Here’s Why I Openly Talk About Suicide

Here’s Why I Openly Talk About Suicide

In a previous post, I discussed the connections of being a clinician and experiencing a suicide loss. Two people in my life died by suicide. And, without naming names, I have had multiple loved ones express suicidal ideation, be involuntarily held for suicidal ideation at the hospital, and be hospitalized from the result of a suicide attempt.

According to the American Foundation for Suicide Prevention, suicide is the 10th leading cause of death in the United States. Each year, over 42,000 people die by suicide. For every suicide death, there are 25 suicide attempts. (source)

It is estimated that for every suicide there are is 6 people who grieve the loss. Some suicidologists believe this is a conservative estimate. Based on this average, it is estimated that 6 million people in the United States have experienced a suicide loss in the last 25 years. (source)

The biggest barrier to preventing suicide is not talking about it. I truly believe that.

I used to be one of those people who believed talking about suicide increases the risk for suicide, that somehow talking about suicide plants a seed and encourages others to consider suicide. This is not true. In fact, talking openly about suicide decreases the risk for suicide.

I am very vocal in my personal life about suicide prevention and my personal experiences with suicide loss. I truly believe that talking about suicide is essential for decreasing suicide risk, validating the experiences of people struggling with suicide, and encouraging people to seek help.

Before my own experience with suicide loss, I had the belief that folks who die from suicide are selfish, shameful, weak, sinful. This is the stigma attached to suicide, and we are taught this stigma our entire lives through social messaging. As a result, we internalize this suicide stigma. For those of us who do not have suicide ideation, it causes us to view others with suicidal ideation and others who pass away from suicide with judgement. For those who have suicidal ideation, this internalization of the stigma increases the ideation and deters folks from seeking help.

When a close friend passed away from suicide, this stigma came up for me. I’d been taught that folks who die from suicide are selfish and weak, but I didn’t believe my friend was selfish or weak. I struggled often with what I’d been taught and what I believed.

One way I have dealt with de-stigmatizing suicide has been by talking about suicide openly without fear, shame, or blame.

Talking about suicide…

…decreases suicide risk.
…decreases suicide stigma.
…eliminates tendency to shame and blame folks experiencing suicidal ideation/folks who passed away by suicide.
…increases possibility for human connection, and, by extension, human compassion.
…increases the likelihood folks experiencing suicidal ideation reach out for help.
…normalizes feelings of suicide.
…normalizes the personal experiences of folks struggling with suicide and mental health.
…makes you a support person for loved ones in your life whom you might not realize are struggling with suicide.
…can be incredibly healing for folks who have suicide loss (as is in my case!)

…CAN SAVE THE LIFE OF ONE OF YOUR LOVED ONES. CAN SAVE THE LIFE OF A STRANGER. CAN SAVE A LIFE.

Stigma is shame. Shame is silence. Silence hurts us all.

Suicide prevention begins with talking about it.

I will never stop talking about it.

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Exploring Suicide Loss as a Clinician

Jason and I at the movies for “The Hobbit” midnight premiere.

In January 2013, my dear friend Jason died from suicide. I felt excruciating pain. Devastation. Overwhelming feelings of shock, grief, sadness. Replaying my last moments with him; the last months in my mind, trying to find the signs that this was coming. Feelings of guilt; what could I have done differently to help him? Why would he do this?

At the time of Jason’s death, I was in my last term as an undergraduate student. That’s the thing about death: the world continues on. I had to continue going to classes, study and complete homework. It was the same as before, except there was an important person missing. There were moments where I looked around me and wished there was a rewind or pause button. Didn’t the universe notice this missing soul?

Experiencing this loss changed me. I couldn’t return to my life before Jason’s death. To me, there is no recovering from the loss of a loved one. I believe there is only healing. Healing isn’t a return to life before the loss, healing isn’t a “cure” to grief; instead, healing is continuing onward after the loss and having a scar as a permanent reminder of the pain felt.

Getting over the loss is not possible. I can’t “get over” it because it has already permanently changed me.

I’m not going to talk about my process through the stages of loss and grief. I don’t believe the healing process is a linear one. I believe each stage is experienced at our own time and pace. I also believe there is no time limit for healing. I can say with full confidence that I am still on my healing journey.

Three years later, the world continues on. Now I’m in graduate school pursuing my Master’s in Social Work (MSW) and working in the mental health field. More than once, I have worked with a client with suicidal ideation, and let me tell you this: my countertransference was so strong in those instances.

