listening skills

Transform Your Therapy Sessions by Mastering These 6 Listening Skills

How Most People Define Good Listening

Most people think good listening boils down to doing three things:

  1. Refraining from speaking when the client is talking
  2. Assuring him that you are listening through sounds and facial expressions
  3. Repeating what the client said, as close to word-for-word as possible

While this may be sufficient for you as the listener, it fails to account for the fundamental distinction between technically hearing what was said on the one hand and listening on the other. Hearing indicates nothing more than the auditory reception of another's words, but it has nothing to do with engaging emotionally in the client said, let alone with the client himself.  

Listening is far more involved as it requires the therapist to be emotionally attuned to the client as well as being aware of his inner own wisdom and how that wisdom can be helpful to the client.  

To become a good listener means to hone skills through conscientious practice. And these skills are not confined to any specific therapeutic environment. They are as necessary for delivering therapy via teletherapy as they are in a face-to-face session.

You may ask, "Why is improving your listening so important?" The answer is quite simple.  Put yourself in your client's shoes and think for just a moment about how powerful it is to be heard.

The 6 Secrets to Better Listening

1. Non-Verbal Cues

Not everything relevant is communicated verbally. The seasoned therapist knows that what the client omits from revealing may be just as, if not more, important than what was explicitly expressed.  

But it doesn’t end there. Therapists need to understand the necessity to pay attention to the client's body language in addition to the spoken or unspoken word. It is a nuanced skill that needs consistent practice to perfect. Extracting valuable information in a session is often slow and tedious, so it behooves the therapist to understand the client's communications in any form they may be present.

Nonverbal cues, such as respiration rates, perspiration, facial expressions, physical gestures, posture, or any other of many subtle body language signals can provide critical insights to the attuned therapist.  Some research has suggested that over 75% of our communication is from these signals! While it may sound odd, the therapist is not only listening with his ears, but with his eyes as well.

2. Mirroring

A very effective active listening technique is mirroring the client's words. With care not mimic him, reflect the words with the his same speech pattern and tone of voice.  Reflecting his words demonstrates that you, the therapist, completely understand what he said as well as that you genuinely care about it.

Aside from his words, you can also mirror his body language and physical gestures. There is research showing that when the listener uses the same gestures as the speaker, the speaker is put at ease, feeling more safe and relaxed.

3. Silence

Although you may be tempted otherwise, try not to interrupt your client. There are times when listening requires a space of silence- nothing said! Don't feel the pressure to offer a verbal response. Although awkward, the space of silence can serve as a nonverbal invitation to share more thoughts and feelings.

The truth is is that it is a precious gift to allow someone space to pour out thoughts and feelings uninhibited of the fear of being interrupted or hijacked. After the lull and the unburdening, there will be ample time to respond.  The "organic pause" — that natural breath between spoken thoughts can be priceless.

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It's uncomfortable to sit in silence for more than a few seconds, but push past the discomfort and sit with it. Sometimes the most powerful connections are made in that silent space.

4. Asking Probing Questions

First, a disclaimer about asking questions. Ensure that your questioning doesn't isn't perceived as an interrogation. Listening is more important than questioning. And when that question is asked it shouldn't be threatening nor ill-timed. Timing can be everything.

On the other hand, don't be afraid of asking questions. They can be vital. Aside from showing your client that you are paying attention and are interested, insightful questions can be the catalyst to help your client uncover answers and solutions himself. Open-ended questions with more than a "yes" or "no" response invite more in-depth searching and enhance your discourse.

5. Responding Carefully

When it comes your time to speak, take care that your words reflect your careful listening. Instead of blurting out what's on the tip of your tongue, reflect upon your response and how it might improve things.

Good listeners often make suggestions such as presenting alternative paths to consider. While some think that making suggestions might be perceived by the client as trivializing the problem, research has shown that It's not that making suggestions is a problem but rather the sensitivity and skill with which those suggestions are made.

You will see that sometimes a specific suggestion isn't needed. Instead, why not make an offering? That offering could be as simple as asking, "Would you like some feedback from me?" or "How can I help?". Remember, your objective is to be helpful, and it is entirely possible that your listening has calmed your client and help create some internal space from where solutions are beginning to form.  

6. Empathy

Since clients are coming to you with complications and difficulties in their lives, they will need to feel as though they have the time and the space to unload in an emotionally safe environment without fearing shame or judgment.

