The Natasha Goulbourn Foundation is a non-profit organization dedicated to bringing depression to light through the use of educational lectures,

confidential crisis lines and referrals to partner psychologists.

1. USING SILENCE...utilizing absence of verbal communication. 2. ACCEPTING...giving indication of reception. "Yes." "Uh hmm." "I follow what you said." Nodding. 3. GIVING RECOGNITION...acknowledging, indicating awareness. "Good morning, Mr. S." "You've tooled a leather wallet." "I notice that you've combed your hair." 4. OFFERING SELF...making one's self available. "I'll sit with you awhile." "I'll stay here with you." "I'm interested in your comfort." 5. GIVING BROAD OPENINGS...allowing the patient to take the initiative in introducing the topic. "Is there something you'd like to talk about?" "What are you thinking about?" "Where would you like to begin?" 6. OFFERING GENERAL LEADS. . . . giving encouragement to continue. "Go on." "And then?" "Tell me about it." 7. PLACING THE EVENT IN TIME OR IN SEQUENCE. . . clarifying the relationship of events in time. "What seemed to lead up to...?" "Was this before or after...?" "When did this happen?"

8. MAKING OBSERVATIONS. . . verbalizing what is perceived. "You appear tense." "Are you uncomfortable when you...?" "I notice that you're biting your lips." "It makes me uncomfortable when you..." 9. ENCOURAGING DESCRIPTION OF PERCEPTIONS. . . asking the patient to verbalize what he perceives. "Tell me when you feel anxious." "What is happening?" "What does the voice seem to be saying?" 10. ENCOURAGING COMPARISON. . . asking that similarities and differences be noted. "Was this something like...?" "Have you had similar experiences?" 11. RESTATING. . . repeating the main idea expressed. Patient. "I can't sleep. I stay awake all night." Nurse. "You have difficulty sleeping." Patient. "The fellow that is my mate died at war and is pending me yet to marry." Nurse. "You were going to marry him, but he died during the war." 12. REFLECTING. . . directing back to the patient questions, feelings, and ideas. Patient: "Do you think I should tell the doctor...?" Nurse: "Do you think you should?" Patient: "My brother spends all my money and then has the nerve to ask for more: Nurse: "This causes you to feel angry." Reflection, Brammer and Shostrom state: ....focuses on the subjective element of what the client says. Reflection emphasizes the pronoun "you" in the phrases, "you feel" and "you think." Reflection serves a useful purpose in that it leads the client to think of the feelings and ideas he is expressing as part of his own personality and not outside himself.

The patient is encouraged to separate himself from the personalities of others and to become a person in his own right. 13. FOCUSING. . .concentrating on a single point. "This point seems worth looking at more closely." 14. EXPLORING. . .delving further into a subject or idea. "Tell me more about that." "Would you describe it more fully?" "What kind of work?" 15. GIVING INFORMATION. . .making available the facts the patient needs. "My name is..." "Visiting hours are..." "My purpose in being here is..." "I'm taking you to the..." 16. SEEKING CLARIFICATION. . . seeking to make clear that which is not meaningful or that which is vague. "I'm not sure that I follow." "What would you say is the main point of what you said?" 17. PRESENTING REALITY... offering for consideration that which is real. "I see no one else in the room." "That sound was a car backfiring." "Your mother is not here; I'm a nurse." 18. VOICING DOUBT... expressing uncertainty as to the reality of the patient's perceptions. "Isn't that unusual?" "Really?" "That's hard to believe." 19. SEEKING CONSENSUAL VALIDATION... searching for mutual understanding, for accord in the meaning of words.

"Tell me whether my understanding of it agrees with yours." "Are you using this word to convey the idea...?" 20. VERBALIZING THE IMPLIED...voicing what the patient has hinted at or suggested. Patient. I can't talk to you or to anyone. It's a waste of time. Nurse. Is it your feeling that no one understands? Patient. My wife pushed me around just like my mother and sister did. Nurse. Is it your impression that women are domineering? 21. ENCOURAGING EVALUATION...asking the patient to appraise the quality of his experiences. "What are your feelings in regard to...?" "Does this contribute to your discomfort?" 22. ATTEMPTING TO TRANSLATE INTO FEELINGS...seeking to verbalize the feelings that are being expressed only indirectly. Patient. "I'm dead." Nurse. "Are you suggesting that you feel lifeless?" or "Is it that life seems without meaning?" Patient. "I'm way out in the ocean." Nurse. "It must be lonely." or "You seem to feel deserted." 23. SUGGESTING COLLABORATION...offering to share, to strive, to work together with the patient for his benefit. "Perhaps you and I can discuss and discover what produces your anxiety." 24. SUMMARIZING...organizing and summing up that which has gone before. "Have I got this straight?" "You've said that..." "During the past hour you and I have discussed..." 25. ENCOURAGING FORMULATION OF A PLAN OF ACTION.