A Case study in sleep paralysis: Rosie

In our assessments of sleep paralysis we came to understand there is a link between sleep paralysis and certain disorders including anxiety, general stress and sleep apnea. The following is a brief diatribe wherein I suggest that there is a greater link between those with schizophrenia and schizophrenia like disorders, who have also been diagnosed with sleep apnea, and sleep paralysis. In particular, I will be providing a brief case study of one client and her apparent symptoms. It must be noted here before proceeding that the suggestions made in this paper are speculative in nature: I can not ascertain their validity or reliability without further assessment and deeper analysis. All qualifying personal information has been removed to uphold confidentiality.


Rosie is a geriatric African-Canadian living with an intellectual disability and she has been formally diagnosed with schizoaffective disorder bi-polar type, chronic obstructive pulmonary disease (sleep apnea), and she exhibits obsessive compulsive like behaviours.

She exhibits typical symptoms for her diagnosis including delusional thought (including persecutory delusions), visual and auditory hallucinations, blunted affect, and alogia. She experiences intense mood swings which invariably affect her behaviour, and she has a general negative attitude. This is particularly exhibited in relation to herself, as well as in her relationships with others. She does not appear to put much faith in others’ reliability or loyalty. It is difficult for her to form and maintain relationships, and she is often closed off from others. In times of great stress she will express her anger and frustration with self harm, screams, shouts, expletives, and eventually aggression towards others. This sort of anxiety can be mediated successfully with anticipatory interventions, and due to her propensity towards anxious states it is best to avoid causing more anxiety or stress.

When Rosie is experiencing a hallucination she appears engrossed in the event as if she is watching a film. It is difficult to pull her from this engrossment and she pays little attention to voices and actions outside of the hallucination. She has demonstrated interaction with her hallucinations through her actions and her speech. At times it appears she is talking to herself, when it is more likely that she is actually communicating or interacting with her hallucination. She does not appear to be negatively affected by these hallucinations or delusions, during the day.

It appears that the ferocity and frequency of her hallucinations increase throughout the day, peaking particularly prior to sleep. I am not sure if this is due to added stress about completing nighttime routine, the thought of sleep, or anticipation of increased hallucinatory experiences.

Rosie uses a continuous positive airway pressure (CPAP) machine on a nightly basis. She averages 12 hours of sleep a night, but it appears this sleep is interrupted. This being due primarily to her sleep apnea and COPD. It is my estimation that her hallucinations worsen during sleep, and that this invariably contributes to her interrupted sleep. Not only does this contribute to disrupted sleep, it contributes to her heightened anxiety and stress related to sleep. This in turn increases the likelihood of more hallucinations. I am not sure if these hallucinations stem from her schizoaffective disorder, or if they more likely are linked to sleep paralysis. I can not confidently determine one way or the other.

In moments of sleep paralysis, the dreamer typically is witness to hallucinations, particularly insidious and persecutory hallucinations that cause great fear and stress. In these moments the dreamer tries to escape the situation. Due to the their vividness, these hallucinations appear real, instilling great fear in the one experiencing them.

As Rosie sleeps and dreams she shouts, uses expletives, and screams. Upon arriving to her room to offer assistance, she can be seen with her body twitching, convulsing and thrashing gently. It appears as if she is trying to wake herself up. These may be nightmares, but it is my estimation that she is in fact experiencing sleep paralysis related hallucinations.

I am led to believe this because of the sheer intensity of these hallucinations in comparison to those experienced throughout the day. They appear to be much more intensely felt, and she appears to be much more fearful of these. This indicates to me that they are outside of the realm of normalcy for her. Her attitude towards these hallucinations is that of concern and fear, and it appears as though she is trying to escape the situation both physically and mentally: evidenced by body thrashing and twitching upon regaining control of the body.