It is crucial to cultivate a non-reactive posture and learn the critical distinction between observation and evaluation.  Listening means giving your thoughtful attention that is open-minded, respectful, non-judgmental and curious.

It is important to express empathy through your body language, words, and expressions.  Every so often a gentle nod in agreement will show your client that you are listening and engaged.  

Smiling or showing concern in an appropriate way can convey that message as well, as can offering words of kindness and affirmation. These subtle communications can go a long way in assuring your client that you are there and that he is safe.

What Every Exceptional Listener Intuitively Understands

Exceptional listeners intuitively understand that they are like trampolines. They are someone the client can bounce ideas off of — and instead of just absorbing their energy, thoughts, and feelings, they dispel inner confusion, clarify thinking, and energize their clients to move forward. This is an uplifting experience, just like someone jumping on a trampoline.

Always remember that being granted permission to listen means that you are receiving the trust and vulnerability of another person, and in so doing you are being honored.  You have been given the gift of providing solace and consolation,  and the potential to assist another in finding answers to their struggles and inner peace.

RAD and teletherapy

Why You May Need to Know About Reactive Attachment Disorder (RAD)

Attachment Disorders and RAD

Attachment is establishing the deep connection between children and their parents; generally the primary caregivers. The attachment will profoundly affect a child's development, the capacity to express emotions, and perhaps most importantly, the ability to build meaningful relationships later in life.

Insufficient attachment, if not adequately addressed, practically condemns a child to experience severe problems throughout his life. A child with an attachment disorder feels unsafe and alone. This will lead to difficulties in managing emotions, a fear of getting close to anyone, and connecting with others in a meaningful way.

Signs and Symptoms of RAD in Older Children

As kids grow up, the signs and symptoms will probably impact their behavior with both adults and children, and their performance in school. What's more, children suffering from RAD often act younger than their age, appear always to be anxious, and become extremely dependent on others, especially those whom they don't even know!

Signs and Symptoms to Watch for Include:

  1. A noticeable aversion to physical affection and touch
  2. Problems controlling oneself
  3. Easily angered
  4. Difficulty displaying love or genuine care for another
  5. Minimal sense of conscience

RAD children develop inhibited or disinhibited patterns of symptoms.

Inhibited symptoms of RAD. These children are emotionally detached, resist comforting and extremely withdrawn. Despite the child being fully aware of what is happening around him, at times even hypervigilant, nonetheless, the child doesn't respond or also react. The only reaction may be to ignore, or push was, sometimes aggressively, when others try to get too close.

Disinhibited symptoms of RAD. The child seeks attention and comfort from practically anyone without any distinction, with no preference to parents over strangers. The child seems to be perpetually anxious, very dependent and considerably immature for his age.

Causes of RAD

RAD sets in between just less than a year until five years old, when it is normal for children to attach to their parents. Children suffering from RAD, rarely seek or respond to comfort when they are in stressful situations. They become irritable for seemingly no reason at all and seem to be sad or afraid when in the presence of their parents or caregivers.

The chronic experience of feeling isolated, abandoned, uncared for, or powerless, irrespective of the reason, ingrains in the child that others are undependable, and that the world around them is a dangerous place. This is often the unfortunate consequence when these circumstances are repeated again and again:

  1. The child cries are not comforted by the parent
  2. The baby is left hungry or wet for hours
  3. The baby child experiences a significant separation from parents
  4. The baby feels alone because no one is looking or smiling at him
  5. The only way the young child can get attention is by "being bad" \
  6. The infant or child's needs, while met, are done so unpredictably
  7. The child has an emotionally unavailable parent because of illness or depression

Although many of these circumstances may be unavoidable, the child doesn't take that into account. Lacking the ability to discern, all the child knows is that "no one cares." The child learns not to trust others as his world becomes an unsafe place.

RAD is Often Deceptive

Not all kids suffering RAD look the same. These same symptoms- difficulty sleeping, seemingly non-existent social interactions, chronically irritable, and never smiling could easily be explained as depression. But in reality, it could be RAD.  

Similarly, that child who is always losing his temper, questions authority figures regularly, and his bullying the other children most certainly meets the criteria for Oppositional Defiant Disorder, but again, could be a RAD child.  

