073 – Active Listening – The Caldicott Principles – Working with Simile and Metaphor in Counselling
In episode 73 of the Counselling Tutor Podcast, Ken Kelly and Rory Lees-Oakes discuss the skill of active listening. ‘Practice Matters’ follows, in which Rory explains the Caldicott principles and how these can support ethical multidisciplinary working. Finally, the presenters discuss the use of simile and metaphor in counselling.
Active Listening (starts at 2.12 mins)
It was the Greek philosopher Epictetus who first pointed out that we have one mouth and two ears. In active listening, we must not just passively let the client’s words wash over us, but must see every word they speak as important, paying full attention to nuances. Active listening extends to their body language too: you can pick up a lot about how a client is feeling by observing this.
Active listening is not just about listening – it’s also about ensuring that the client feels heard. To do this, we must also respond respectfully, for example using the skills of reflection and paraphrasing. Our own body language also helps with this – for example, we must use an open posture, make appropriate eye contact, and allow the right amount of personal space (depending on cultural norms and individual clients’ preferences).
It is important to listen not only to the narrative (the story), but also to the meaning behind this – that is, the emotions and themes. Carl Rogers called this ‘the music beneath the words’.
Minimal encouragers (e.g. ‘Mmm’, ‘Yes’, ‘Aha’ and ‘Oh right’) and facial expressions can be useful to show the client you are listening attentively, but do let these flow naturally so that they don’t sound contrived.
The Caldicott Principles (starts at 11.53 mins)
Counsellors often work as part of a multidisciplinary team, for example in a school. This raises challenges for confidentiality. Whether we are working in a paid or voluntary post, we must be guided by the organisational policy on confidentiality and limits to this.
Most importantly, you should set out and explain in your contract what the limits of confidentiality are in the particular context – in other words, reflecting what might be asked of you by other professionals. The client can then make an informed decision on whether to go ahead on this basis.
The murder of eight-year-old Victoria Climbié in 2000 by her guardians illustrates why information sharing can be important: many different authorities knew parts of what was going on, but none was aware of the full picture.
In 1997, the UK government commissioned a review on the use of patient information in the NHS. The committee was chaired by psychiatrist Dame Fiona Caldicott. The resulting report highlighted six key principles, with a seventh added later, in 2012:
- Justify the purpose of using confidential information.
- Don’t use personal confidential information unless it is absolutely necessary.
- Use the minimum necessary personal confidential data.
- Access to personal confidential information should be on a strict need-to-know basis.
- Everyone with access to personal confidential information should be aware of their responsibilities.
- Comply with the law.
- The duty to share information can be as important as the duty to protect patient confidentiality.
Rory explains each of these in detail in the podcast. You can also download Rory’s handout on working in a multidisciplinary team here, or it is also available in the Handouts Vault and Counselling Study Resource (CSR).
Free Handout Download
Working in a Multidisciplinary Team
Working with Simile and Metaphor in Counselling (starts at 24.44 mins)
Simile and metaphor are both types of imagery. While simile compares something to another thing (e.g. ‘I feel like I’m riding choppy seas’), metaphor suggests that something actually is another thing (e.g. ‘I have a knot in my stomach’).
Many clients use imagery as a way to talk about difficult feelings using external points of reference, as it can be so painful to fully immerse oneself in emotions. When this happens, it is like they are opening a door for you, which you can then gently pass through and respectfully explore what lies within.
Imagery is often culturally linked – for example, people in the UK have recently referred to ‘the beast from the East’ to mean the cold, snowy weather that hit the country from Siberia. We all understood what this meant, but people in other countries may not be familiar with the term. Caution therefore needs to be used if you introduce imagery yourself in the counselling room.
Imagery uses a different part of the brain than does spoken language; this means it may reveal things are at the edge of the client’s awareness – and thus very rich learning material.
Why not try speaking to your peers about the use of simile and metaphor, listen out for how other people use imagery, and explore your own use in your journal? This will help hone your skills in engaging with language. You might also like to read work by Eugene Gendlin, who wrote on focusing – which involves examining the felt sense and images that come out of this.
If you are a member of the CSR, you can listen to a lecture on working with metaphor featuring expert Jonathan Lloyd. (You need to be logged into the CSR for the above link to work)