REFLECTION OF FEELING

(a real communication tool to take home with you)

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The reflection of feeling is the best way to get at, explore and discover, another’s hurt feelings and do some good at the same time. It is a specific therapy technique, pioneered at a branch of the Hospital For Sick Children (Thistletown-Warrendale) in Toronto, Canada. With its wide, sweeping, green and beautifully treed grounds, that old countryside place was dedicated to the residential treatment of extremely disturbed children. Some 90-100 of the most upset boys and girls in Ontario lived there at any one time. The reflection of feeling (ROF, if you like acronyms) was ‘in play’ when I was medical resident there in paediatric (child) psychiatry. What worked for those children then is bound to work for almost anyone, even now. That is one reason why I am writing this.

I consistently used reflection of feeling in clinical practice (in both general medicine and psychiatry) for over 50 years with singular success. But, virtually nobody I talk with nowadays appears to know about it. It’s one of those neat little clinical tricks that seems to have fallen by the wayside. That’s the other reason for this little piece.

Now, if some people feel like ‘dumping’ out their feelings it is hard to stop them. On the other hand, when a concerned person (parent, friend, therapist, family doctor), unsolicited, asks about or points out a person’s feelings, a lot of people, including little children, may well clam right up – particularly if the feeling is anything but happiness. And some even deny that. Certainly, anger is about the most commonly denied feeling, although feelings associated with sexual appetite may come in a close second. In short, some people dump their feelings indiscriminately, while others may need help expressing them.

So, for those who need it, how can we deliver feelings as safely as a doctor delivers a baby? That is to say, how can we do it in a ‘hygienic,’ non-reifying and therapeutic way? One method, tried and true, is the reflection of feeling. But before laying it out, let’s see how not to elicit feelings. Mind-picking and mind-reading are two essentially noxious approaches commonly used by parents, teachers, bosses and police. Neither is recommended as part of any kind of ‘kind’ treatment.

MIND-PICKING

Any comment or sentence, aimed at emotions, with a question mark at its end, is prying, mind-picking. “Aren’t you upset? Are you angry? You’re depressed – aren’t you? Scared?” It is hard to convey compassion in a question. If a person is sad and depressed, the question, “You’re depressed, aren’t you?” is an overt intrusion. The injunction, “You ought to see a shrink,” will be next, and that is a gross insult.

In the hands of teachers mind-picking is basically quizzing: “What is the sum of 2 + 2?” It is quite expected, appropriate and innocuous. Teachers are allowed to pick minds.

Doctors have the unique license to ask intimate questions about body systems, but if a patient has a mild cough it is inappropriate and insensitive to dig right into, say, sex life, or, into private feelings. It’s like doing a routine rectal exam, immediately, on anyone with a sore throat!

In the hands of police mind-picking is interrogation: “We know you did it! You’re guilty, aren’t you?” Because interrogation is essentially accusatory, fraught with potential dangers to human rights, its use must (should) be prefaced with a legal warning. Screeching out the word ‘scumbag’ is not enough to impart that! To have legal counsel during police interrogation is a hard-won right.

MIND-READING

Nobody can really read minds. But some parents almost can. And some people think they can. Almost all parents indulge in ‘mind-reading’ and very small children expect it: “I know you’re not feeling well. You’re upset, angry, bad…” The child might think, “Who else will (miraculously) know how I am, if my parents don’t?” But parents and parents only, with their implicit-explicit love and acceptance, are the only people with a privilege to ‘read’ immature minds. And even then it must never be done with such judgmentally pejorative words as stupid, bad, etc. To observe and say, “You’re angry, You’re upset, You’re cranky,” is OK when tendered gently. Such observations discharge an essential parental task. They teach their child to understand and clearly label his/her own feelings, as well as commiserating and helping the child to cope with them. But by saying this sort of thing to other adults, people impose an awfully irritating familiarity – attempting to read another person’s mind is quite impossible to do outside of the family framework in childhood and, to boot, is inherently offencive. Even the most compassionate rendition of “you are angry” is a presumptuous put-down that more often sounds like an accusation, and if not meant that way comes across that way. If the other person really is angry the statement “You’re angry!” will make them even angrier. Minds cannot really be well read. (But think of it: Police and scandal show hosts ‘read’ minds with polygraph machines and do pretty well at it.) Summing up, no one, not even children (certainly as they get older), likes a stranger or anyone to read their mind – unless they are having a lark and paying a psychic to do so.

Everyone almost intuitively dislikes these clumsy mind-reading and mind-picking ways. Used in what should be a compassionate setting, therapy, they are almost always intrinsically authoritarian and insensitive – by definition slipshod. “You’re angry, aren’t you? You’re depressed.” In the face of such queries and assertions children and adults, both, tend to clam up when they should open up. Mind-reading and mind-picking in the mouth of a therapist bespeak a temporary lapse of polite thoughtfulness at best, incompetence at worst. To sum up thus far, any assertion is mind-reading and any query is mind-picking. Both will do more harm than good when used to dig for feelings in therapy.