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Others have mistaken the child’s lack of interest in interacting with peers as Pervasive Developmental Disorder, Autism Spectrum Disorder or PTSD.  In fact, there are some who believe that RAD is a derivative of PTSD altogether.

What it boils down to is this. Without a developmental history conducted with care, access to the relevant medical records, and the benefit of interviewing one or both of the parents, there is no way to be confident of a RAD diagnosis.

How to Successfully Treat RAD

Unfortunately RAD is unique and therefore doesn't lend itself to most of the conventional therapies available to most therapists, who conduct therapy face-to-face or via teletherapy.

Most therapists trained in CBT (Cognitive Behavior Therapy) will implement this therapy, whether face-to-face or via teletherapy on their RAD clients, but with little success. Child therapists who may be proficient with play therapy often won't find their success duplicated with RAD children either.

Effective treatment for RAD usually involves a combination of therapy (face-to-face or teletherapy) and parenting education. Involving the parents is essential to any successful intervention first and foremost to guarantee that the child's environment will be safe and that the interactions will be positive and nourishing.

Often the most effective therapeutic approach with children suffering from RAD both unconventional and confrontational. Often sensory input plays a vital role as well. More innovative trauma therapies such as EMDR has had success with RAD children as well particularly for those children suffering from panic attacks or flashbacks.  

Whatever the specific treatment to be used, it is critical to remember that restoring a sense of safety and security is the core issue that healing must address.  These children are distrustful and detached as a result of their feeling unsafe in their world. The same vigilance that protects them is their impediment from accepting support and love.

It may very well be that the most valuable function that the therapist can serve is to become another trustworthy, consistent authority figure in the RAD child's life; someone whose concern and care are genuine.  

It is crucial to keep in mind that RAD children need help, even though they will do practically anything to resist it.  Working with these children requires a willingness on the part of the therapist to try some unconventional approaches. The rewards are that the efforts can profoundly affect many lives for the better, for years to come.

ADHD and mental health therapy

Looks Like ADHD, Feels Like ADHD, but Guess What… it isn’t ADHD!

Everyone knows that when they have a headache, it could be for any number of reasons, from the innocuous to something quite serious. A good doctor will ask many detailed questions in her quest to determine the exact cause of the headache.

Without a thorough examination and assessment, it would be irresponsible for the doctor to declare a diagnosis of either the flu or a life-threatening brain tumor, either of which may be the culprit.

Mental illness and psychological disorders are no different. Entirely different diagnoses can easily explain the identical symptoms. That’s why a qualified, responsible mental health professional will submit your child to an exhaustive examination before declaring any conclusive determination.

Understanding what is causing a particular behavior is crucial as the diagnosis will drive the treatment in one direction or another. Medications designed to alleviate ADHD symptoms won’t work if the reason for the child’s inattention is something else entirely.

ADHD is the Common Diagnosis for Inattention

Teachers are generally the first to observe the child’s inability to focus or pay attention. She may notice that the child is susceptible to daydreaming, is unable to follow directions, or is easily distracted. While young children have shorter attention spans than their older counterparts, nonetheless a significant inability to focus stands will stand out.  

The marked inability to focus or pay attention, along with hyperactivity and impulsivity is one of the three symptoms of ADHD. So naturally, when a child is easily distracted, the first thing the clinician or parent jumps to is to proclaim it ADHD.

However, there is another, a perhaps, more chilling explanation that can explain these symptoms just as well.

Post-Traumatic Stress Disorder

Just a few years ago Dr. Nicole Brown, then a resident at Johns Hopkins Hospital in Baltimore, became quite frustrated by the ineffectiveness of standard ADHD treatments for many of the children she was observing. She hypothesized that perhaps the behavior, classically considered ADHD, was rather the result of some trauma.

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Dr. Brown performed a study to test this link between trauma and ADHD diagnosis. She found the following correlation: children who endured four or more adverse childhood events were three times more likely to use ADHD medication. From this study, Dr. Brown concluded that what she was actually seeing in these children may very well not have been ADHD but trauma.

What often seem to be classic ADHD symptoms; impulsivity, hyperactivity, and inability to focus could be masking hypervigilance, dissociation, and impulsivity that might be the result of exaggerated stress response due to some traumatic experience.

