Positive outcomes from therapy and counseling rely on the strength of the relationship between the mental health professional and the client.
Such connections build on effective communication: what we express and how we express it (Wachtel, 2011).
Establishing empathy with clients requires a high degree of insight and a strong sense of shared understanding (Norcross, 2011).
Thankfully, communication is a skill that can be monitored and improved through awareness, education, and practice.
This article explores the importance of communication in therapy and counseling, introducing several vital skills and techniques and providing a set of worksheets to improve communication both inside and outside sessions.
Before you continue, we thought you might like to download our three Positive Communication Exercises (PDF) for free. These science-based tools will help you and those you work with build better social skills and better connect with others.
This Article Contains:
- Communication in Therapy and Counseling
- Why Is Communication Important in Therapy?
- 5 Skills of Effective Therapists and Counselors
- 17 Communication Techniques for Your Sessions
- A Look at Nonverbal Communication in Counseling
- 6 Worksheets & Activities for Improving Communication
- Resources From PositivePsychology.com
- A Take-Home Message
Communication in Therapy and Counseling
A task force set up by the American Psychological Association reviewed research on what makes therapeutic relationships most successful. Based on 16 meta-analyses, they found the following to be vital (Angelis, 2019):
- Agreeing therapy goals
- Getting client feedback
- Repairing ruptures (breakdowns in the therapeutic alliance)
With the therapeutic relationship as essential as the treatment method, communication and collaboration become increasingly valuable to the overall outcomes of therapy and counseling (Angelis, 2019).
Wachtel (2011, p. ix) highlights the importance of communication in the therapeutic technique and the need to “move from understanding the patient or client to putting that understanding into words.”
Communication may differ depending on the situation and the approach, yet it remains central to both talking cures and behavioral interventions. As a result, both seasoned professionals and those new to counseling or therapy will benefit from focusing on what they say and how they say it (Wachtel, 2011).
Framing effective therapeutic comments and achieving a fuller understanding of what is being said are skills that rely on awareness, good technique, and practice.
Communication can be subtle and multi-layered; an overt message often conveys a secondary meta-message. While we may not be conscious of the latter, it has considerable potential to affect therapeutic transformation – and failure. With that in mind, mental health professionals must care about what they and the client say and how they say it (Wachtel, 2011).
Why Is Communication Important in Therapy?
The words and phrases we choose with clients in therapy express feelings we want to convey and therefore matter greatly.
They have the power to significantly impact the therapeutic alliance and outcome (Wachtel, 2011).
Our communications are more than simple interventions; they shape “the climate of the relationship and the tenor of the alliance” (Wachtel, 2011, p. 3). Even subtle changes in communication style and content can alter the client’s experience of the relationship, their progress, how they see themselves, and their potential for change.
In addition to paying close attention to and comprehending their client, it is therefore vital that therapists consider what they say based on the understanding received. Therapists must use good communication skills to effectively and empathically put their observations into words, enabling the client to integrate new knowledge into an expanded sense of self without feeling shame (Wachtel, 2011).
5 Skills of Effective Therapists and Counselors
There are at least five essential communication skills for use in counseling and therapy, including the following (Nelson-Jones, 2005).
Verbal communication skills
Messages sent using words, such as “I understand. Please tell me more.”
Trained and empathic listening professionals should consider:
- Is the language too formal or informal?
- What are the content and focus of what is being said?
- How much is said? It is usual for the client to talk more than the professional.
- Who owns the speech? The pronoun “you” should be used carefully; it can suggest judgment.
Vocal communication skills
How we talk can signify what we are really thinking and how we truly feel.
Messages sent through the voice are influenced by the speaker’s:
- Speech rate
Each factor must be considered, tuned to the situation and subject, and modified to add variety to the conversation.
Bodily communication skills
Sometimes we forget to consider our whole body when we communicate, yet it can significantly affect communication, adding to or distracting from what we are saying.
Touch communication skills
When appropriate, a gentle touch to the arm or shoulder can communicate as much as and function alongside other communication skills.
However, physical contact risks over-familiarity or inappropriate interest and must be considered carefully.
Taking action communication skills
Communication is not always face-to-face. Reminders may be sent before a session or as a follow-up, including homework, such as further reading or exercises.
Communication boundaries are required to ensure that contact remains professional and through agreed methods.
17 Communication Techniques for Your Sessions
While seeking understanding in therapy and counseling is vital, so too is helping clients recognize possibilities in their lives and replace life patterns that have been the source of problems (Wachtel, 2011).
The following communication techniques are equally helpful in therapy and counseling, improving overall communication.
Many factors can lead to a breakdown in the alliance between the mental health professional and the client, including misunderstanding, mistrust, and disagreement on treatment goals (Angelis, 2019).
Good communication and related techniques can repair ruptures and lead to better outcomes (Saffran et al., 2011).