Further evidence points towards Rosie’s condition as being related to sleep paralysis. Hishikawa and Shimizu (1995) inform us that motor paralysis due to REM sleep can cause breathing difficulties, including what may appear like choking or suffocating. It may feel as if there is a weight or pressure on the chest, making it difficult to breathe deeply without feeling as if one is being suffocated. This is interesting to note because Rosie has been diagnosed with COPD. Could these feelings also be intensified through sleep paralysis? We know sleep apnea to be one disorder that contributes to the onset of sleep paralysis. While Rosie is diagnosed similarly, could this be contributing to her (as of yet undiagnosed) sleep paralysis? Simply put, her pre-existing breathing condition contributes to sleep paralysis, and her sleep paralysis contributes to her breathing condition, ad infinitum.

Although this information helps us in conceptualizing her sleep paralysis condition, what we are most interested in is the hallucinatory components of sleep paralysis, in particular Rosie’s nighttime hallucinations. I am unable to confirm sleep paralysis as a primary diagnosis for Rosie. Sleep paralysis at this point is mere speculation based on variance in hallucination profile from day to night, the intensity of the hallucination, and the apparent escape tactics used while experiencing these hallucinations. I do believe however, that due to the constant state of stress and anxiety Rosie is in daily, along with her diagnosis of COPD/sleep apnea, that it would be highly likely for her to experience sleep paralysis from time to time. Anywhere from 8% to 44% of people will experience sleep paralysis at one point in their lives, and according to psychologists at Penn State and Pennsylvania University, sleep paralysis occurs more frequently in students and psychiatric patients (Penn State News, 2011). Further, the sleep paralysis project reports that sleep paralysis more often occurs in African American individuals (www.thesleepparalysisproject.org). These statistics do not determine with any clarity that Rosie is in fact experiencing sleep paralysis, they merely contribute to my belief that she is.

In order to determine if Rosie is experiencing sleep paralysis we would need to study her case much further. We are still left with three unanswered questions. Does Schizophrenia contribute to sleep paralysis hallucinations (and what should we consider the primary diagnosis: sleep paralysis or schizophrenia?) Are hallucinations experienced by persons diagnosed with schizophrenia and schizophrenia like disorders more vivid, insidious or threatening in sleep paralysis? And does schizophrenia heighten one’s awareness of hallucinatory experiences, thus making it not only more likely for a person with schizophrenia to experience sleep paralysis, but for them to also be more aware of the accompanying hallucinations?

We are left wondering if the diagnosis of schizoaffective disorder is correct, or if perhaps hallucinatory complications arise due to sleep paralysis. Constant stress and anxiety contribute to sleep paralysis, and sleep paralysis is accompanied by hallucinations. We must consider daytime hallucinations. These could be explained by hypnagogic sleep paralysis: sleep paralysis which occurs prior to sleep. It would make sense for Rosie to be in a constant state of exhaustion due to her disrupted sleep caused by COPD. This could be cause for a general lethargy, perpetuated of course by anxiety and stress. The cycle of over-tiredness due to the avoidance of sleep or experiencing disrupted sleep is continuous and unrelenting. This lays way for sleep paralysis and hallucinations, the fear of which contributes to the avoidance and disruption of sleep.

Due to our prior observation that daytime hallucinations appear different from nighttime hallucinations, it would not make sense for us to dismiss schizoaffective disorder as the primary diagnosis. Although I am sure upon further analysis we could make a compelling case for why daytime hallucinations occur, and are experienced differently from nighttime hallucinations, we will not expel resources to do so now.

Rosie is but one case of many, and I believe it is important to conduct further research into the relationship between schizophrenia and schizophrenia like disorders and sleep paralysis. I propose some of our questions would be answered, and upon uncovering these answers we would lay way for many many more questions.


Hishikawa, Y., & Shimizu, T. (1995). Physiology of REM sleep, cataplexy, and sleep paralysis. In S. Fahn, M. Hallett, H.O. Lüders, & C. D. Marsden (Eds.). Advances in neurology (Vol. 67, pp. 245-271). Philadelphia: Lippincott-Raven.

