MINIMAL VERBAL BEHAVIORS
There are two minimal verbal behaviors that helpers can use to facilitate client exploration: minimal encouragement and approval–reassurance.
Minimal Encouragers Helpers encourage clients to keep talking through nonlanguage sounds, nonwords, and simple words such as “um-hmm,” “yeah,” and “wow.” Helpers use minimal encouragers to acknowledge what the client has said, communicate attentiveness, provide noninvasive support, monitor the flow of conversation, and encourage clients to keep talking. Minimal encouragers are often used in conjunction with and serve the same purpose as head nods.
Too few minimal encouragers can feel distancing, whereas too many can be distracting and annoying to the client. I suggest helpers use minimal encouragers and acknowledgments, mostly at the end of client sentences or speaking turns (i.e., everything a client says between two helper interventions), to encourage clients to keep talking (assuming they are actively involved in exploration). A minimal encourager here suggests that you are giving up your speaking turn and would like the client to continue speaking. Interrupting a client to provide minimal encouragers, however, can be distracting, so helpers should pay attention to the appropriate timing of this intervention.
Approval–Reassurance Approval–reassurance is a helpful skill that can be used occasionally (and I stress occasionally) to provide emotional support and reassurance, indicate helpers empathize with or understand clients, or suggest that clients’ feelings are normal and to be expected. The key is to use approval–reassurance to foster exploration and to make clients feel safe enough to keep talking at a deep level about their concerns. For many clients, approval-reassurance that their problems are normal and that they are not alone in their feelings can be empowering and help clients in deeply exploring their concerns. The following are some examples of approval– reassurance that could be helpful depending on the situation:
“That’s really hard to handle.” “That’s a devastating situation.” “How awful!” “Wow! That’s an awesome opportunity!” “Good try!” “It was really terrific that you were able to express your feelings to him!” “Yeah, I know what you’re going through.” “I’ve been there too.”
Approval–reassurance can also be used to provide reinforcement, indicating that the helper values something the client has said or done and wants to encourage the client to continue the effort to change. Some clients need support or acknowledgment that they have done something well. In addition, approval,
reassurance, and reinforcement can help some clients persist in exploring because they know someone is listening and sympathetic; this is especially important if clients are exploring difficult or painful topics.
When using approval–reassurance, it is important that the helper stay close to where the client is and know the client well enough to know what behavior is being approved. For example, Beth had been working on being assertive came into her session and said that she finally told her boss that she wanted more control over her schedule. The helper immediately said, “Wow, that is great that you were able to stand up for yourself.” Beth burst into tears and said that she was fired from her job. It perhaps would have been more helpful for the helper, instead of assuming that the experience was positive and thus giving approval-reassurance, to say something like, “And how did that go for you?”
Approval-reassurance is especially inappropriate if used to minimize or deny feelings (e.g., “Don’t worry about it,” “Everyone feels that way”). When used in this manner, approval-reassurance stops rather than facilitates clients’ exploring and accepting feelings. Such statements can make clients feel they have no right to their feelings. Helpers sometimes use these interventions as misguided attempts to reassure others that everything is okay. Unfortunately, problems typically do not go away because they are minimized or denied. Most of us have heard the old sayings, “Give it time” or “Time cures all.” It is not “time” that makes feelings go away; in fact, feelings often fester when they are bottled up or denied. Rather, it is awareness, acceptance, and expression of feelings that aid in resolution of painful affect. To reiterate, our goal as helpers is generally to help clients identify, intensify, and express feelings rather than minimize or deny them.
Furthermore, approval–reassurance can sound false if used excessively, prematurely, or insincerely. If such interventions are used to promote helper biases (e.g., “I think you’re right to feel guilty about getting an abortion”), they can also be problematic because they stop client exploration or make clients feel compelled to agree or comply.
In general, then, if done judiciously and sparingly, approval–reassurance can encourage clients and facilitate exploration of thoughts, feelings, and experiences. Approval–reassurance should not be used, however, to diminish feelings, deny experiences, stop exploration, or provide a moral judgment. When helpers find themselves using approval–reassurance in a counterproductive way, they may want to think about what is going on in their own lives.
Here is an example of a positive use of approval–reassurance (in italics): Client: I just learned that my sister needs to have a kidney transplant. She’s
been sick a lot lately and hasn’t been getting better. Helper: That’s too bad. Client: Yeah, I feel terrible for her. She’s only 21 and has always been active,
so this is a real shock for her. I feel guilty that she got this horrible disease while I’m healthy and able to function.
Helper: It’s pretty natural to feel some guilt. Client: Really? I’m glad to hear that. I have been trying to do more for her.
I’m thinking of organizing a campaign to find a donor and raise money for her treatment. Because she has an unusual blood type, it will be difficult to find the right person, and it’s going to cost a lot of money.
Helper: That’s terrific that you would do that for her. Client: I feel like it’s the least I can do. It does interestingly bring up a lot of
issues for me about obligation versus doing things because I want to. (Client continues exploring her thoughts.)