- Outline the therapeutic rationale at the beginning of the treatment and then reiterate it throughout.
- Respond to disagreements by modifying behavior to something more meaningful to the client; for example, use validation rather than challenge.
- Clarify misunderstandings early. When the client appears to withdraw, explore what is happening and acknowledge their feelings.
- Exploring the themes related to the rupture can help uncover more general problems, issues, and concerns.
- Link ruptures in the alliance to other areas of the client’s life. For example, concerns regarding lack of control during treatment may exist in other life domains.
Communication can successfully strengthen relationships in therapy and counseling by gathering feedback from the client and incorporating it into treatment. Taking note of feedback is likely to improve therapeutic outcomes and reduce client dropout (Angelis, 2019).
Several interventions can boost feedback in sessions and improve communication, including (Lambert & Shimokawa, 2011):
- Asking for and providing feedback on the therapeutic relationship
- Discussing shared experiences
- Increasing empathic engagement
- Offering more positive feedback
- Openly discussing readiness for change with the client
- Discussing the consequences of changing and not changing
When communicating with a client, displaying empathy strengthens the therapeutic alliance and promotes client openness (Elliott et al., 2011; Angelis, 2019).
As an essential element of emotional intelligence, empathy promotes change and is a vital aspect of therapy and counseling.
The ability and capacity to understand and share client feelings can be encouraged through several techniques, including (Elliott et al., 2011):
- Talking at a slower pace with periodic check-ins
- Actively listening to the client and reflecting back to them for their consideration
- Closely following the moving focus of the conversation as the therapy progresses
- Using empathic affirmation, such as, “Yes, it must be hard being pulled in all directions”
- Individualizing responses to clients so that they are relevant and personal
- Using evocative language to bring clients’ experiences alive
A Look at Nonverbal Communication in Counseling
“Nonverbal behavior exists in the interface between nature and culture” (Rimondini, 2011, p. 110). Its function in communication is to create meaning (Eaves & Leathers, 2018).
Nonverbal factors add to verbal communication by improving its accuracy and efficiency. Feelings and emotions are often more fully and accurately revealed nonverbally (Eaves & Leathers, 2018).
“When both speaking and listening, counselors, trainees, and clients disclose themselves through how they create their bodily communication” (Nelson-Jones, 2005, p. 22).
Nonverbal communication factors to consider include:
- Gaze – useful for coordinating speech and collecting feedback.
- Eye contact – crucial for showing interest and empathy.
- Facial expression – are we showing shock, disgust, or understanding?
- Posture – turning your body toward the speaker shows interest and engagement.
- Gestures – used to frame or illustrate what is being said or heard.
- Physical proximity – too close, and it can be awkward; too far, and a lack of connection may be felt.
- Clothes and personal grooming – appearing professional is vital, but so too is being able to connect, especially with a young person or group.
6 Worksheets & Activities for Improving Communication
As with any skill, reflection and practice are valuable tools for improving communication in therapy and counseling.
The following worksheets focus on multiple aspects of communication, enhancing awareness, and improving practical use.
Practicing verbal communication skills for therapists and counselors
Creating a safe environment for practicing communication skills is helpful for therapists and counselors new to the profession and the more experienced wishing to hone their skills.
Use the Practice Verbal Communication Skills worksheet in a group setting to practice verbal communication and reflect on skills you could improve.
Assess Vocal Communication Skills
Often, we are either unaware of our verbal skills or fail to reflect on them.
Use the Assess Vocal Communication Skills worksheet to both self-assess and receive feedback from others regarding key factors in vocal communication.
Consider what went well, not so well, and what you could do differently next time.
Active listening in therapy and counseling
We listen most effectively and form greater understanding when we actively listen to what is said.
Use the following questions in the Active Listening in Session worksheet to reflect on a recent session with a client and the vital factors of active listening.
- Did you use open-ended questions?
- Were you attentive?
- Did you seek clarification?
- Did you summarize what was said?
- Did you observe nonverbal as well as verbal communication?
- Did you use reflection (repeating back what you understood for confirmation)?
- Reflect on the answers you gave to each question and consider where you could improve or add additional focus in the future.
Being present for communicating in therapy and counseling
Awareness and being present are vital for effective communication in both counseling and therapy (Westland, 2015).
Use the prompts in the Being Present worksheet to increase awareness of what is happening inside your mind, body, and the environment.
- Describe your subjective awareness at that time. What physical sensations did you experience (e.g., tension, tingles, pressure)?
- Describe your outer awareness at that time. What did you sense in the environment (e.g., noises, smells, touches, tastes)?
- Describe your awareness of fantasy at that time. What mental processes took you out of the present moment into planning, explaining, and thinking?
Reflecting on each answer will help you increase understanding and awareness of your inner and outer world and improve your communication and understanding of the client.