Psychologists chase down sleep demons. (2011). Retrieved from: http://news.psu.edu/story/154433/2011/10/17/research/psychologists-chase-down-sleep-demons

Prevalence. (2017). Retrieved from: http://www.thesleepparalysisproject.org/about-sleep-paralysis/prevalence/

Saying Goodbye & What I’ve Learned

We work in a vulnerable profession. The people we work with are considered part of the “vulnerable populations”, and through working and living with them they teach us how to become vulnerable. Through our caring for them we start to break down our own walls and open ourselves up to growth, change and learning about ourselves and others. As with any relationship, we form attachments. These relationships are symbiotic, and very rarely do we recognize this. We see ourselves as a sort of essential component in their lives without recognizing the overwhelming impact they have on ours. Our lives become shared experiences –they are very much a part of our lives as we are a part of theirs. I think it isn’t until we face the challenge of living without these people do we realize just how much of an impact they have made.

The people we work with teach us how to communicate, how to express our feelings, and how to foster and maintain relationships. Typically this occurs in such an atypical fashion that we fail to recognize it as a learning experience, or an opportunity for growth. In my experience working in this profession our learning occurs in a very nuanced and subtle way.

First, let me begin by introducing you to one client in particular who had a significant impact on my life. Let us call him “Barry. Barry is a middle aged man with an intellectual disability on the Autism Spectrum Disorder. He uses cryptic language to communicate, talks through his stuffed bears, and exhibits typical symptoms found on the DSM scale for Autism. Typical interventions used are visual stories, following a set schedule, and providing Barry with different options to choose from. Typical of ASD is a stunted ability to express emotions, which we can see when Barry becomes frustrated or upset and is unable to share with those around him, either through body language or words, how he is feeling. This can be frustrating for someone who uses typical modes of communication, and quite often, things get lost in translation. In these situations you need to stop and ask yourself how frustrating would it be to know how you’re feeling, but be unable to share that with another person so that they too understand how you’re feeling? That must be hard. You then have to ask yourself, how can I express empathy and understanding, without being able to understand fully? Carl Rogers shows us how important and essential empathy is in any relationship (Rogers, C., 1951;1961). The ability to understand another person’s soul. The ability to understand the pain, joy, anger, frustration they are experiencing is one of the most intimate and connecting abilities we as humans have. When we emote with another person and they are able to express their complete understanding and acceptance of that we feel a new sort of connection with them, we feel seen and understood. Empathy fosters connectivity and a deeper level of intimacy with others, and it opens doors for stronger communication and relationships. Erich Fromm details the eight basic human needs, one of which is relatedness (Fromm, E., 1941; 1997). Relatedness can be achieved through the relationships we form, sharing our innermost feelings with others, and having them understand those feelings through empathic understanding. Now imagine being a person who has an inability to connect in such a way, a block of some sort which makes it difficult, sometimes what may feel near impossible, to connect with another person in such a way. How would you feel? Perhaps lost, disconnected, frustrated, angry, irritated? The list could go on. What are we to do? Are we to alter our communication, tailor our interactions with this man and others like him?

The reality is that those living with ASD are no less able of communicating, emoting, or experiencing fulfilling empathic relationships, it just takes a bit longer, and it may display itself in a different way. If relatedness is a basic human need, even those with alternative ways of communicating or emoting, will find a way to fulfill that basic human need. What has Barry taught me then? Barry has taught me that we communicate in different ways and the only way we will be able to understand each other is if we are open to and willing to understand each other, even if that involves extra work. With most of our relationships communication comes much more easily, we speak the same language, we express similar emotions to the same triggers, we become comfortable while around each other. This makes us lazy. We are so keen to believe we understand each other we fail to try. Barry shows us to listen to the silence, to attend to the potentially cryptic language, to ask the right questions and to make room for each other. Sometimes in relationships one person takes up more space and that’s okay. In our laziness we fail to see how hard others may be trying. We need to recognize how easy it is for us to emote and connect with others, and how potentially scary it may be for someone like Barry to do the same. This teaches us to be more understanding, patient, and open to forming relationships and perhaps helping others form the same relationships. We don’t all speak the same language, and we’d certainly be boring as a species if we did.

We are so wont to believe that they need us just to live and in the process we other them, believing that without us as their support they would fail to survive. This is the furthest thing from the truth.

