Attending skills and attending the client are the initial phases of patient interaction with a counselor. It involves how well the counselor attends the client through listening, observing and feedback skills. These basic skills set the table for productive counseling.
The fundamental foundation in conversation and communication is listening. When others try to interrupt or speak over each other, the purpose of communication is crippled. Listening is a key communication skill that helps one understand the other half of the conversation. It allows one to learn about the other person and be able to make productive comments to the process of the conversation. When listening fails, communication fails. No wonder then, counselors, whether clinical or pastoral, whether in grief, spiritual or general counseling fields need to develop this skill in counseling.
When working with someone, whether in basic clinical interviewing where information is collected, or in counseling itself, where one hopes to help someone find healing or progress in life, listening is a key ingredient. When counselors fail to listen properly, the counseling process itself fails. Clients sense when their issues are addressed or if the counselor cares about what they are telling them. Hence, listening and giving good feedback is key not only for providing help but also creating a relationship between counselor and client. A counselor who listens is not only better able to help the client but is also better able to give the client a sense of meaning. Through listening, the client feels someone cares about his/her problem and is willing to listen and offer productive advice and guidance in the process.
The Counselor and Client Relationship
The counselor and client relationship is key. When the counselor makes him/herself available to the client, he/she invites the client into a professional and therapeutic relationship. Through this communication, a team evolves that works together for the benefit of the client. In essence it becomes an alliance (Egan, 2019, p. 67). Any good alliance is built upon good communication and listening. The counselor builds the relationship first via listening. Through listening, communication begins, through communication, trust emerges, and through trust, a relationship that can heal begins.
The Art of Attending
Attending a client involves both listening and also observing. When attending to a client, the counselor reduces talk time and provides clients with the timeframe to speak (Ivey, 2018, p. 75). Conducive to this is how a counselor attends to the client from four physical aspects. These attending aspects include visual contact, vocal qualities, verbal tracking and body/facial expressions (Ivey, 2018, p. 75). In regards to eye contact, when someone looks away, it denotes for many, a sign of disrespect or lack of interest. Hence good visual contact involves eye contact. This does not necessarily mean awkward staring, but it does denote eye contact during conversation. This promotes the sense that one is genuinely interested in the story of the client and promotes the process of counseling itself. Vocal qualities also play a key role in the attending art. Tones and speech rate can be interpreted by the client as positive or negative based on the counselor’s speech. A counselor who seems upset via a tone, can quickly scare away a client or embarrass a client from further discussion. A calm and sensitive tone is essential to provide security to the client while his/her story is being told. While listening it is also essential to track the conversation. It is important to keep the client tied to the initiated topic (Ivey, 2018, p. 75). Good listening helps keep the conversation in a good and purposeful direction. Finally, one’s body language and facial expressions can play a key role in attending. An awkward or angry face, or turning away from a person can have the same negative effects as the tone of one’s voice. Egan recommends facing the person squarely, adopting an open posture and sometimes leaning forward as needed during the conversation (2018, p. 101). Instead of folding one’s arms, or shifting and moving, one can create a safe sense of being for the client during the narrative. Bear in mind also cultural aspects. Some individuals may be from a different and diverse culture that utilizes different ways of expressing certain emotions. This can lead to different postures or emotional ways of expression. It is important to be aware of other cultures and their views and to also be aware of oneself and how one’s own appearance, race, faith or culture can affect the client one is attending and trying to help.
Dialogue and Listening
A good conversation involves taking turns during it. It involves connecting and mutually influencing each other (Egan, 2018, p. 100). It not only a monologue but a shared story that each party invests in. Good listening skills help the counselor make the most of the narrative but some types of listening miss the point. Egan points out that partial listening is one type of listening that counselors need to avoid. When counselors only partially listen, they only skim the surface. They pick up parts of the conversation and miss others. When questioned by the client, their response is less complete and can cause problems with the client (2018, p. 107). Another poor listening skill, according to Egan, is an audio-recording style of listening, where the counselor simply parrots what the client has expressed. In this case, the paraphrase adds no insight or questioning but merely repeats. Sometimes, repeating something has power and can be utilized but if paraphrasing is utilized in parrot form consistently, then it only mirrors and gives no true insight. Counselors need to listen to the client’s experiences, thoughts, behaviors and feelings and better respond to those things with insight (Egan, 2018, p. 108). This insight should not be judgmental, but should be slowly integrated into the responses. The response then should not merely always paraphrase or repeat, but the listening should produce a paraphrase that not only restates but also probes deeper, but without judgment or necessarily value based accusations. The key is to help the client find the answer because ultimately the client is in the driver seat. Finally, Egan points out that another form of bad listening involves rehearsing. Many novice counselors are looking for the perfect answer or solution, or even the proper response. During this, counselors can become dominated during listening as to what their response will be instead of what the client is discussing (2018, p. 107). Effective helpers do not stop listening to derive a solution but continue to listen instead of preparing what they will say next.