For those who don’t know, countertransference is a phrase used to describe unconscious reactions and feelings of the therapist towards the client during psychotherapy.

I had a client who was hospitalized involuntarily for threats of suicide. Part of my agency’s protocol during this type of situation was to meet the client at the hospital to conduct a risk assessment. When I was notified of my client’s admittance at the hospital–and instructed by my supervisors of agency protocol–I flashed to three years prior.

I found myself feeling sadness, guilt, overwhelmed, helpless, grief. Images of my friend laughing, talking, giving me a hug flashed through my head like a picture flip book. What could I have done for him to prevent his death? Why did he do it?

And then in regards to my client: rewinding through every session of therapy with them, wondering what I could have said or done for the client that could have helped them turn away from suicide. Feeling guilty and wondering if I was a “good enough” therapist for this client. Feeling guilty that I didn’t do enough to help.

And then: anger. Angry that suicide exists in my personal and professional worlds. Angry that my friend died from suicide. Angry that my client was contemplating suicide. Angry that my studies hadn’t included suicide prevention efforts. Angry that my studies hadn’t discussed countertransference and suicide loss. In fact, as of April 2016, suicide rates in the United States are at a 30-year high point. With one death by suicide every 12.3 minutes in the United States, with about 105 Americans passing away from suicide every day, with one suicide death for every 25 suicide attempts (source)…it seems like the chances of a therapist experiencing a suicide loss (and/or suicidal ideation) is too relevant to ignore.

Jason and I hanging out one month before his death.

When I went to the hospital to conduct the risk assessment of my client, I knew that I needed to take care of myself. On the drive to the hospital, I took that opportunity to breathe and honor my feelings by allowing myself to feel them. I didn’t push my feelings away because that would have been disastrous for my mental health. In the parking lot of the hospital, I continued to breathe and mentally placed the countertransference in a box, closed it, and shelved it temporarily. I then placed myself into the mental health professional role so I could conduct the risk assessment.

After the risk assessment, I went home and practiced self-care. The next day during clinical supervision, I consulted with my supervisors about my countertransference.

I know I make it seem like I conquered my countertransference in this clean, linear process–but trust me, it was a messy and emotional process.

How does suicide loss influence clinical practice?

Self-confidence is affected when working with clients with suicidal ideation
Second-guessing/uncertainty of clinical decisions/observations
Hypervigiliance of suicidal ideation, self-harm behaviors in clients
Feelings of guilt when a client experiences suicidal ideation, is at-risk for suicide
Fear of consequences when working with clients with suicidal ideation (e.g. legal)
Emotional/reactionary responses to clients with suicidal ideation
Fear of being “good enough” for clients

If you have experienced a suicide loss and are a clinician, I’m interested to hear about how your loss has impacted your clinical practice.

Ways I’ve come up with to help myself as a person who has experienced suicide loss:

Ground yourself with mindfulness techniques. Take the time to notice what’s going on around you (nature, people, yourself). I like to use my hand to signify each of the five senses (touch, taste, smell, hear, see) on my fingers. I close my eyes and go through each of the five senses. My feet are touching the ground right now and I can feel the security of the cement. I can smell barbecue cooking at the neighbor’s house. I hear cars driving by, my dog’s paws clacking on the pavement as she walks.
Kristin Neff writes that suffering = pain + resistance. I think it’s important to remember that practicing mindfulness isn’t about avoiding the pain of the loss. Practicing mindfulness is about feeling the pain without the resistance.
Practice self-compassion. Be kind to yourself. Replace negative thinking with positive, reality-based self-talk. Here are some examples of negative thinking replaced with self-compassion that I’ve experienced in relation to my suicide loss.
“I should have done something to help him.” –> “I did everything I could to support him.”
“I should have called him that night.” –> “I did everything I could to support him. I was busy when he reached out. That’s not my fault.”
“I should have been a better friend to him.” –> “I was there for him. He considered me a good friend.”
“Why didn’t I see this coming?” –> “I didn’t see this coming, but his death is not my fault.”
Honor your feelings. One thing I tell my clients about holding in/avoiding feelings is to picture a soda can. Imagine shaking the soda can and then opening it. What happens? It explodes. We are like soda bottles; if we hold our feelings in, they are going to build up and build up until we explode. Explosions look different to everyone (anger outbursts, anxiety attack, sheer exhaustion, etc.), but it’s important to note that they happen. By honoring your feelings, you are being your authentic self.
Give yourself permission…to cry. to laugh. to feel. to go out with friends. to be alone. to seek help. to do what you need to do on your healing journey.
Make connections for support. Consider going to therapy or joining a support group for folks who lost loved ones to suicide. If you are a religious person, go to your place of worship. Connect with your loved ones for support. It was incredibly healing for me to maintain connections with me and Jason’s mutual friends. To this day, I am still in touch with a few of those mutual friends. Every year, several times a year, we send messages of support and love and positive energy to each other. To this day, it means so much when I receive a text message, phone call, email from any one of them.
Bring your countertransference to clinical supervision. One of the best moves I made was to talk about my countertransference with my supervisor. She helped me process my feelings and reactions when working with clients with suicidal ideation. She helped me come up with individualized ways to work with my countertransference should it come up again (and it did, many times).

