Therapeutic Listening Skills

Therapeutic alliance is the foundation for therapy since it is what is needed to establish and sustain a profession relationship with a client.   Studies have shown that poor therapeutic alliance with clients  can affect treatments and contributes to client dropping out of psychotherapy (Sharf & Jennie, 2010). It is about building trust with your clients so they can elaborate on what is really wrong with them.  There are several micro skills needed to establish a successful therapeutic alliance, however, these are some of the ones I considered as very important: listening skills, empathy, and open and close questions.

LISTENING SKILLS
          Listening skills is one of the most important skill you can have, especially as a therapist.  How well a therapist listens can have a major impact on being effective with their clients.  Listening skills says to the client that the therapist is completely in the moment with them (Ivey et al., 2011, pp.115). Listening skills helps the therapist to accomplish tasks geared towards helping the client.  These tasks are:  1. Listening skills helps client to tell their story by encouraging the client to be narrative about themselves. While the client is narrating their life story, you learn, understand and obtain useful informations (Ivey et al., 2011, pp.115). 2.  This bring us to the next point in listening skill which is to draw appropriate background and contextual information.  This is the point where the therapist use their listening skills to obtain background information such as family of origin,  cultural background, presenting complaints, medical history

etc  (Ivey et al., 2011, pp.115). This is beneficial to the client because it helps the therapist to work with the client as a "whole person" taking into account their history, and their social/cultural context rather than focusing on issues/symptoms.  3. Listening skill helps to communicate  an understanding to the client that you understand what they have been talking about, how you feel about the information you have received and they feel compassion coming from you the therapist  (Ivey et al., 2011, pp.115). 4. The next task for the  therapist is how to facilitate a level of understanding  with the client. This can be achieved by acting on the information that was received while listening;  action can be strategies to help the client cope with their feelings  (Ivey et al., 2011, pp.116). 5. Making connection is a task that the therapist has to utilize because it helps the therapist to see the patterns, themes and make connection of the narratives from the client. This helps by connecting the dots and grasp a better  understanding of the client's narratives.  6. The therapist has to demonstrate empathy which is the need for the therapist to understand the client's experience from their perspective (Ivey et al., 2011, pp.116). Empathy is not only a good listening skills, but a good micro skill in building therapeutic alliance with a client.

Barriers 
       Poor listening, excessive talking, not paying attention etc can create barriers and can result in ineffective communication.

These aforementioned barriers  can hinder therapist-client relationship. Fortunately, one can learn listening skills by attending workshops, identify what triggers poor listening skills  or excessive talking and work on it.

EMPATHY
           Empathy has had a controversial stance in psychotherapy (Elliott et al,. 2011), however, for the past several years it has emerged as a key  process in psychotherapy.  Empathy in psychotherapy is defined as the therapist's sensitivity to the client's struggles, thoughts and feelings from the client's perspective (Elliott et al,. 2011).   I consider empathy essential in therapy because for a therapeutic tactic to be successful, the therapist has to make the client feel that he/she is understood.  The therapist not only worries about what the clent is saying, but also be concious of what the clent is not saying and be able to communicate this understanding.  There are three main modes of expressing theraputic empathy with a client and they are empathic rapport, communicative attunement and persona empathy.  Empathic rapport requires the therapist to show a compassionate attitude towards the client.  This means the therapist build rapport with the client, understand the client better and see where the client is coming from (Elliott et al,. 2011).  Communicative attunement is the active, ongoing efforts  to stay attuned with the client, additionally it makes the therapist more aware and responsive to the client.  How does the client feel?  Is the client happy, interested, engaged or in distress? Hence the reason why a therapist stays attuned to their clients.   Persona empathy is the effort of the therapist to understand the kinds of experience the client has gone through (Elliott et al,. 2011).  The therapist has to understand how the client's experience led to him/ her feeling that way.  
        Empathy can have a negative connotation on a client, especially if the client is confusing it as sympathy.   Studies suggest that clients who are sensitive, suspicious or poorly motivated perform poorly with therapist who empathize with them.  However, the same study noted that therapist who are attuned to their clients' need can adjust on how much empathy they can express (Elliott et al,. 2011). Personally, I believe too much empathy can cloud professional judgement, so it should be in moderation or as needed.

Barriers
     Differences in age, gender, race can all create barriers in empathy.  These can alter  our perception on how we deal or  relate to the client including being empathetic. Another barrier for empathy  is that not all client will appreciate it and may be uncomfortable when dealing with an empathetic therapist.  The therapist should gauge the client's behavior and know when to show empathy.  The best way to deal with these barriers is to proceed with caution by giving the client time to develop trust, get to know the therapist and develop a rapport.

OPEN-CLOSE QUESTIONS
      Questioning is a way for therapist to begin a session and gather informations that are specific and important,  especially if the client is not forth coming with informations.  There are many benefits to questioning in a therapy session, it can identify positive asset, it helps the client to elaborate and enrich their narrative and reveal concrete specifics from the client (Ivey et al., 2011, pp. 117). There are two types of questions, open questions and closed questions and they are equally important (Ivey et al., 2011, pp.117).  Open questions are the ones that cannot be answered in a few words.  This is to enable the client to elaborate and dig deeper for informations.  The open questions typically begins with, what, how,why or could and are normally used to begin an interview. Questioning the client can make the client see things in a whole new way. Take for example a question  that requires critical thinking such as  "what is the consequence of doing such thing"? This will make the client reflect and explore other option which can be discussed with the therapist. Questions will also enable the therapist to make accurate assessment of their client's  issues and also guide the discussion in the right direction.  Closed questions can also bring out specifics as well especially if the therapist wants an accurate understanding of what they are discussing.  

Barriers
       Open-close questions are great, however, when used inappropriately it can create problems.  Some questions can have a negative impact if not worded or presented correctly.  According to  Ivey et al (Ivey et al., 2011, pp.126), some clients can feel bombarded with too many questions, questions as statement and why questions. Barrage of questions can turn the client off, can confuse them or cause anxiety. Some questions may be too embarrassing for a client to answer at that  moment, the therapist should allow trust to develop, so that the client can feel comfortable. Questioning can also promote distrust if the therapist and the client are from a different cultural background. The therapist can explain the reason behind the question, develop trust and rapport which can reduce tension as well. 

The potent factor in therapy is the relationship between the client and the therapist.  If there is no alliance, then the relationship will not work.  Studies have suggested  that it may be  useful if therapist build a stronger therapeutic alliance with their clients in order to reduce dropouts in therapy (Sharf & Jennie, 2010).  A good therapist will not alienate a not so forthcoming clients, instead meet them halfway.  It takes a lot to open to strangers and the best way is to gradually develop a the relationship with a client.

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