85Summarizing: Summarizations are somewhat longer than paraphrases, and they
contain more information (Pedersen and Ivey 1993 ). When patients have disclosed
a large amount of information, summarization is useful because it synthesizes dis-
parate parts of their stories. Furthermore, “Many cultures [e.g., the Deaf culture
(Williams and Abeles 2004 )] use story-telling as a major vehicle in disseminating
their culture” (Pedersen and Ivey 1993 , p. 119). When working with a patient who
uses a storytelling vehicle, you may be able to communicate your understanding
with a summarization that ties together the major themes.
Example Pt: “I really want to be tested for this gene. My mom and her sister died
of breast cancer, and my sister was diagnosed two months ago. I have
two daughters myself. What will happen to them?”
Co: “What I’m hearing is, you’re very scared. And with all of the cancer
in your family, you’re worried about getting it and passing it on.”
Content Reflection (Content Responses): Content responses concisely emphasize
the cognitive gist of a patient’s experience. Content responses help patients explore
their goals and values and gain deeper understanding of their experience. They also
allow counselors to identify “...different or conflicting culturally learned perspec-
tives without necessarily resolving them in favor of either viewpoint” (Pedersen and
Ivey 1993 , p. 156).
Example A deaf couple wants a non-hearing child. However, their desire may con-
flict with the values of the broader culture.
Pts: “We don’t know how to raise a child to live in the hearing world.
We’re fully prepared to raise a deaf child. But you can’t believe what
people are saying about our decision!”
Co: “It seems like you’re kind of caught between your Deaf culture and
the judgments of others.”
Feeling Reflection (Affective Responses): Affective responses concisely stress the
emotional aspects of a patient’s experience. They contain explicit labeling of a
patient’s feelings.
Example Pt: “I’ve tried to find out information about Trisomy 18, and nobody’s
telling me what I need to know!”
Co: “You sound frustrated and angry.”
Content and Feeling Reflections: These responses concisely combine statements
about patient feelings and the situations/factors contributing to these feelings. One strat-
egy for making this kind of reflection is to say, “You feel ... because ....” (Egan 1994 ).
Example Pt: “I’m glad we went ahead with the prenatal testing. I can’t wait to tell
my husband the good news! We were so worried about our baby hav-
ing muscular dystrophy.”
Co: “You feel very relieved because the results are negative.”
4.5 Primary Empathy Responses