Aside from teaching me how to communicate and how to listen, Barry also showed me what it means to be in relation with another person. He showed me how difficult it may be at times, and how two completely different people can develop and foster a meaningful relationship through mutual understanding, trust, and awareness of the other. Although difficult at times, potentially extra-strenuous, the relationship which I built with Barry showed me just how important the qualities listed above (trust, understanding, awareness) are in building a relationship with another person. A quality I did not list but which is equally as important is acceptance. Rogers presents unconditional positive regard as an essential component in a therapeutic relationship (Rogers, C., 1951; 1961) and there is nowhere in my life I have been able to experience this quality more than in my relationship with Barry. In fact, he showed me just what it looks like.

Regardless of what I wore, how I acted, or how I was feeling, he continued to accept me as I was, and continued to acknowledge me as an autonomous person. This may not have happened instantaneously, in fact, there were times where he needed to process why I wasn’t wearing jeans when he asked me to, or why I was upset with something he said to me – but after this period of processing, he would be able to look at me and see me for who I was, and still accept me as my self. This was one of the most powerful experiences I had while living and working with Barry.

As I reflect upon what I have learned from the people I have met and worked with, I come to think very fondly of the intimate moments I shared with the persons I was charged with caring for. Care-work is much more than a profession, it seeps into every facet of your life, and what you learn while working with others stays with you once you’ve severed ties. Throughout my time in this profession I learned not only how to care for others and come to understand the myriad of ways in which we as humans can care for and express our care for others; I learned how to care for myself. Care-work and self-care are inextricably intertwined, and I’ve touched on this before – the importance of caring for yourself and replenishing your energies so that you do not experience burnout. Even outside of care-work however, it is an important take-away: make time for yourself. I will not outline here the endless ways in which you can practice self-care because that would be an interminable digression. The important thing to remember is that care-work teaches you how to handle yourself in a much more understanding, forgiving fashion: and this attitude extrapolates to all other relationships you currently have or are in the process of building.

The next client I would like to discuss is someone who has taught me a number of things including self-acceptance, self-awareness and forgiveness. Let us call her “Rosie”.

Rosie is a senior living with schizoaffective disorder bi-polar type, with observed OCD like behaviours, anxiety and substance over-use/dependency. She spends a significant portion of her time in quiet contemplation and solitude. At times she will scream or yell, shout obscenities or appear to be talking to herself. In these moments it is important to understand who the vocalizations are directed at: are they directed at others, herself, or perhaps her hallucinations? This conundrum eluded me sometimes, but I tried my best to give her her space. In instances where she would exhibit increasing anxiety while vocalizing, it was important to assess whether this anxiety came from my failing to communicate with her, or if it stemmed from an internalized mental experience.

When Rosie exhibits anxiety it may very quickly escalate into self-harmful behaviour. This self-harm is a way to regain power and control, or could very well be a response to a persecutory hallucination. Even though we do not know the reasons behind it, this self-injurious behaviour serves a purpose. Although we do not want Rosie to injure herself, we are unable to control for it at times and the best thing to do is to try to understand her as a person, instead of trying to keep her from injuring herself. Again, here we return to Rogers’ idea of empathic understanding, and unconditional positive regard. The best way to get to know someone, to truly see into their soul and express back to them your complete understanding of them, is to express and practice empathy with them. This becomes difficult with someone like Rosie, who has only ever experienced understanding as controlling. Controlling for anxiety, behavioural issues, injurious behaviour, violent tendencies and so forth. Perhaps the behaviours we fail to understand are her way of trying to communicate and instead of listening and being receptive to this we control the behaviour because it is atypical, therefore wrong. This is how Rosie taught me about self-awareness.