And now we come to the one tried and true method of properly getting at and getting out locked up feelings, namely, the reflection of feeling (ROF). Doctors and therapists have a timely responsibility to dig into patients’ feelings – but only quite appropriately. Everyone should approach anyone, not only children, in the gentlest way possible. On top of those basics, our well-designed method enables yet more.

REFLECTION OF FEELING (ROF)

Here’s how to do it. The main message, in words, is deceptively simple:

“You seem

as ifyou’re upset. You lookas ifyou’re a bit down.”

“You act

as ifyou are sad, scared, irritated, disgusted.” Et cetera.

1) Note the key syntactic use of

as if: The crucialas ifphrase gives the patient, especially a very upset child, a face-saving, comfortable, temporary ‘way out’ if not yet ready to open up and talk. It enables the hurting person to deny private feelings until they feel safe in acknowledging them. A patient might at first grump (lie), “I’m OK!” really meaning, “Leave me alone.” But that is OK too – for now. The essentialas ifphrase always makes it possible and permissible for a therapist (or any truly concerned friend for that matter) to come back to the subject at another time. And that they should. Follow-up is part of it.

2) The ROF is kindly and engenders trust: The tone of voice (kinesic metamessage in communication terms) accompanying the words must be compassionate, gentle and accepting. One’s posture and facial expression will also fully harmonize to convey genuine concern and interest. Sit back relaxed, alert and open – with arms apart (definitely not hugged across the chest) and palms partly up. Don’t make this visual openness too obvious or it may come across as phony.

3) Semantics: The ROF is never ever blunt. For once, vague mild euphemisms are permissible, even desirable. When trying to tap into anger, you might use the word ‘irritated’ instead of ‘angry.’ In most cultures the admission of anger as such will be denied even if the person is foaming at the mouth. “You look as if you’re in a ‘bad mood'” is sometimes all right. Use ‘upset’ at other times and for other feelings such as fear and sadness. You can always be more specific later. It’s not a bad idea to comment upon happiness when it happens. “You look as if you’re a bit happier than you were.” Getting the upset person to dwell on nice things too is all part of ROF. It is cognitively sound Rx. The gentle use of words is tactful on the part of a doctor or therapist and face-saving for patients. Use discretion and common sense about semantics.

And that is it. Practise doing it, over and over again … until it feels natural.

USES OF ROF

The reflection of feeling is primarily a therapeutic tool. And, by eliciting blocked or unlabelled feelings it is diagnostic too. But don’t reify feelings; don’t give them a life of their own outside of social transactions. The next step is to show the person how to label and recognize his/her own feelings. Then, in therapy they can work on how their emotions are used with others, between themselves and others.

ROF is very valuable in marital counselling (as well as in family therapy). Married couples really benefit by learning a way to tap into each other’s feelings. Each partner needs compassion for the other’s feelings and point of view. Most are not all that good at it, and welcome this tactful addition to their repertoire…

But please note this important difference between the genders! Men and women feel fear and shame at different levels. It is crucial to realize that men avoid conversations if they think they’ll be criticized (shamed). Suggestion: In marital Rx, before leaping into getting everything out in words (ROF), encourage couples to connect nonverbally with touch, sex, dancing and doing things together.

Again, reflection of feeling is a clinical technique that takes practice. It must be tried over and over again with gentle patience and persistence, with an expectation for and acceptance of repeated temporary failures. As hinted at, it is more than a mere clinical technique; it can be a human asset. But, to reiterate, it requires practice with normal people and much practice with disturbed people.

It is noteworthy that the psychopathic person, while often extremely good at dispassionately reading others, usually displays a hollow, masked and essentially false set of personal feelings; ROF may not work with them. You can be deceived!

In the long run, however, the method does work. When hurt feelings that are denied or suppressed are finally openly acknowledged and clearly labelled, perhaps with some emotive ventilation in the process, the door to subsequent discussion and real change in behavior is opened wide. To emphasize, this empathic labelling is not just diagnostic, it is therapeutic. It is healing by its very nature – for it conveys, in an acceptable way, that someone understands and cares.

The ROF should be a very valuable addition to the pediatrician’s and family doctor’s repertoire. Perhaps all doctors. The reasons are outlined in a special note below. Here, no more need be said.

Incidentally, reflection of feeling is also helpful in everyday adult social intercourse, at parties and the like. If you are not too obvious about it (and so come across as intrusive), in addition to opening up wider vistas of other people’s minds, the ROF will subtly leave them with warm fuzzy feelings about you. You could become oddly popular with little or no effort! Do you think that’s sneaky or just a nice friendly use of uncommon sense?

Note: In order to do a reflection of feeling in the first place, a person has to be able to pick up the subtle kinesic emotional signals that are automatically sent out by all feeling people. (Sherlock Holmes, in a virtuoso display of tuning in to facial expressions, read Dr. Watson’s mind in

The Adventure of the Cardboard Box.) In this regard, those that engage in mind-reading and mind-picking really do the same; they are good natural lie-detectors. The essential difference is in the way it’s done: reflection of feeling is considerate and nice; mind-reading and picking are not so nice.

