PAC 120 Module 3 Attending, Observing and Questioning Example

Eleven Questions and One Long Silence: Attending, Observing and Questioning in a First Session With a Mandated Client

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 120: Multicultural Advocacy

Instructor Name

Month Day, Year

Eleven Questions and One Long Silence: Attending, Observing and Questioning in a First Session With a Mandated Client

Luis is thirty-eight, an ironworker born in the Dominican Republic who has lived in Milwaukee for fifteen years. Three weeks ago he slipped on a beam at a job site, was caught by his harness and was found by the safety officer to have alcohol on his breath. His employer required an assessment at Northside Community Recovery, an invented outpatient program, before he could return to work. He arrived for his first session with his arms folded and the referral form rolled tight in one hand. I was the counselor in training who met him. This paper analyzes how I attended, observed and questioned in the first fifteen minutes, what went wrong and how I would do it differently. Luis and Northside are composites created for this course, and the cited research is real.

The Skills

Attending is the set of verbal and nonverbal behaviors through which a counselor shows that they are listening: posture, facial expression, eye contact, vocal tone and pace, and verbal tracking, which means staying with the client's topic rather than jumping to the counselor's agenda. Hall et al. (1995) reviewed research on nonverbal behavior in clinician and patient interactions. Clinicians who showed more nonverbal closeness, such as leaning forward, nodding, gesturing and maintaining an open posture and appropriate gaze, tended to receive more positive evaluations from patients. The authors cautioned that the meaning of nonverbal behavior depends on context and culture. Direct eye contact, for example, reads as attention to many clients but as confrontation or disrespect to others, especially in exchanges with someone seen as an authority.

Observing means noticing the client's nonverbal behavior, shifts in topic or tone and discrepancies between words and body. Questioning is the skill of drawing out the client's story. Closed questions, which can be answered in a word, gather specific facts. Open questions, which often begin with what or how, invite clients to explain in their own words. Apodaca and Longabaugh (2009) reviewed studies of how motivational interviewing works. Clients' own statements about change, such as their reasons and their intention to change, were associated with better outcomes, while counselor behaviors inconsistent with motivational interviewing, such as warning and confronting, were associated with worse outcomes. Open questions are one of the main ways counselors invite clients to voice their own reasons.

The Original Exchange

What I Observed and Missed

Reviewing my notes and the session recording with my supervisor, I counted eleven questions in fifteen minutes, ten of them closed. My questions followed the intake form, not Luis. I did observe some of his nonverbal behavior: the folded arms, the rolled form, the glances at the door. But I treated these as signs of resistance rather than as information. A man sent by his employer, facing the loss of his livelihood and speaking in his second language to a stranger in an institution, had good reasons to be guarded.

The biggest miss was his daughter. When Luis said, "If I lose this job," he named what mattered most to him. That was an invitation, and I did not take it. Instead I asked about family history of drinking, which followed so closely after his mention of his daughter that it may have sounded like an accusation about his family. His silence, and then "You think I'm a drunk," told me the alliance had ruptured.

My attending also had cultural dimensions I had not considered. I maintained steady eye contact, as I had been taught. Luis looked away often. I later learned from my supervisor, and from Luis himself in a later session, that in his family looking steadily at an older person or authority could seem disrespectful, and that he found my gaze uncomfortable. I am younger than Luis, but in that room I represented the institution that held his job in its hands.

Repairing the Rupture

Owen et al. (2014) surveyed racial and ethnic minority clients in therapy about microaggressions from their therapists. About half reported at least one, and most said the microaggression had not been discussed in therapy. Clients who had experienced microaggressions reported weaker working alliances, but when the microaggression had been discussed, alliance ratings were similar to those of clients who reported none. My question about family drinking was not a racial microaggression, but the lesson applies: when a client names a rupture, discussing it openly can restore the relationship.

I did respond to Luis's statement, though not skillfully. I said, "No, not at all," which denied his perception instead of exploring it.

A Revised Exchange

In the revision, I would also sit at an angle rather than directly across, soften my gaze and let Luis set the pace of eye contact. The intake questions would still be asked, but later in the session and with a brief explanation of why.

Lessons for My Practice

Three lessons stand out. First, my questions should follow the client before the form, and most should be open. Second, I should treat guardedness from a mandated client as understandable and say so. Third, when a client names a rupture, I should explore it rather than deny it, for example by saying, "It sounded like I was judging you. Tell me more about how that came across." Luis returned for his second session, and when I acknowledged that the first had started badly, he laughed for the first time.

Conclusion

In my first session with Luis, I asked ten closed questions, missed the cue about his daughter and denied the rupture he named. Hall, Harrigan and Rosenthal show that nonverbal closeness, adapted to culture, shapes how clients experience a clinician, Apodaca and Longabaugh show the value of drawing out clients' own words and Owen and colleagues show that discussing missteps can restore trust. Attending, observing and questioning are not checklists but ways of following the client.

References

Apodaca, T. R., & Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: A review and preliminary evaluation of the evidence. Addiction, 104(5), 705-715. https://doi.org/10.1111/j.1360-0443.2009.02527.x

Hall, J. A., Harrigan, J. A., & Rosenthal, R. (1995). Nonverbal behavior in clinician-patient interaction. Applied and Preventive Psychology, 4(1), 21-37. https://doi.org/10.1016/S0962-1849(05)80049-6

Owen, J., Tao, K. W., Imel, Z. E., Wampold, B. E., & Rodolfa, E. (2014). Addressing racial and ethnic microaggressions in therapy. Professional Psychology: Research and Practice, 45(4), 283-290. https://doi.org/10.1037/a0037420