I very quickly became more aware of the things I said, the way I acted, even things as simple as my body language, tone, and facial expressions. Sometimes the way we communicate with each other can misconstrue the things that we are saying. Our tone, body language and facial expressions are saying one thing while our words are saying another. This can cause confusion, and makes it more difficult for trust to flourish. Trust is a fundamental component of any healthy relationship, without trust as our foundation we cannot build a solid relationship. This awareness did not end with myself, I became more aware of others non-verbal communication patterns and was more receptive to deeper meanings. This also led to a greater understanding of the way others communicate and the possibility for their not being alternative meanings. Perhaps, there are other explanations for why the tone did not match the message being shared. Rosie taught me to read into things when needed, and to recognize things at face value when needed.

Along with her lesson in self-awareness she taught me forgiveness and self-acceptance. Forgiveness because we all make mistakes, and she was quick to apologize when needed: sometimes she apologized when there was no need to. Her apologies came quickly, and sometimes she didn’t understand why she was saying she was sorry. I’m sure this stems from something in her past that makes it so easy for her to apologize, sometimes needlessly. The important thing she taught me was that sometimes, even when we don’t know why we’re apologizing, we need to do it anyway. This is because the person we have hurt needs to hear it said – there is always a reason we apologize (to mend broken hearts, hurt feelings and relationships) but sometimes we aren’t always completely aware of why. It isn’t until after the fact do we understand why the apology was needed. Being stubborn about apologizing only increases hurt feelings, making it more difficult to rectify the situation. On the other side of the argument, forgiving someone can be just as hard as apologizing. It’s a matter of pride: Rosie taught me pride means nothing when it comes to mending hurt feelings. Pride merely gets in the way, and relationships are much more important than personal pride. Admitting your faults is a sign of strength.

The last thing Rosie taught me was self-acceptance. Akin to how Barry taught me what unconditional positive regard looks like, Rosie taught me what real self-acceptance looks like. She struggled with body-image issues, and the majority of the time was quite distressed over her weight and the size of her stomach. She would compare herself to others around her wondering why they were so skinny and she wasn’t. Sometimes she would say things that made it clear her desire to be skinny was heavily influenced by those in her life who had told her before how important it was to lose weight and get smaller. There were times of quiet where I’m not sure if she had actually started to think of something else, or if she was sitting ruminating on these negative perceptions of herself. When she didn’t vocalize these feelings, I merely assumed she had forgotten about the issue, but I have a feeling these thoughts remained with her in the back of her mind permeating through every day, and every activity. There were times when she would become increasingly anxious and would vocalize an issue with her stomach or weight. This leads me to believe she was in fact ruminating on these perceptions, and for the most part these fuelled her anxiety. The amount of distress she experienced over something as seemingly insignificant as her weight caused tension in all other areas of her life. I can’t conclude with any authority that Rosie has accepted herself, or that there have been any significant changes in her mindset. She did not lead by example. However, watching Rosie become increasingly distressed over her weight encouraged me to practice self-love and acceptance. She showed me how important it is to accept yourself, be forgiving of your faults and shortcomings, and change what it is about yourself you don’t like.

Just like Barry, Rosie projected acceptance and love more so on others than on herself. In these moments, the importance of self-acceptance was reinforced.

We consider ourselves as care-workers to be the leaders, the teachers, the guides, when in all reality it is our clients who are teaching, leading and guiding us. They open our eyes and minds to a plethora of experiences we would not be open to experiencing if not for them. They also provide us with different ways of seeing and understanding things. There is nowhere in my life where the sentiment of different intelligence’s is more obvious than in care-work. Not only are you exposed to these different forms of intelligence, you are exposed to varying presentations of these intelligence’s. Each new day is a marvel, learning how others see and make sense of the world around them, and coming to the realization that you, sadly, are missing a large percent of the world and its happenings because you are stuck in the monotony of typical modes of intelligence. Your being stuck in these modes not only limits your ability and willingness to see the world from a different perspective, it blocks you from experiencing life to your fullest ability.

I have learned a great many things in this profession, particularly that care-work can be stressful, frightening, and challenging. At times these challenges may overwhelm us, leaving us feeling drained and empty. When we step back and reflect on our experiences we are able to see the work we’ve done has made a difference, but our work is just the beginning. Our care-work is much more a self-reflective experience than it is a mode of treatment or assistance for others. Through this self-reflection, and of course our close work with our clients, we form meaningful attachments. These attachments strengthen our sense of self, and bolster our understanding of the world around us. When we sever these ties we feel the aftershocks of detachment. If there is one thing I can take away from these experiences with any confidence it is that there is nothing more challenging, frightening or stressful than saying goodbye.