AVOIDING INTERRUPTIONS One particularly distracting behavior is interruptions. When the client is exploring productively (i.e., talking about innermost thoughts and feelings), the helper does not need to interrupt. Often in the exploration stage, the helper simply has to attend and listen and stay out of the client’s way, so that the client has the opportunity to keep talking. Matarazzo, Phillips, Wiens, & Saslow (1965) stressed that helpers should not interrupt and should delay talking for several seconds after the end of client statements. This pause (noninterruption) allows clients to continue thinking and talking without undue pressure from helpers. Matarazzo et al. found that inexperienced helpers interrupted far more often than did experienced helpers.
Interruptions can occasionally be helpful, however. If the client is stuck, cannot think of what to say, or is rambling or talking nonstop but not exploring in much depth (e.g., is telling stories in a bland tone), the helper may need to interrupt to help the client get back on track through the use of exploration skills (see Chapters 8, 9, 10, and 19).
SILENCE A silence is a pause during which neither helper nor client is speaking. The silence can occur after a client’s statement, within a client’s statement, or after a simple acceptance of the helper’s statement. For example, after the client says something like “I just feel so confused and angry and don’t know what to say,” the helper might pause to allow the client time to reflect on the feelings and see if the client has anything new to add. If the client pauses in the middle of saying something and is obviously still processing the feelings, the helper might be silent to let the client think without interruption. If the client responds minimally to something the helper said, the helper might be silent to see if the client can think of something else to say. It is important to note that to say nothing is not necessarily to do nothing. Helpers can be attentive and supportive, and they can listen without saying anything. In fact, sometimes the most useful thing a helper can do is to say nothing.
I often recommend the use of brief silences for beginning helpers because it gives them a chance to listen to clients without having to formulate an immediate response. Thus, when clients pause, the helper ponders how to reflect all that has been said while of course still attending to the client. Often, beginning helpers are surprised to discover that clients keep talking, indicating that they just need permission to talk.
Silence can be used to convey empathy, warmth, and respect and to give clients time and space to talk (Hill, Thompson, & Ladany, 2003; Ladany, Hill, Thompson, & O’Brien, 2004). Silence can also allow clients time to reflect or think through what they want to say without interruption. Some clients pause for a long time because they process things slowly and thoroughly or because they are in the middle of thinking through something and need time to get in touch with their thoughts and feelings. At such times, silence is respectful because it provides space for clients to think without feeling pressured to say anything. Warm, empathic silences give clients time to express their feelings. By allowing clients the space, helpers can encourage clients to express feelings from which they might otherwise run away. Silence can indicate to clients that helpers are patient and unrushed and have plenty of time to listen to whatever comes out. During these empathic silences, helpers can sit attentively focused on being with the client while the client is deeply immersed in thoughts and feelings. Hence, I suggest that helpers avoid interruptions and give clients several seconds after speaking to see whether they have anything else to say. Likewise, some empirical evidence suggests that clients talk more when therapists delay speaking (Matarazzo et al., 1965).
Silence also is often inadvertently used for negative or inappropriate reasons (Hill et al., 2003; Ladany et al., 2004). Some helpers are silent because they are anxious, angry, bored, or distracted. Many beginning helpers are uncomfortable with silence. They do not know what to do and are often concerned about how clients might perceive them. To relax, helpers can breathe deeply, relax, and think about the client and what might be going on inside the client. In other words, helpers should try to establish an empathic connection with clients during silence rather than focusing on themselves. If silences go on for a long time (i.e., more than a minute) or if a client is obviously uncomfortable, the helper should consider breaking the silence and asking the client how she or he is feeling.
As with other skills, the acceptability of silence varies by culture. D. W. Sue and Sue (1999) noted that in Japanese and Chinese cultures, silence can indicate a desire by the person to continue talking after making a point. In contrast, European Americans are less comfortable with silence and often rush to fill the space.
Here is an example of how silence might be used therapeutically when the client is actively exploring and engaged in the process:
Client: My dog Sam just died. I’m really upset because I’ve had that dog since I was very little. I grew up with the dog.
Helper: (Silence of about 1 minute) How are you feeling? Client: I was just thinking about how I got the dog. I begged my parents
forever to get me a dog. I said I would take care of it. Of course, I didn’t much at first, but I did later. Sam was kind of like Red Rover in the comics—he waited for me at the bus stop, and we had great adventures together. I could tell Sam everything.
Helper: (Silence of 30 seconds) Client: Sam helped me get through my parents’ divorce. I felt like I could rely
on him then like no one else. It’s like losing my best friend—we went
through so much stuff together. I felt so terrible when I left for college and couldn’t take him with me. He looked so sad, and I didn’t even say goodbye to him.
AVOIDING TOUCH Touching is a natural inclination when helpers want to indicate support to their clients and in fact can make clients feel understood and involved in a human relationship (Hunter & Struve, 1998). Montagu (1971) noted that touch is a natural physical need and that some people hunger for touch because they do not receive enough physical contact. Unfortunately, touch can sometimes have negative effects. Clients can feel that their space has been invaded. If the touch is unwanted or if clients have a history of unwanted touch, touch can be frightening and make clients feel unsafe.