Moving Forward

I will always remember Jason’s energy.

As I mentioned earlier, I don’t believe it is possible to completely recover from a suicide loss. I believe in healing, but not completely. A scar is left as a reminder of the pain felt from the loss.

My scar is deep. I see it often during my clinical practice, reminding me of my changed world. I used to think my countertransference about suicide loss was something to be ashamed of, something to fight against.

To be authentically myself and to provide mental health services to my clients, I realized I can’t fight against my countertransference. The moment I stopped fighting it was a forward moment for my personal healing process and a learning moment during my professional training.

I will always miss Jason and feel the pain of his departure from this world…and I will not fight it any longer, whether personally or professionally.

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Therapy Directive: “All About Me” workbook

Therapy Directive: “All About Me” workbook

When I first started working with children during my Clinical Social Work internship, I wanted to find an intervention that built rapport with the client and was a self-esteem building activity and incorporated art (naturally).

The result was this “All About Me” workbook.

At 11 pages, this workbook contains directives which prompt the client to write and draw about various aspects of themselves.

My favorite part of this workbook is that it is designed to direct the client to think about who they are in the present moment of time. How have they grown? What
are their strengths? What do they like to do for fun? How do they describe their family?

Therapy Type: Individual

Number of sessions: Varies on the client. Generally I’ve done 1-2 pages per session.

Materials Needed:

“All About Me” workbook (purchase and download at my Teachers Pay Teachers store)
Colored pencils, markers, crayons, etc.
Yarn
3-Hole Punch

Process:

Introducing the workbook to your client
- When I introduce the workbook, my intent is to focus on building rapport and to increase their feelings of self-worth and self-esteem.
- “[Client], I want to get to know more about you.”
- “We’re going to make your very own book together. It’s going to be all about you!”
- “I can already tell you are a unique person, that’s why we’re going to make a special book all about you!”
Working on the pages together
- Direct the client according to each page’s directive. For example, the first page is entitled “This is me!” Ask the client to draw a self-portrait. If you have a client who is focused on their future self, direct them to draw their self-portrait as they are in the present moment. Sometimes I provide a mirror so the client can view their reflection and draw what they see.
- Remove all erasers from the art supplies. One technique I’ve come up with when working with children who have low self-esteem and self-worth is to remove all erasers from the art supplies. The intent of this is to allow the client to flow through their creative process instead of worrying about achieving perfection.
  - “You’ll see there’s no erasers in the room. This is because what you draw the first time is perfect the way it is and you don’t need to erase it.”
  - If you see the client becoming discouraged over a “mistake” they made, encourage them to work through it… “I don’t see a mistake, I see a work of art in the process of creation. How can you work with what you’ve drawn so far?”
- This is not graded. I had a client whose main source of anxiety was from school. They believed that their grades were a reflection of their self-worth.
  - For example, when a client became distressed if they couldn’t spell a word, I would reassure them: “This isn’t an assignment for school. I’m not going to give you a grade. Remember this is your special book that is all about you.” This became a perfect opportunity for the client to become more self-confident in their ability to write and spell. After a few sessions, the client was writing and spelling words without becoming distressed about whether it was correct or not. Eventually, the client was able to ask for help with their spelling without experiencing anxious distress.
- Every page opens the door for further conversation. Take the opportunity to explore more about the client. For example, one page is about the client’s family. This becomes the perfect opportunity to discover how the client perceives their family–both in drawing and in writing.
Bind the pages together when the book is complete. Use a 3-hole punch to poke holes in the pages. Use yarn to bind the book together. Bam! The client has their very own book that’s all about them.

