learning, and development can occur in many ways, such as through books, teachers, experience, or therapy. Therapy seems less instructive and less directive than reading a book, for example. In a book, the reader is more passive, listening, and the book is doing all the talking. My first question, then, is what is the actual mechanism of learning that occurs in therapy? How is it different from, say, more passive consumption like reading a book? Therapy seems more experiential and active than simply reading or being instructed to, but less active than the trial and error approach of real life, and say the "school of hard knocks." Therefore, my second question is: How does the learning that comes from direct experience differ from learning derived from a therapeutic engagement? If we consider life experience to be about individualized empirical learning and direct instruction often being the ingestion of theoretical collective knowledge, we can conceptualize a kind of spectrum. Therefore, my third question is: For what kinds of learning is passive consumption and direct instruction best suited, and what kind of learning is life experience the best for? What about therapy? What kind of learning is it best for?

 Finally, these chapters did cause me to reflect on knowledge. In conversation, sharing knowledge (and opinion) is often a big part of an interaction. Many people make the pursuit of knowledge a goal for their lives. Should a therapist disseminate knowledge as one of the primary modes of conversation? Or should a therapist relinquish their desire to communicate knowledge and relinquish directive behaviors overall? For some people, communicating knowledge is the main way they speak, and potentially a defense mechanism. I believe a counselor should be okay with no longer being a knowledge expert. Some people use knowledge dispensation as a way to demonstrate expertise. Perhaps a therapist should take on other hobbies to express their expertise so they don’t rely on needing to be knowledgable in therapy. Perhaps they could pursuing artistic creation (music and writing) as a modes of expression. Overall, the point I am making, is that I believe a therapist should not be a knowledge expert or a teacher as a primary role. The therapist should lean into non-directive behaviors and open ended questions, and only rarely share knowledge with clients. Sharing knowledge changes the focus to teaching, instead of empowering the client to teach themselves, through presence and well placed questions.