As Thomas Fuller MD long ago said, “Seeing’s believing but feeling’s the truth.”

CAUTIONS

As with any powerful method or technique, however seemingly simple, there can be a downside. Sometimes it is not healthy to express or pull out inner feelings at all. Here are some cautions to bear in mind:

Negative emotional expression (of core feelings like anger-rage, fear-terror, disgust, sadness and their socially complex variants of hate, shame, pathological jealousy and many more) needs to be well timed or sometimes temporarily tamped down.

Encouraging the release of pent-up feeling, as in time-honoured ‘ventilation’ therapy, may give rapid temporary relief in crisis situations, but is not recommended as a general remedy. Some people tend to get into the silly game of what Eric Berne called ‘greenhouse flower.’ They revel in their noxious feelings, fondly tend and water them, but do nothing constructive about them! Normal grief and ‘dry’ depressions are exceptions: The very constricted person may be gently coached to be normally, socially expressive. Be extra careful if any notion of suicide comes up. Profound melancholy combined with hopeless thoughts calls for serious professional help. But, if you’ve got someone in front of you or on the phone sobbing uncontrollably, don’t nervously shy away. You must help them see things through. Get a distraught person to a hospital ER if

youare scared.

I emphasize that ‘getting it all out’ indiscriminately, especially deep-seated rage, may sometimes backfire and be quite dangerous. Tamping it down may, in the short run, be prudent; I would not say that for any other emotion. The brittle, poorly controlled, internally roiling, frustrated ‘postal’ worker if foolishly, carelessly opened up might just, at long last, translate simmering rage into violent action; the same with loner high school students. It is well to heed the wise old surgeon’s adage, “If you are going to open up someone’s belly, make sure you can get back out safely

beforeyou start cutting.” The same applies to someone’s mind and negative angry feelings. Unless you are well trained, never try to open up the inner feelings of a psychotically paranoid person. It is fact that such people who may habitually hold things in at home, farther afield may start seriously rampaging, running Amok! in an unrestrained, towering rage. This can be precipitated by ‘forced casual dumping’ inadvertently brought on by a naive but well-intentioned, evocative-type, therapist. To reiterate, unwisely opened up, angry people not only need to be heard out for as long as it takes, but to be taught and brought to contain their anger. My pet slogan for dealing with anger that is clearly proceeding to uncontrolled rage: release cautiously, label carefully, or contain it. That is the therapist’s goal – that should come to be the patient’s goal too. If you are really worried (that someone is on the edge), and cannot get the person to a hospital, you might just have to call the police.

Please don’t let these ‘dire’ cautions scare you off. The reflection of feeling is safe with children as long as you are keeping an eye on them. In fact, it is the preferred way of dealing with the full range of children’s feelings – from toddlers to pubescent pre-adolescents. As a parent try it and practice it. As a loving spouse do the same for your marriage. Emotional ‘first aid’ is within the purview of all sensible people. But, repeat, do not try to play around with any seriously disturbed emotional state in adults or teenagers! Avoid being a casual dilettante. See things through and if you open up a mess, immediately get, insist upon, fully qualified professional assistance.

A SPECIAL NOTE TO MEDICAL DOCTORS

Of all helping professions, doctors daily confront the strongest of emotions in their patients. Knowing these feelings, the apprehensive fear of the unknown or the sadness and grief of loss, more accurately, is an essential part of thorough diagnosis and may enhance the outcome of any kind of treatment, surgical and medical, physical and mental. It is my observation that doctors use too much mind-picking and mind-reading and unwittingly aggravate their patients – right into the laps of lawyers. Understanding and suitably dealing with anger or even rage at unwanted treatment results may avert litigation. But, if it comes to that, gauging greed may just partly immunize the hurting doctor and facilitate self-healing. So, I say, learn ROF! The ROF is a very simple technique to learn. Physicians should make it a key part of their clinical repertoire. I assert this, without absolute scientific proof, because the method along with its intent is morally good and ethically sound. Used right, it will do no harm.

SUMMARY

The ROF is the best way to get at another’s hurt feelings and do some good at the same time. Reflection of feeling packs a powerful wallop: in one neat little package it combines a diagnostic method with a treatment technique and they both act simultaneously. It is not, as some ‘hard-nosed’ conservatives might think, a ‘bleeding-heart’ libertine fuzzy-wuzzy. It is an effective and genuine tool for drawing out truth. It can be used by anyone.

Disclaimer?

The truth will out … and who said that? Oops, sorry for the mind pick.

If the Reflection Of Feeling is ever twisted into a tool for prying or manipulation – for ‘bad’ instead of good – I’d be less surprised than anything else. Steel can be pounded into swords as well as moulded into ploughshares. So, keep a sharp eye open for its misuse as a part of the good-cop bad-cop ploy in police interrogation. It’s bound to happen. Should the CIA ever use it, please afford me a bit of credit – as ROF is definitely nicer than water-boarding. /End