Rehearse answers to common questions

Clients are likely to have questions about our services. Some may be asked, others may remain unspoken unless raised by the therapist.

No information sheet can answer every question our clients may have. Even if one did, some wouldn’t read it and others might be unable to either read or comprehend the text. You should therefore be ready to answer, and in some cases, pre-empt clients’ questions.

As a supervisor, I have asked my trainees to explain the difference between a psychologist and a psychiatrist before ever meeting a client. Most have managed a reasonable explanation. The learning point was not the quality of the explanation but the confidence with which it was delivered: everyone was caught off guard by the question and so came across as unsure, defensive, even shifty.

Continue reading

Slow speech makes for clear communication

Speaking more slowly can improve communication between therapist and client. Slow speech is more comprehensible and more considered.

Anxiety is characterised by rapid speech. Therapists, especially trainees, may be anxious in sessions, but may also feel the need to speak more quickly in order to pack more into the time available. This can backfire by making the therapist seem anxious.

Following rapid speech demands greater attention. When listening, we are attempting to make sense of what is being said. The more time we have to consider what is being said, the more likely we are to understand what we are hearing.

Clients are by definition functioning less than optimally. Anxiety, depression, pain, fatigue and medication effects can impair concentration and therefore affect clients’ ability to follow and make sense of what we are saying.

Continue reading

Writing when you speak preserves eye contact

Writing only when you are speaking maintains normal eye contact. This serves to normalise the interaction, reassures the client that they have your attention and that you are writing what they are saying.

Writing while the other person is speaking reverses the normal pattern of eye contact.

Anyone who has had a medical appointment will know the unease associated with describing your symptoms to the top of your doctor’s head. They write feverishly while you speak, only meeting your gaze to ask a question, then dive back into their notes again as you begin your answer. All the while you’re asking yourself: what is it that they’re writing about me?

Continue reading

Eye contact tells you when to speak

Steady eye contact from a client is your prompt to speak. Attending to eye contact helps us to minimise interruptions of the client’s train of thought and to be more comfortable with silences.

In 1:1 conversation we spend 50% of our time looking at the other person. It is important to remember that this is an average across two distinct roles: speaker and listener.

When listening, we look for 50–90% of the time. We can see expressions and gestures, the non-verbal modulators of the spoken word. More importantly, we can see if the other person shows signs of finishing, so that we can have our turn.

When speaking, we look from 10–50% of the time. We need to know that the other person is listening, but we can reassure ourselves of this with a quick glance. When we have the floor, it is more useful to look away from the other person, minimising distractions from our train of thought.

It is difficult to be sure when someone has finished speaking. A pause may be for reflection or may be the signal that you have the floor. In ordinary conversation between equals, interruptions are inconsequential, easily remedied in the to & fro of the chat.

Interruption by a therapist can discourage a disclosure. A client who has stopped speaking may be awaiting a response or marshalling their thoughts. Speaking just as the client is about to can distract at best; at worst, it can be taken to mean that the forthcoming disclosure was unwelcome or irrelevant.

You will know it is your turn to speak when they look steadily at you. A quick glance need only be to check that you are still listening. A steady gaze indicates that a reply is now expected.