Mod6-Microskills-Counselling Skills Notes: Reflection, Normalising, and Questioning Techniques

Reflection of content (paraphrasing)

• Definition and purpose

  • Reflection of content, or paraphrasing, is a micro-skill used to draw out important details and clarify what the person has said.
  • It is more than just attending or matching non-verbal cues; it involves an active response that helps the person feel heard and understood.
  • The counsellor does not repeat the person's words verbatim but re-expresses the most important content in the counsellor's own words.

• How reflection of content is used

  • Focus on the essential content details the person has said.
  • Express these details in the counsellor's own voice, not the speaker's exact phrasing.
  • Can be used throughout a session, but is most effective when combined with other skills discussed later.

• Examples of paraphrasing or reflection of content

  • Example 1
  • Person: "Yesterday I rushed around, I seemed to have no time to myself, I went from one place to another and it was really hard to fit everything in."
  • Counsellor: "You had a very full day yesterday."
  • Example 2
  • Person: "I'm fighting with my son, my husband's not speaking to me, at work the boss keeps picking on me, and what's more my best friend doesn't seem to understand me anymore."
  • Counsellor: "You're having a lot of relationship problems."
  • Example 3
  • Person: "My daughter's a very attractive girl; she's good-looking and vivacious, she dresses very nicely and she is a good-natured person. She often smiles and seems to be very happy."
  • Counsellor: "Your daughter has many positive qualities."

• Longer statements and reflections (examples 4–6)

  • Example 4
  • Person: A detailed account of losing a father to a heart attack, constant thoughts about him, preoccupation, memories of good times, etc.
  • Counsellor: "You have a great sense of loss as you have so many good memories of your father."
  • Example 5
  • Person: Description of a lifelong enjoyment of life, drinking problem, recent relapse, worry about future coping.
  • Counsellor: "Although you surprised yourself, you're not too sure how you'll cope with alcohol into the future."
  • Example 6
  • Person: Feeling unable to please grandmother after a day of chores and attempts to help.
  • Counsellor: "It seems as though you just can't please your grandmother."

• GIVING THE PERSON TIME

  • In counselling, people may pause after short statements or speak for several minutes before pausing.
  • It is best to give them time without rushing them.
  • New counsellors sometimes feel pressured to respond immediately; pauses can be helpful, allowing the person to think before responding.

• COMBINING THE USE OF MINIMAL RESPONSES WITH REFLECTION OF CONTENT

  • A short counselling transcript demonstrates how minimal responses paired with reflection help a person reach resolution.
  • Transcript highlights:
  • Mary invites Susan to talk: "Susan, you said that you would like to talk something over with me. Can you tell me what's troubling you?"
  • Susan: expresses work-related stress and feeling at odds with colleagues.
  • Mary uses minimal responses (e.g., "Mm-hmm.") and paraphrasing: "You're not fitting in." (and similar reflections)
  • Susan elaborates on policies and personal work approach; reflected back to maintain focus on core issue.

Normalising

• Core idea

  • Normalising is a counselling skill used to communicate that a person’s emotional responses or developmental changes are understandable and expected given their experiences.
  • It can reduce anxiety and provide hope, by placing distress within a normal developmental or situational context.
  • The skill is not about denying real problems or suggesting no help is needed; referral to appropriate professionals may be necessary if problems are severe.
  • The idea emerged from a real case where a distressed person asked, "Do you think I'm going crazy?" and the counsellor responded with a humane, validating explanation.
  • A key reference: Geldard & Geldard (2003); related discussions in later chapters.

• The need for care

  • Normalising must be used carefully and ethically.
  • Do not tell someone with potential psychiatric illness that they are OK or do not need help; seek supervisor input and proper assessment when in doubt.
  • If in doubt about a person’s psychological condition, consult a supervisor and refer to a competent professional.

• Uses of normalising

  • 1) Emotional states
  • 2) Changes in behaviours, roles and relationships due to developmental crises

Normalising emotional states

• Goal

  • Help reduce anxiety by validating that the emotional response is normal for the situation.
  • Acknowledge that intense emotions in crisis can be frightening and that fear of losing control or requiring hospital care is common.

• Suggested wording

  • Example: "The emotional state you are experiencing seems to me to be a normal response to your situation, but if you are unsure about your ability to cope then you may want to look for more specialist help. What are your options in that regard?"
  • If appropriate, mention the possibility of medication with medical consultation; some clients may choose not to pursue medication and may show improvement over time.

• Concept of inevitability

  • You might say, "It's inevitable that you would feel this way" to help clients see their distress as a predictable response, reducing self-blame.
  • This framing can help clients recognize strengths and seek constructive responses rather than wallow in failure.

• Context: developmental crises

  • Distress can occur during life changes (e.g., becoming parents, changes to parenting roles, children growing independent).
  • Normalising can be used to convey that anxiety is common and often predictable during such transitions.

Normalising changes in behaviours, roles and relationships due to developmental crises

• Examples and rationale

  • When a second or third child arrives, parental attention shifts, leading to potential relationship strain.
  • The mother may have less time for her partner, causing resentment, while both partners may fear something is wrong with the relationship.
  • Normalising helps both partners understand that these changes are an expected developmental crisis within the family system.
  • Phrasing might include: "What is happening to you could almost have been predicted because you have reached this developmental stage in your family life." This signals inevitability and reduces self-blame.