It is estimated that over 10% of American children, 6.4 million kids currently carry an ADHD diagnosis! However, some parents and mental health experts have begun to question if this growing epidemic of ADHD is more a function of hasty evaluations, the massive investment of pharmaceutical companies, and increased pressure on educators to produce high-performing students than ADHD.

Other researchers following in Brown’s path have pointed out a seeming eagerness to lean towards and ADHD diagnosis over PTSD. There is far more involved in diagnosing PTSD in a child than observing impulsive and hyperactive behavior. To discover the trauma more time needs to be spent in the evaluation going deeper into the child’s experience.

It’s unclear how many kids are misdiagnosed with ADHD annually. A 2010 study estimated that the number could be close to one million!

To make matters worse, the medications prescribed for ADHD patients are stimulants that increase levels of neurotransmitters in the brain associated with pleasure, movement, and attention. Mental Health professionals are concerned about the detrimental effect these medications will have on children who have PTSD and already feel agitated or hyper-vigilant.

One clinician who has accepted Dr. Brown’s findings is urging her colleagues to abandon the “all-knowing clinician” persona and replace it with the persona of the “really curious practitioner.” Instead of asking, "What is wrong with the child?”, it would be better to ask, “What happened in his or her life?”

autism awareness

Is Sensory Processing Disorder Just a Fancy Name for Autism?

Sensory Integration

Sensory Integration is the process performed by the central nervous system when it takes information in from your body’s eight senses and then responds accordingly. Yes, there are eight sensory systems in your body, not just five!

  • Auditory (sound/hearing)
  • Olfactory (smell)
  • Gustatory (taste)
  • Tactile (touch)
  • Vestibular (movement)
  • Proprioception (input from muscles and joints)
  • Interoception (internal sensors indicating physiological conditions)

What is Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is a neurological disorder that compromises processing information from these eight senses. Unlike blindness or deafness where the sensory information is never received in the brain, the brain of children suffering from SPD receives the sensory information, but it is processed abnormally. This invariably causes child distress, discomfort, and confusion.

Sensory Processing Dysfunction

  • language delays or deficits
  • fine and gross motor delays
  • strong sensory interests
  • sensory aversions
  • an inability to interact with people and objects
  • a failure to stay within an interaction
  • repetitive sensory stereotypies (stimming)

A closer look at Autism and Sensory Processing Dysfunction

Although a sensory processing disorder doesn’t qualify a child for an autism diagnosis, many therapists claim that they have yet to meet a person on the autism spectrum who is not suffering in this area. In fact, most teenagers and adults who are on the spectrum claim that sensory processing challenges are their highest difficulty.

These same teenagers and adults claim that their sensory challenges have impacted every aspect of their lives - relationships, communication, self-awareness, safety and so on. It all begins at the beginning of life. Babies and toddlers learn about the new world around them by using their senses. If a baby processes information abnormally from her senses, she will acquire a distorted view of the world around her and also of herself.

Most teachers and parents are quite aware of how compromised visual and auditory processing can impair classroom learning. Yet, many don’t understand that sensory processing difficulties are a lot more complicated and can have more far-reaching consequences. For example, an LCSW explained that body and spatial awareness are so tricky that when he walks, he has to look at the ground because otherwise, he would lose his sense of balance.

Furthermore, many children on the spectrum find it difficult to tolerate everyday social situations. Meeting someone new can be overwhelming - a different visual stimulus, smell or voice can wreak havoc. This sheds new light on a child who is having difficulties with social relationships. The culprit is not only communication but the total sensory processing experience.

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So while all agree that some children do have severe sensory challenges, the debate whether SPD should be considered an independent disorder or is merely a manifestation of Autism goes on unabated. For most children, however, there is little practical consequence as they require the same help irrespective of the classification.

Who can help your child?

Occupational Therapist: Physical activities and strategies are used to help the child to meet their particular sensory needs and enhance processing sensory input in their everyday environments.

Speech Therapist: Helps the child to learn how to reduce sensitivities to sound and stimuli that help improve speech, muscle movements of the mouth and swallowing

Mental Health Therapist: Helps the child’s tolerance to overwhelming sensory experiences to gradually increase through cognitive behavioral therapy

With the advent of teletherapy, many more of these children with sensory processing difficulties can be helped. Teletherapy goes beyond the bounds of time and place and as such offers hope to those many of these suffering children previously unserviced.