Other Distortions in Listening
Egan points out a few other ways distortions to listening that can occur even to counselors who are fully paying attention. Egan states that it near impossible to listen to someone in a completely unbiased way but counselors need to try their very best to filter these assumptions (2018, p. 125). A counselor who is a white male may use filters from his own life that could distort cultural differences from a black female. This bias could side track both parties. Hence it is critical to remove types of subconscious bias when listening to the narrative of a person from a different race, culture, or faith. In addition, during listening, it is important to avoid evaluative listening. Egan defines evaluative listening as judgmental listening. It involves seeing statements as good or bad, or right or wrong or acceptable or unacceptable (2018, p. 126). Clients need to be first understood before productive change is introduced. Another type of distortion involves stereotyping a client based on diagnosis. This type of listening involves labeling the individual. While diagnosis is important, when focusing solely on diagnosis of the individual, the counselor puts the client in a box. Egan states the counselor can be correct in diagnosis but still lose the person (2018, p. 127). Finally, it is important for counselors not to fall victim to sympathetic listening, where they become solely captivated and emotional about the client’s situation while missing the objective facts. Sometimes too much sympathy can limit effective helping (Egan, 2018, p. 127).
Importance of Empathy and Finding Missing Cues
Empathy is crucial in human relationships. An empathetic person is able to understand the other person emotionally and feel what it may be like to experience certain things. Empathetic listening allows the counselor to take a sincere and honest interest in the client but still remain objective. Carl Rogers, author of the Humanistic Approach in counseling, emphasized the importance of acute empathy and the utilization of it throughout the discussion. Empathetic listening according to Ivey can be subtractive, basic or additive. When subtractive, the counselor gives less back in response and the response is sometimes distortive and hence ineffective. When the empathy is basic, it is an accurate feedback. One needs to avoid completely audio-repeating but it sufficient to help the client. Additive empathy is the best because it reframes but also may include past statements or include additional information to produce positive change (Ivey, 2018. p. 67). Again, these rephrases, summaries or reflections are not meant to be commands but are used to guide. They are not meant to impose judgment or value either, but awaken the client to other views or self actualizations.
Counselors have a wide variety of ways to respond through their listening and observing skills, some may include generalizing or summarizing, paraphrasing or reflecting on various issues. Regardless, they need to be at least additive or basic in empathy. Summarizing is a broad basic account of the dialogue. Paraphrasing is more acute but it can be basic or additive. Reflective is very additive in nature but connects the dialogue to self and offers insight and questions on the statement.
Empathetic listening is key in helping clients and is the basis for a client-based therapy (Egan, 2018, p. 67). Through empathetic listening, one can become more attune to verbal and non-verbal cues that can reveal issues surrounding the story. Counselors should watch for tone of voice in responses, facial expressions or body movements during the conversation. How a client speaks or responds to a question can be a key clue (Egan, 2018, p.116). Ivey recommends mirroring sometimes the client. When movements do not clearly match and shifts and jerks within the client appear, then this could be a sign of an issue (2018. p. 99).
As noted, counselors need to watch for changes in tone of speech or physical movements. Good observing skills, in addition to good listening can help counselors discover other missing pieces of the puzzle. In regards to some verbal behaviors, Ivey emphasizes that counselors should carefully watch “I” statements or “other” statements. Are these statements positive or negative regarding “I” or “other” (2018, p. 93). Ivey also recommends looking for words such as “can” and “can’t”. Some clients as well are more concrete in their speech, while others are more abstract. During listening and observation, a counselor needs to identify this. Abstract clients are excellent at self analysis and reflecting on an issue, but may struggle with concrete issues. More concrete clients may be able to provide specifics, but be less able to see the point of views of others. Both types have their strengths, but it is important for a counselor to identify which type of speech one is listening and observing (Ivey, 2018, p. 91). During interviewing or counseling, a counselor may be able to find cues to the issue through various discrepancies throughout the clients story. Ivey points out that contradictions may occur between statements, or between words and actions, or regarding goals. It is important for the counselor to identify these discrepancies and in a non-confrontational way expose them to the client (Ivey, 2018, p. 99).
In listening empathetically and avoiding bad and distortions of listening , one can better hear the client’s experiences, thoughts, behaviors and feelings and not miss various cues of other issues.
Conclusion
Attending a client involves good listening and observing with feedback that reflects this. Counselors need to develop good listening skills for the betterment of their clients. Listening forms the foundation for any relationship and it is important to avoid bad listening habits. Counselors can better attend their clients through a patient-centered model that is empathetic and humanistic. Neuro-science studies portray that when clients are properly listened to and given feedback that show thought and reflection corresponding with listening, then certain parts of the brain light up in positive ways (Ivey, 2018, p. 77). Listening plays a key role in making a positive effect on one’s client. It lets the client realize someone actually is listening and cares and is providing feedback to produce positive change.
If you would like to learn more about helping other people or would like to become certified in Grief Counseling or Christian Counseling, then please review AIHCP’s certifications in these fields. The programs are open to both clinical and non-clinical counselors who would like to earn a certification in these fields and add to their existing practice. The Grief Counseling and Christian Counseling programs are online and independent study and lead to a four year certification.
References and Additional Resources
Egan, G & Reese, R. (2018). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (11th)”. Cengage.
Ivey, A. et, al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society (9th)” Cengage.
Sutton, J. (2021). “Defining the Counseling Process and Its Stages”. Positive Psychology. Access here
“Reflecting Skills”. Counseling Education. Access here
“7 Attending Skills”. Optimist Minds. Access here