• Benefits

  • Provides relief and hope, helping couples to search for new coping strategies rather than blaming themselves.
  • Encourages action to adapt to the crisis without escalating guilt or hopelessness.

• Additional considerations

  • Acknowledge that some parents may feel insignificant as children gain independence; discuss potential adjustments and new role definitions.

• Language guidance

  • The word "inevitable" can be useful to convey normalcy, even though it may feel like an overstatement.
  • Emphasise that crises are typical but manageable with new strategies and support.

The need for care (continued)

• Key caution
  • Normalising is not an excuse to dismiss pain or deny the seriousness of a problem.
  • It should help the person understand their situation in context and support constructive responses, not minimize the pain.

Warning!

• Important caveat
  • Normalising must not demean or trivialise a person’s pain.
  • It should provide developmental context and empower the person to move forward, recognizing it as a normal and inevitable crisis.

Types of questions and the information they gather

• Closed vs Open questions

  • Closed questions

  • Elicit discreet, short, definite information (often yes/no).

  • Examples include: "Is the pain sharp?", "Did you use the splint?", "Are you comfortable?", "Were you able to walk today?", "Is your workstation appropriate for your needs?", "Are you taking your medication?" (Archee et al 2013; Beesley et al 2018; Harms 2015)

  • In Family/Person-centred care, the first question after introduction should be closed to seek permission to ask more questions, e.g., "Is it all right if I ask you some questions?" Then move to open questions to build trust.

  • Language considerations for non-English speakers

    • Some closed-question formats can be misinterpreted across languages (e.g., "It doesn't hurt, does it?"). A yes/no may reverse in other languages, causing confusion.
    • Relying on head movements for yes/no can also be culturally confusing; use clearly worded questions and clarify when needed.

  • Open questions

  • There is no right or wrong answer; they invite thoughtful discussion, memory, opinion, detail, and feelings.

  • Useful when information is not discreet or when a broader discussion is needed; good at establishing rapport and exploring sensitive topics.

  • Often begin with: "How …?", "What …?", or phrases like "Tell me about…"

  • They allow the person to control the information they provide and can reduce defensiveness.

• Changing closed questions to open questions

  • The following closed questions can be rewritten as open questions:
    1) Do you feel angry? → How are you feeling about anger or your emotions right now?
    2) How many children do you have? → Tell me about your children.
    3) Did you make yourself comfortable? → What would help you feel comfortable here?
    4) Did you follow your exercise regimen carefully? → How did you get on with your exercise routine this week?
    5) Is your workstation comfortable? → What is your workstation like, and how does it feel?
    6) Does taking your medication make you feel ill? → How do you feel after taking your medication? Have you noticed any effects?

Questions that probe

• Purpose and use

  • Probing questions seek more detail about a topic that has already been introduced, offering deeper insight into situations, people, events, thoughts, and feelings (Stein-Parbury 2017).
  • They can be triggered by information provided or by non-verbal cues that suggest emotional needs.
  • Probing can help clarify understanding or uncover underlying supports and needs.

• How they should be used

  • Begin with phrases such as: "Can you tell me more about…?", "What happened before…?", "What were you thinking when… happened?", "How did you feel about …?".
  • When probing is used to explore emotions, ensure the client is comfortable with discussing those emotions (offer referrals if needed).
  • Probing can shift focus to new information or revisit earlier points, but overuse may feel like interrogation and reduce trust (Harms 2015).

Questions that clarify

• Purpose and use

  • Clarifying questions aim to achieve mutual understanding rather than simply gather more information (Stein-Parbury 2017).
  • Use them when a statement is unclear or could be interpreted in several ways.
  • Examples: "What did you mean when you said …?", "Can you explain what happened …?", "Do you mean …?"

• Considerations

  • Clarifying questions can be asked by either party to avoid misunderstandings (Haddad et al 2018; Purtilo et al 2014).
  • Overuse may imply the professional cannot understand or be understood; balance with effective listening, respect, and empathy.

Questions that lead

• Description and caution

  • Leading questions direct the response and are not person-centered; they can undermine trust and reduce honesty.
  • A leading question might cue the desired answer (e.g., "It's a beautiful day, isn't it?"), prompting compliance rather than genuine feeling.
  • Potential positives: if the topic is external to the person, a leading question can acknowledge presence and create rapport.
  • Potential negatives: for important information gathering, leading questions constrain truth and hinder accurate assessment.
  • Best practice: avoid leading questions when seeking honest, thorough information to support respectful, non-judgemental care (Beesley et al 2018).

• Examples

  • "You weren't drinking alcohol while you were on this medication, were you?" (leading and potentially biased)
  • "You're all right, aren't you?" (suggests a desired answer)
  • In contrast, neutral wording supports open discussion and trust.

• Practical guidance

  • When the aim is honest information and relationship-building, prefer non-leading, patient-centered questions that respect autonomy and encourage truthful responses.