Fromm, Erich. (1997). On Being Human. London: The Continuum International Publishing Group Ltd.

Fromm, Erich. (1941). Escape from Freedom.

Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable.

Rogers, Carl. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable

The Power of Listening

The reason therapy works for so many is because therapists are trained to listen to their clients, and this active listening lets the client feel that they are important and what they have to say is important. When someone accesses therapy it is typically because they have something they need to communicate and have no one in their lives that will listen. This may present itself in different ways; either they have no one who is available to listen, or they feel threatened in some way by the people in their lives – perhaps what they have to say could be misconstrued as damaging to their character, or may be generally embarrassing – but they still need and are seeking help. They are seeking someone to offer an active ear and a non-judgmental, empathetic approach to their situation.

I do not believe that active listening and empathy are limited to therapeutic settings. Typically when laymen think of therapy they imagine a client lying on a couch pouring out their feelings across from a clinician expressing “how does that make you feel?” This is not how all therapy unfolds, and a lot of therapy does not have to be as structured. However, because of this conceptualization of therapy, it is believed that if there is no couch or no closed room, therapy cannot happen. This is not necessarily the case.

I have met with a number of persons who have needed counsel outside of typically identified therapeutic settings, and the same components were present – empathy, non-judgmental attitude and active listening[1]. Empathy and active listening are two very closely related actions which can be combined in order to create empathetic listening, which Burley-Allen characterizes as resisting distractions, noting and acknowledging the speaker’s verbal and non-verbal communication, and being empathetic towards the speaker’s thoughts and feelings (Burley-Allen, 1995).

image-17Interpersonal connectivity : sharing thoughts, feelings and emotions

Stewart and Logan (2002) identified three competencies in developing empathetic listening, which include focusing, encouraging and reflection. All three competencies work together to encourage the speaker to communicate their feelings, issues and desires. It also allows the speaker to feel more at ease while discussing their thoughts. Ender and Newton (2000) demonstrate the importance of paraphrasing the thought and feeling of what the speaker has said in a non-evaluative way, while still interpreting their understanding accurately. This is important because we do not wish to make the speaker feel uncomfortable, or uneasy. We want the speaker to feel able to express him or herself free of judgment, so we must take care to withhold judgment from both thoughts and feelings. This is directly linked to empathetic understanding, which as we know, is the understanding of the clients’ views and experiences from their frame of reference (Ender and Newton, 2000). Cuny, Wilde and Stevens (2012) point out that through empathetic listening and understanding we can help the client/speaker develop personal understanding. Empathetic listening can be used to promote communication, develop cognition and enhance self-concept. Empathetic listening and understanding also promotes a specific attitude which translates to the client as them having worth, and something to offer, which helps develop self-confidence (Cuny, Wilde, & Stevens, 2012).

Stanley Jackson states that “the psychological healer, in particular, is one who listens in order to learn and to understand; and, from the fruits of this listening, he or she develops the basis for reassuring, advising, consoling, comforting, interpreting, explaining or otherwise intervening” (Jackson, 1999). This demonstrates the importance of listening for the counselor, outside of building trust and offering a cathartic experience for the client. Of course, listening is important in assisting the client through catharsis, building trust between client and counselor, and aiding in self-development, esteem and efficacy; but it is also important in understanding the client and situation better. We are unable to help a client without first knowing, and understanding, what it is they need help with. It is true, that listening in and of itself is powerful in facilitating healing for the client; but we must be able to provide further assistance after the fact, through proper application of interventions or therapies.