Under- and over-involvement for communicating in therapy and counseling
Two kinds of reaction in therapy can significantly affect and even harm communication: under-involvement and over-involvement. “The under-involved psychotherapist is aloof, cool, and insufficiently responsive. The over-involved psychotherapist has lost touch with boundaries and become submerged in the client’s world” (Westland, 2015, p. 95).
Use the Under- and Over-Involvement in Communication worksheet to become more aware of what being too much and too little engaged with a client can be like.
Consider each of the following reactions:
- Neutral – remaining present without any particular type of reaction or engagement.
- Over-involved – over-engaging yourself with the client; feeling fully and emotionally involved in everything they have to say.
- Under-involved – disengaging yourself from what the client is sharing; physically and mentally distancing yourself from what the client shares; gazing out the window or thinking about a recent event.
Types of speech during communication in therapy and counseling
Depending on their personality, the treatment, and what is being discussed, the client may use one or more talking styles during a session (Westland, 2015).
Use the Types of Speech worksheet to become more aware during counseling by identifying and reflecting on the different styles used by the client and considering what they may mean.
Reflect on a recent session with a client and consider the following:
- Did the client talk at any point in a monotone – a single note?
- Did the client talk at any point on the horizontal, meaning their words were monotonous and seemed to fill the space?
- Did the client talk in an enticing and enthralling way?
- Did the client talk in a friendly yet circular way, never getting to the point?
- Did the client talk like a runaway train?
Resources From PositivePsychology.com
Good communication is essential to the process and outcome of therapy and counseling, and we have many resources that will help.
Why not download our Positive Psychology Coaching Manuals or our On Becoming a Therapist guide for a wealth of information regarding the skills, practices, and training that will help you excel in your career as a counselor or therapist?
Other free resources include:
- Nonverbal Mood-Spotting Game
A fun activity for engaging children and adults in using and spotting nonverbal communication.
- Matching Nonverbal and Verbal Communication
A set of questions to examine communication and attitudes during a recent engagement or session.
- Interpreting Body Language
A practical worksheet for helping adults and children become more familiar with body language and its impact on communication.
- Body Communication Competence Using SOLER
Use these helpful questions to reflect on your own and others’ body language using the SOLER acronym.
More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:
- Listening Without Trying to Solve
This valuable tool promotes listening without trying to problem-solve.
During this group exercise, participants pair up to explore two different scenarios:
- Sharing a problem while being listened to
- Sharing a problem while being offered advice and solutions
Taking turns, each member of the pair considers which listening approach is more beneficial.
- Mindful Versus Mindless Listening
Mindfulness encourages moment-to-moment awareness of the speaker’s message rather than becoming distracted.
Through teaming up with a partner, each person takes the role of both speaker and listener and adopts mindful and mindless listening.
The experience is evaluated with a series of questions, including:
What was it like being the storyteller/listener using mindful listening?
What was it like being the storyteller/listener using mindless listening?
If you’re looking for more science-based ways to help others communicate better, check out this collection of 17 validated positive communication tools for practitioners. Use them to help others improve their communication skills and form deeper and more positive relationships.
A Take-Home Message
While essential in all aspects of our lives, effective communication is particularly valuable in therapy and counseling, impacting the treatment alliance and outcome.
Direct, clear, and positive communication can help confirm treatment goals, encourage and provide feedback, and repair breakdowns to the overall process.
Reflecting on verbal and nonverbal communication can help us remove misunderstandings while clarifying the needs and meaning behind clients’ actions and identifying the changes they wish to make and the goals they want to set.
Whether you are new to the field or have years of experience, it is valuable to take time away from your busy schedule to consider what you say and how you say it. When treated as a craft, communication skills can be learned and improved through knowledge and practice to improve the client’s treatment experience.
Why not review the article and try out some of the communication worksheets? Reflect on where improvements can be made to your approach and style and how you can further enhance your skills to improve the therapeutic process and outcomes.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Communication Exercises (PDF) for free.
- Angelis, T. (2019). Better relationships with patients lead to better outcomes. Monitor on Psychology, 50(10), 38.
- Eaves, M. H., & Leathers, D. G. (2018). Successful nonverbal communication: Principles and applications. Routledge
- Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. (2011). Empathy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 132–152). Oxford University Press.
- Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 203–223). Oxford University Press.
- Nelson-Jones, R. (2005). Practical counselling and helping skills. Sage.
- Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. Oxford University Press.
- Rimondini, M. (2011). Communication in cognitive behavioral therapy. Springer.
- Saffran, J. D., Muran, C., & Eubanks-Charter, C. (2011). Repairing alliance ruptures. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 224–238). Oxford University Press.
- Wachtel, P. L. (2011). Therapeutic communication: Knowing what to say when. Guilford Press.
- Westland, G. (2015). Verbal and non-verbal communication in psychotherapy. W.W. Norton & Company.