4: Reflecting What Is Said and Shown
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Resources and Links
Deadman, P. (2018). The Transformative Power of Deep, Slow Breathing. Journal of Chinese Medicine, 116, 56–62.
Prologue
Welcome to Episode 4, Reflecting What Is Said and Shown. Last time, we talked about how to catch what clients communicate verbally and nonverbally and saying that back to show them what they are communicating. Today, I want to give you some practical ways to do that.
Different scholars conceptualize this a little differently, but I suggest three levels of reflection: parroting, paraphrasing, and pairing with emotion.
Parroting is simply saying back to the client exactly what he is saying or showing to you. “The car crashed.” This can be tracking if the client is not talking, but if the client is talking, parroting is repeating what is said. This is the easiest because it doesn’t have to be filtered through you. If you do it excessively, though, it can feel like being mocked.
Paraphrasing is still saying back what the client has said or shown you, but it goes through the filter of you, and so it gets put in your own words. You might switch the order or substitute an emotion word or put a few things together. This is a deeper level reflection, and it can build awareness as you hold up that mirror of reflection so the client can see what they are showing you.
The last kind of reflection is often the deepest level reflection. With it, you specifically try to identify the emotion the client is expressing. By naming it, it may give freedom to really express it.
Take in what the client is communicating, and then parrot, paraphrase or pair with an emotion to reflect back what the client is sharing with you.
Reflecting What Isn’t Said
With adolescents and adults, you use the same skills. Sometimes, though, my rationale for the skill is a little different. For example, with adults, I often will parrot a significant phrase that the client has said to call attention to it. “It’s all your fault.” “Everyone depends on you.” “You wonder if he loves you.” It’s very intentional, and it’s important to use the client’s exact words to do that. I never did that in my work with kids, but I do it often with adults.
One additional skill that helps me know what to reflect and which way to reflect it (parrot, paraphrase, or pair with an emotion) is to rely on my professional intuition. I was trained and grew up in a family that valued rational cognitions, so intuition was not something I initially embraced. Then, I had a colleague, Dr. Melanie Morris, who explained professional intuition, and my plain hamburger turned into a deluxe cheeseburger with all the fixin's. I felt like I had permission to trust what I was picking up from clients, but didn’t have concrete data to describe.
Here’s what I mean by professional intuition. We all have an intuitive side that tells us subtle things. It’s that “vibe” that someone isn’t trustworthy, or niggling thought that this is a bad idea. It also works on the positive side when you “just click” with another person or something feels right. Those things are hard for me to trust, but professional intuition relies on more than just vibes or feelings. It is informed by your education, what you read, trainings you've attended, listening to this podcast, and other educational things. You might hear your client say something that reminds you of your theories class when you studied Beck’s cognitive theory and you reflect something about “faulty thinking”… even when your theory of choice is client-centered. Your education has informed you that the information you are getting from your client has revealed something about how the client thinks, so you trust it.
Here’s another example. Your client has shared tremendous anxiety around school and work achievement. You’ve been learning about how anxiety is often tied to fear, so even though the client hasn’t talked about fear at all, you intuitively reflect, “It seems like you’re afraid that if you don’t overachieve, you fail, and if you fail you don’t have worth, so I can see why this gives you so much anxiety. It’s either over-achieve or be worthless.” Ouch!
Paraphrasing is still saying back what the client has said or shown you, but it goes through the filter of you, and so it gets put in your own words. You might switch the order or substitute an emotion word or put a few things together. This is a deeper level reflection, and it can build awareness as you hold up that mirror of reflection so the client can see what they are showing you.
The last kind of reflection is often the deepest level reflection. With it, you specifically try to identify the emotion the client is expressing. By naming it, it may give freedom to really express it.
Take in what the client is communicating, and then parrot, paraphrase or pair with an emotion to reflect back what the client is sharing with you.
Research Summary
In today’s episode, Dr. Denis mentioned breath-work and activities that can enhance the body-mind connection and lead to better mental health. In America and other Western cultures, we tend to look at these types of alternative and adjunct therapies as “out there” and maybe even a little weird. Yet, in traditional Eastern cultures, especially in Asia, things like breath-work, yoga, qigong (chi-gong) are used as powerful tools for emotional, mental and physical health and wellbeing.
Today, I’m going to talk about the science of slow breathing and its impact on the nervous system. You may find that some of this relates to what I discussed in Episode 2 about Polyvagal Theory. Most of this research comes from an article written by Peter Deadman in the Journal of Chinese Medicine. In the article, he describes 3 different reasons why slow, abdominal breathing can help regulate the mind and body.
When you breathe through your nose (not through your mouth), the molecule Nitric Oxide (NO) is released. NO increases circulation, lowers blood pressure, and reduces inflammation—all important things for wellbeing. Studies have shown that slow breathing and even humming/chanting can increase NO production fifteen-fold.
Another benefit of slow breathing is an increase in CO2 (carbon dioxide). A lack of CO2, which occurs when we breathe shallowly and exclusively in the chest, leads to or worsens symptoms of anxiety, worry, and panic. Deep breathing allows more blood flow and oxygen to go to the heart and the brain, which soothes the nervous system.
This brings me to my last point: deep breathing calms our nervous systems. The fight/flight branch of the nervous system is called the sympathetic nervous system (SNS), which is activated in the face of threat or danger. It is activated in times of stress, and even in external exercises such as running or weight training. Raised SNS activity causes: constriction of blood vessels, raised blood pressure, raised heart rate, faster breathing, and even pupil dilation (better able to see danger). This system is adaptive, but if its chronically activated, as it is for many of our clients struggling with anxiety, PTSD, ADHD, insomnia, it can be harmful.
Scientifically speaking, deep breathing activates our parasympathetic system (PNS) — our “brake” system. In this state, blood vessels relax and dilate, heart rate and blood pressure reduce, and the immune system is enhanced. Activation of this system helps achieve a healthy vagal tone, which is a fancy way of saying that there is a balance between the PNS and SNS.
Inhalation promotes the SNS and exhalation activates the PNS, and when we evenly and equally inhale and exhale for five to six seconds each, we put the autonomic nervous system (ANS) into a beautiful harmony! I’m going to leave you with a fun fact: If we want to more strongly promote a rested and relaxed state, we can make the out-breath longer than the in-breath.
*If you’re interested in reading more, check out the article in the show notes!
Deadman, P. (2018). The Transformative Power of Deep, Slow Breathing. Journal of Chinese Medicine, 116, 56–62.
Credits
Thanks for listening. Try this today in your own active listening: practice parroting, paraphrasing, and pairing with an emotion. You might start by repeating this: subscribe now so you always get each new episode. You can always find the links to the research and references in the show notes. Play Therapy Across the Lifespan is made possible through the Lipscomb University Center for Play Therapy and Expressive Arts.
If you have any comments or questions, pass them along at playtherapypodcast.org. Thanks to grad student Rachel Sellers, audio engineer Sheldon Clark who makes the magic happen, and Sara Beth Geoghegan, who wrote “Firefly.” I’m your host, Dr. Denis’ Thomas. Go play, create, and heal.