The most relevant person to mention while discussing the power of listening is of course, Carl Rogers, who championed empathic listening in his client-centered therapy. Rogers identifies the value of empathy in a multitude of ways. First he states that empathy indicates to the recipient that someone cares for, accepts and values who he is as a person (Rogers, 1975). He states that empathy “dissolves alienation.” That is, it breaks down barriers between person and therapist (Rogers, 1975). The analysand in question is requiring attention and care, possibly for issues that may arouse judgment or isolation. Through our use of empathy we no longer see alienation as an option, and we allow the clients to fully express themselves, to fully experience the all too needed catharsis. This of course, leads to better therapeutic results.

There cannot be active listening without empathic understanding; the two go hand in hand, and work in conjunction with each other. By understanding a person more fully through our listening, we pave the way for the client to understand himself in a full or complete way without inhibitions (Rogers, 1975). Rogers indicates that by our full understanding of the client we offer them a way to understand their self, which facilitates congruence (Rogers, 1975).

Rogers and Farson (1987) show that people who are listened to in such an active and sensitive way learn to apply such methods to themselves, and listen with more care and are able to vocalize more precisely how they are feeling and what they are thinking. They identify that there are two essential components to what a speaker is saying; there is the content of the message, and the feeling or attitude, which underlies the content. Both are equally important and must be attended to in order to understand the complete picture, (Rogers, C., & Farson, R., 1987). There are a few ways that we as listeners may attend to these underlying messages: firstly, we must consider the emotions, and respond to the feelings conveyed by the speaker. By our responding to the feelings we acknowledge the speakers emotional state, and offer a space where they may feel safe and able to express themselves. Secondly, we must note all cues; facial expression, verbal cues such as inflection, speech style, and body language. All of these things may work together to let us know more of what the speaker is trying to convey. For instance, a client may wish to express they are feeling hurt, but may fear reprisal and so they may try to mask these feelings. It is our job as listeners to study their body language, facial expressions and tone, all of which may help indicate the underlying emotion the client may be shying away from expressing. In this way, we may respond not only to the content, but also to the underlying emotion, which truly shows the client that we are listening and that we care.

Active listening is an important component of any therapeutic scenario, and can be employed in every interaction with another person. It demonstrates respect, builds trust, and facilitates a relationship between speaker and listener. It tells the speaker that they are valued, and it encourages them to value themselves.

Many consider listening as a passive component in therapy, when in fact it is the most significant component in any therapeutic scenario without which we would not have an understanding of the other person. Listening is a powerful tool, and truly listening leads us to develop healthier, stronger relationships with our clients, and leads our clients to better understand themselves and relationship dynamics. Listening is an all too important tool that we can apply to every scenario, and offer our clients when we find ourselves with nothing but our attentive ears to give.


[1] Therapy cannot occur without a licensed practitioner, just the same as art therapy cannot occur without a licensed art therapist. However, we can employ therapeutic methods while counselling our clients in atypical settings (within their homes, at school, on the street).



Burley-Allen, M. (1995). Listening: The forgotten skill: A self-teaching guide (2nd ed.) New York, NU: John Wiley & Sons, Inc.

Cuny, K, M., Wilde, S, M., & Stevens, A, V. (2012). Using Empathetic Listening to Build Relationships at the Center. In. Yook, E, L. & Atkins-Sayre, W. (Eds.), Communication Centers and Oral Communication Programs in Higher Education. UK: Lexington Books.

Ender, S, C., & Newton, F, B. (2000). Students Helping Students: A guide for peer educators on college campuses. San Fransisco, CA: Jossey-Bass.

Jackons, S, W. (1999). Care of the Psyche: A history of Psychological Healing, New Haven & London: Yale University Press.

Rogers, Carl. (1975). Empathic: An Unappreciated Way of Being. The Counseling Psychologist. Vol. 5, No. 2-10.

Rogers, C., & Farson, R. (1987). Active Listening. From Communicating in Business Today R.G. Newman, M.A. Danzinger, M. Cohen (eds) D.C. Heath & Company.

Stewart, J., & Logan, C. (2002) Empathetic and dialogic listening. In J. S. Stewart (Ed.), Bridges, not walls: A book about Interpersonal communication. (8th ed., pp. 208-229) Boston, MA: McGraw-Hill.