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By Ben Benjamin, PhD

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Listening to Your Clients

The importance of reflection in therapeutic communication.

One of the key components of effective communication with clients is attentive listening. Individuals who communicate well are frequently described as being good listeners. On its own, however, simply listening isn't enough to have a positive impact on a conversation. Typically, people perceived as good listeners don't just sit back and passively absorb what someone else says; they show that they've heard and understood what was said by reflecting. The description of reflection that follows is drawn, with some adaptations, from Robert Bolton's discussion of reflective listening in his book "People Skills".

In reflecting another person's message, you capture the essence of that message in your own words. You don't need to reflect every individual idea; the goal is to succinctly distill the core meaning. Useful starter phrases for reflection include:

  • You feel
  • You're saying
  • You're thinking
  • Your point of view is
  • Your concern is

massage client - Copyright – Stock Photo / Register Mark The purpose of rephrasing what the other person said, rather than repeating it verbatim, is to drive yourself to go beyond hearing the words to getting a clear understanding of what the person meant. This also gives you an opportunity to verify that your understanding is accurate. Imagine that a client says, "I'm worried that if my shoulder doesn't heal soon, everything is going to start falling apart." You reflect, "You're worried that if your shoulder injury persists, you'll start to have problems in the rest of your body." The client may say, "Yes, that's right," or else, "No, I'm worried that I won't be able to do my job, and the rest of my life will start falling apart." Had you simply repeated, "You're worried that everything is going to start falling apart," the client might never have provided that clarification. Note that if the person doesn't volunteer an agreement or disagreement with your reflection, it's useful to ask for one: "Is that accurate?" "Did I get that right?" "Have I heard you correctly?"

Throughout the conversation, give your physical attention to the other person by facing them, leaning slightly into the conversation, and maintaining eye contact. While they're talking and you're silently listening, nod your head from time to time and briefly acknowledge what they're saying (e.g., "Mmhmm," "I see," "Go on"). When you're reflecting a feeling or other emotionally charged content, attune to the person's mood and resonate with them through your tone of voice and facial expression. This is advisable to do when responding to any strong emotion, from joy to fear to rage. Just be sure that you're resonating sincerely, fueled by a genuine interest in and attunement to what the other person is saying. Otherwise, even a simple "Mmhmm" may come across as inauthentic or patronizing.

Reflecting a client's communication helps them to say what's on their mind and encourages them to finish a train of thought, rather than jump from topic to topic. It also creates a safe, empathetic climate where they feel freer to discuss any concerns they might have about the treatment or the therapeutic relationship.

Clarifying Unspoken Concerns

In some situations, you may suspect that a client is not being direct, or not saying everything that's on their mind. Possible clues include hesitation or wavering; vague, ambiguous comments; a sudden change in their voice tone or body language; or voice tone or body language that contradicts what they're saying (e.g., the words "Yes, that pressure is fine," accompanied by a grimace and sudden tightening of the muscles you're working on). Be alert for these sorts of signals, particularly if you're discussing a potentially sensitive or upsetting topic. Consider this interaction:

After performing an assessment on a new client with low back pain, a massage therapist began to outline the treatment plan she recommended. The client nodded his head, agreeing, until the therapist mentioned doing some deep work on the psoas muscle; at that point, his eyebrows raised and he said hesitantly, "Um, I don't think that's really necessary." The massage therapist said, "Actually, it will be a very important part of the treatment," and proceeded to explain why she thought working on the psoas muscle would help ease his back pain. As she went on to describe the remainder of her treatment plan, the client remained silent. He left saying he'd call to schedule a follow-up session, but never contacted her again.

When discussing any potentially stressful topic – in this case, a plan to work on a very sensitive part of the body – any indication of discomfort is a clear cue to check in with the person. If the massage therapist had picked up on the client's hesitation, she might have made the reasonable guess that he was reluctant to agree to the psoas release. Instead of persisting and arguing for the value of the technique, she could have reflected his comment and followed up with an open question:

Client: Um, I don't think that's really necessary.

Therapist: You're thinking that's not an essential part of the treatment.

Client: Yeah, I think you can skip it.

Therapist: Your assessment results suggest that working on your psoas muscle could help to ease your back, but I want to make sure you're comfortable with all aspects of this treatment. Do you have specific concerns about working on that muscle?

Client: Yes, I do. I had it done once and it was extremely painful. I'd really prefer to avoid it.

Therapist: That's really helpful to know. Then let's definitely start by working on other areas, and then see how you do. After a couple of sessions, if it still seems like the psoas is important to address, I'll check back in with you to see if you're willing to try it. The work I do on the psoas is very gentle and only occasionally uncomfortable, but you always have the option to say no. How does that sound?

Client: That sounds good. Thank you.

Notice that the issue of the client's concerns were raised with a question, not a definitive statement. It would be presumptuous of the practitioner to say, "I can tell you're uncomfortable with the idea of that treatment." Be careful not to rely on your own assumptions about what's going on for someone else. If you find yourself speculating about a client's unspoken thoughts or feelings about your work with them, get a reality check. Suppose you ask a client how they felt after their last treatment, and they say "Same as usual," in a flat tone of voice; you suspect they're disappointed that they didn't leave feeling better. After reflecting this comment, you might say, "I'm thinking you might be feeling disappointed that the session didn't make more of a difference for you. Is that true?" In this way, without claiming to know what a client is feeling, you gently encourage them to share a concern that they might be reluctant to volunteer.

Reflection in Everyday Life

Clear and accurate reflection is an important skill to have in many different types of conversations – whether you're discussing your client's treatment plan, your child's difficulties in school, your friend's relationship difficulties, or your partner's desire to move or buy a new car or change careers. By ensuring that you clearly understand someone's message, while also demonstrating to them that they've been heard and understood, you can avoid many of the most common communication breakdowns in both professional and personal life.

Editor's Note: This article was adapted from The Ethics of Touch, Second Edition. Learn more at www.theethicsoftouch.com.

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