Highlen and Hill (1984) reported that the few studies conducted on touching in therapy were inconclusive. Some studies have shown positive effects of touching, whereas others have found no effects. A survey of practicing therapists indicated that about 90% never or rarely touched clients during sessions (Stenzel & Rupert, 2004). The only type of touch that was used much at all was a handshake, typically before or after a session. Some therapists, however, were reluctant to even shake hands due to concern that any touch could be misinterpreted as sexual or exploitative and result in harm or litigation. Furthermore, therapists indicated that they were more likely to accept a hug or handshake than to initiate such behaviors.
Given the potential benefits, misunderstandings, and harm related to touch, it clearly requires clinical judgment to know when to use touch. It is better for beginning helpers to refrain from touching to avoid ethical and clinical problems that may arise. General guidelines for touch for more advanced helpers, as suggested by Kertay and Reviere (1998) and E. W. L. Smith (1998), are to
1. seek consent from the client before touch, 2. explain the use of touch to the client, and 3. discuss the experience with the client afterward.
Examples of Inappropriate and Appropriate Attending, Listening, and Observing
It helps to have an example of what these attending and listening behaviors might look like in practice. The first example is of an inappropriate use of these behaviors, whereas the second example is an appropriate use (although remember that these will vary based on the client and helper).
EXAMPLE OF INAPPROPRIATE ATTENDING, LISTENING, AND OBSERVING
In the following example, the helper is distracted by other events and has a hard time paying attention to the client:
Helper: (leaning back, arms folded, and looking at the ceiling) So, how come you came today anyway?
Client: (very softly) Well, I’m not sure. I just haven’t been feeling very good about myself lately. But I don’t know if you can help me.
Helper: (shifts forward in seat and looks intently at client) Well, so what is happening?
Client: (long pause) I just don’t know how to . . . Helper: (interrupts) Just tell me what the problem really is. Client: (long pause) I guess I really don’t have anything to talk about. Sorry I
wasted your time.
EXAMPLE OF APPROPRIATE ATTENDING, LISTENING, AND OBSERVING In this example, the helper is fully present with the client and able to attend and listen to the client, as well as observe what is going on with the client:
Helper: Hi. My name is Debbie. We have a few minutes to talk today so that I can practice my helping skills. What would you like to talk about?
Client: (very softly) Well, I’m not sure. I just haven’t been feeling very good lately about myself. But I don’t know if you can help me.
Helper: (matches the client’s soft voice) Yeah, you sound kind of scared. Tell me a little bit more about what’s been going on lately.
Client: I’ve been kind of down. I haven’t been able to sleep or eat much. I’m behind on everything, and I don’t have the energy to do any schoolwork.
Helper: (pauses, softly) It sounds like you feel overwhelmed. Client: (sighs) Yes, that’s exactly how I feel. It just seems like there’s a lot of
pressure in my first year of college. Helper: Um-hmm (head nod) Client: (continues talking)
Difficulties Helpers Experience in Attending, Listening, and Observing
Many beginning students reading this chapter have said that it is difficult to observe another person and decide how to intervene. They feel intimidated in trying both to monitor themselves and to pay attention to the client, let alone figure out what to say. It makes sense that bringing these behaviors up to awareness initially feels strained and tense because these are things that we have done automatically all our lives. Once we focus on them, it feels almost surreal and like an out-of-body experience. After focusing on them for a while, however, and paying attention to what you observe and how you come across, you will hopefully again begin to feel comfortable in your new stance. The key is practicing with lots of feedback.
Another difficulty is that some helpers are not sensitive to cultural differences in nonverbal behaviors. When someone from another culture does something nonverbally that is different from their custom (e.g., using eye contact differently), some helpers judge these clients according to their own cultural standards. It is important to become aware of this tendency and try not to judge clients using your own cultural standards. I want to again emphasize that there are no right nonverbal behaviors. The key is figuring what helps the client relax and explore. Within the bounds of looking professional, each helper needs to determine which attending behaviors feel comfortable and natural to use. For example, sitting in an uncomfortable but technically correct counselor posture will probably communicate discomfort rather than professionalism to the client.
Attending behaviors set the stage for helpers to listen and to let clients know they are being heard. Helpers also need to listen carefully to clients’ verbal and nonverbal behaviors to hear what clients are saying and observe to pick up clues about underlying thoughts and feelings. In addition, attending and listening provide the foundation for all the other skills taught in this book, so helpers should be particularly attentive to learning these skills.
What Do You Think?
Do you think that attending is different from listening? What are some rules for nonverbal behavior in your culture? How do you think rules are established for nonverbal behaviors? Can these rules be changed? What do you think about the role of culture in attending and listening? What are your thoughts about manipulating your nonverbal behaviors to achieve desired goals with clients? How much of communication is nonverbal versus verbal? How do you feel about using silence? How was silence used in your home? How might touching help or hinder the helping process? How was touching used in your family?
R E S E A R C H S U MMA RY Nonverbal Communication Citation: Hill, C. E., Siegelman, L., Gronsky, B. R., Sturniolo, F., & Fretz, B. R. (1981). Nonverbal communication and counseling outcome. Journal of Counseling Psychology, 28, 203–212.