We’ve been talking about emotions in our Group Counseling course at the University of Montana. Even though focusing on emotions has grown immensely in popularity within contemporary counseling and psychotherapy, some students seem to be missing a few basics. Last week, when I took time to talk about the differences between (a) reflection of feeling, (b) interpretive reflection of feeling, and (c) feeling validation most of the students found the information useful. Consequently, I’m including here (and in a following blog post or two) excerpts from the latest edition of our Clinical Interviewing textbook. https://www.wiley.com/en-us/Clinical+Interviewing%2C+7th+Edition-p-9781119981985

The foundation that guides how clinicians respond to clients is described in our “Listening Continuum” (see below).

This excerpt is from the section in Chapter 4 on Reflection of Feeling.  

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Reflection of Feeling (aka Empathy)

The primary purpose of a reflection of feeling is to let clients know, through an emotionally focused paraphrase, that you’re tuned in to their emotional state. Nondirective reflections of feeling encourage further emotional expression. Consider the following example of a 15-year-old male (he/him) talking about his teacher:

Client: That teacher pissed me off big time when she accused me of stealing her phone. I wanted to punch her.

Counselor: You were pretty pissed off.

Client: Damn right.

In this example, the feeling reflection focuses only on what the client clearly articulated. This is the rule for nondirective feeling reflections: Restate or reflect only the emotional content that you clearly heard the client say. No probing, interpreting, or speculation are included. Although we might guess at underlying dynamics contributing to this boy’s fury, a nondirective feeling reflection focuses on obvious emotions.

Emotions are personal. Every attempt to reflect feelings is a move toward closeness or intimacy. Some clients who don’t want relational connection with you may react negatively to reflections of feeling. You can minimize negative reactions to reflections of feeling by phrasing them tentatively, especially during an initial interview:

When using reflection to encourage continued personal exploration, which is the broad goal of reflective listening, it is often useful to understate slightly what the person has offered. This is particularly so when emotional content is involved. (W. R. Miller & Rollnick, 2013, p. 59)

Emotional accuracy is your ultimate goal. However, if you miss the emotional target, it’s better to miss with an understatement than an overstatement. If you overstate emotional intensity, clients will often backtrack or deny their feelings. As we’ll discuss in Chapter 12, there’s a proper time to intentionally overstate client emotions. Generally, however, you should aim for accuracy while proceeding tentatively and understating rather than overstating clients’ emotions. Rogers (1961) would sometimes use clarification with clients after giving a reflection of feeling (e.g., “I’m hearing sadness and pain in your voice… am I getting that right?”).

If you understate a reflection of feeling, your client may correct you.

Client: That teacher pissed me off big time when she accused me of stealing her watch. I wanted to punch her.

Counselor: Seems like you were a little irritated about that. Is that right?

Client: Irritated? Fuck no—I was pissed.

Counselor: You were way more than irritated. You were pissed.

In this example, a stronger emotional descriptor is better because the client expressed more than irritation. However, any adverse effect of “missing” the emotion is minimized because the counselor phrased the reflection tentatively with “Seems like…” and then added a clarifying question at the end. Then, perhaps most important, when the client corrected the counselor, the counselor repaired the reflection to fit with the client’s emotional experience. From a psychoanalytic perspective, the repairing of emotional mirroring or empathy might be the most therapeutic part of listening (Kohut, 1984; see Practice and Reflection 4.3 to practice emotional responses to clients).

Reflections of feeling are often labeled as empathy. If only empathy were so simple. As Clark noted, “Rogers . . . was appalled by this . . . as the rich and nuanced process of empathy was reduced to trivial and repetitive expressions of a therapist identifying a client’s feelings” (p. 23). As we move forward through this chapter and other content on more directive interviewer responses, remember that empathy should be woven into nearly every therapist utterance, including confrontation, advice, and behavioral homework (Clark, 2023). 

With clients, mental health professionals engage in emotional clarification, exploration, validation, and education. Your role varies depending on your clients’ needs and situation. As a technique, reflection of feeling aids clients in clarifying and exploring their emotions.  For this chapter and reflection of feeling, the best path is a tentative one, wherein you function as a mirror to help clients experience and articulate their emotions with greater clarity. Doing so can serve to help clients explore and gain greater understanding of their emotional worlds. To accomplish your interviewing goals, you don’t need to know everything about the academic and popular debates over emotions; instead, you partner with clients to deepen your mutual understanding of the emotional experiences. 

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Gender, Culture, and Emotion

Imagine you’re in an initial clinical interview with a Latino (he/him) cisgender male husband and father. He looks unhappy and your impression is that he’s angry about his wife’s employment outside the home. You’re aware that some Latine/x people have traditional ideas about male and female family roles. This knowledge provides you with a foundation for using a reflection of feeling to focus on his anger:

I’m getting the sense that you’re a little angry about your wife deciding to go back to work.

He responds,

Nah. She can do whatever she wants.

You hear his words. He seems to be empowering his wife to do as she pleases. But his voice is laden with annoyance. This leads you to try again to connect with him on a deeper level. You say,

Right. But I hear a little annoyance in your voice.

This reflection of feeling prompts an emotional response, but not the one you hoped for.

Sure. You’re right. I am annoyed. I’m fucking annoyed with you and the fact that you’re not listening to me and keep focusing on all this feelings shit.

This is a dreaded scenario for many clinicians. You take a risk to reflect what seems like an obvious emotion, and you get hostility in return. Your emotional sensitivity and effort at empathy backfires. The client moves to a defensive and aggressive place, and a relationship rupture occurs (see Chapter 7 for more on dealing with relationship ruptures).

It’s tempting to use culture and gender to explain this client’s negative reaction to your reflection of feeling. But it’s not that simple.

Although culture, gender, race, and other broad classification-based variables can sometimes predict whether specific clients will be comfortable with emotional expression, individual client differences are probably more substantial determinants. Comfort in expressing emotion is often a function of whether the client comes from a family-neighborhood-cultural context where emotional disclosure was a norm. For example, Knight (2014) reported that Black and Latino males who were unlikely to disclose to their peers attributed this tendency to their experiences living in violent communities. These young men learned that emotional expression and trusting others were bad ideas in their neighborhoods. Conversely, emotional disclosure is more likely in the comfort range of Black and Latine/x males raised in safer communities. This makes good common sense: Whether clients perceive you as safe to talk with about emotional concerns probably has more to do with their backgrounds and past experiences than you.

Overall, it’s likely that clients’ willingness to tolerate feeling reflections is based on a mix of their cultural, gender, and individual experiences. Although biogenetics may be involved too, how people handle emotions is largely socialized (McDermott et al., 2019). If you have reason to suspect that your client is socialized to be uncomfortable with emotions, you should avoid emotionally specific words. Examples of emotionally specific words include angry, sad, scared, and guilty.

Instead of emotionally specific words, you can substitute words that are emotionally vague (and less intense). Later, as trust develops, you might be able to use specific emotional words. Consider the following phrases:

• You found that frustrating.
• It seems like that bothered you a bit.
• It’s a little upsetting to think about that.

Practice and Reflection 4.4 lists examples of emotionally vague words you might use instead of emotionally specific words.

PRACTICE AND REFLECTION 4.4: USING VAGUE AND EMOTIONALLY SAFE WORDS

Emotionally Specific Words	Substitute (Safer) Words
Angry	Frustrated, upset, bothered, annoyed
Sad	Down, bad, unlucky, “that sucked”
Scared	Bothered, “didn’t need that,” “felt like leaving”
Guilty	Bad, sorry, unfortunate, “bad shit”

Note: These words may work as substitutes for more emotionally specific words, but they also may not. It will be more effective for you to work with your classmates or in your work setting to generate less emotionally threatening words and phrases that are culturally and locally specific.

[End of Practice and Reflection 4.4]

Gender diverse clients may be emotionally sensitive in ways different than clients on the gender binary. Due to their neutrality, reflections of feeling—even when accurate—can be activating if clients are sensing you’re coming from a place of judgment. Consider the following:

Counselor: You said your family is rejecting your sexual identity, and you’re feeling terribly sad about that.

Client: Wouldn’t you?

When clients have a substantial history of interpersonal rejection, emotional invalidation, and/or oppression, neutral comments from clinicians can be perceived as judgmental. In this exchange, the counselor uses an accurate simple paraphrase along, with an emotional reflection, but the client feels judged and responds defensively. Given the client’s history, feeling judged in response to neutral reflections is natural. What the client needs (to feel connected and supported) is a response that’s explicitly affirming or validating (Alessi et al., 2019). In this case, at least until rapport is established, rather than a feeling reflection, the client would likely react better to a feeling validation (“Your sadness in response to your family’s rejection of your sexual identity seems totally normal”; see Chapter 5 for information on feeling validations). 

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Thanks for reading. In the coming week, there will be additional posts on the basics and nuances of working with emotions in counseling and psychotherapy.