Check out my Teachers Pay Teachers store to purchase and download this workbook for your own use.

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Worksheet: Writing about feelings…with cars

Worksheet: Writing about feelings…with cars

I had a client who had a hard time sharing their feelings and loved playing with toy cars.

I made this worksheet specifically for them. (picture at left)

Here’s how it works: give the client the worksheet and direct them to circle the emotion they are currently feeling. Ask them the reason behind this feeling and direct them to write about it.

When the client was done, I had them read what they wrote. The intention behind this was to give them an opportunity to practice communicating verbally their feelings. This then proved to be a perfect gateway to more conversation.

I also created this second worksheet. (picture at right)

I introduced this worksheet when the client was becoming to feel more comfortable talking about their feelings. Notice it uses the following format:

I feel __________ when __________ because ________. I need _________.

This format identifies…

the feeling(s) being felt
the situation that sparked the feeling(s)
why that situation sparked the feeling(s)
what is needed from that point (e.g. coping skills)

Like the first worksheet, I provide it to the client and direct them to fill it out. Once completed, they read aloud what they wrote. This opens a door for further conversation.

Eventually, we were able to include additional emotions on this worksheet. In fact, my client added more feelings as they became more comfortable identifying their own feelings!

I’ve also used these worksheets during family therapy with this particular client. The client completed the worksheet and read it to their parent. This opened up a conversation between the client and their parent. Additionally, I coached their parent how to engage in active listening when their child was sharing their feelings.

You can download this worksheet for free on my TeachersPayTeachers store! I’d love to hear about how you use the worksheet for your own interventions.

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Therapy Directive: My Anger Book

Therapy Directive: My Anger Book

During my work as a Clinical Social Work Intern with children and families, I worked with a kindergartener for anger management skills. It was the first time I worked with a client at that stage of development. I was nervous, anxious, and of course excited! After one session, I found myself wanting a creative workbook to discuss anger with them. So, I created My Anger Book to use during our sessions together.

Here’s how it works: the workbook is separated into four sections. Each counseling session, we completed one or two pages per section.

The first objective was identifying scenarios and situations that made the client angry.

The second section of this anger workbook is focused on somatic symptoms when angry as well as angry actions. I divide this section into 2-3 counseling sessions, depending on the client.

After identifying the scenarios and situations that made the client angry, the next step was exploring the body. When we feel emotions, we often feel them in our body. This is called somatic symptoms. For example, when a person feels anger, they may experience chest pain, sweating, a rise in body temperature, etc.

Why talk about somatic symptoms? Because physical symptoms can inform our thoughts, feelings, and actions. Because physical symptoms can also act as warning signs to our decompensating behavior.

In this section of the anger workbook, the client identifies any somatic symptoms they may experience when they feel angry. Most notably is a page that features a blank human body template. The client draws on the human body where they experience their anger.

Here is an example:

After the client identifies somatic symptoms, it becomes time to identify angry behaviors, or their actions when they are angry. It is important for the client to be aware of their behaviors, especially if they involve harm towards the self or others. This portion of the workbook incorporates drawing the anger actions.

Anger is always accompanied by other emotions. This is why I incorporated the Anger Iceberg activity: to explore other emotions the client may be experiencing when they are angry.

I created this portion after seeing a similar iceberg from the Creative Social Worker. That particular iceberg can be found here.

The last portion of this workbook involves learning and practicing self-soothing skills. It incorporates the Anger Iceberg. The client becomes Captain of the Self-Soothing Sailboat. When the captain spots the anger iceberg, they have four options to choose from to calm down.

“When you see your anger iceberg, which direction will you steer the ship?”

Check out my TeachersPayTeachers store to purchase this workbook!

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Art Therapy Directive: Torn Paper Art

Art Therapy Directive: Torn Paper Art

I had a client who was a perfectionist when it came to their art creation. Their perfectionism became a barrier to their creative process. I stumbled across this post while exploring Pinterest and was inspired to adapt the technique for my own intervention.

But first, let’s talk perfectionism and anxiety.

It’s not a bad thing to have high standards for ourselves. Striving for those goals we set for ourselves can demonstrate good work ethic or strong character. When do these goals and high standards become debilitating?

Perfectionism is the tendency to set standards that are so high that 1.) they can’t be met, or 2.) they are met with great difficulty. Perfectionists might believe that anything short of perfection is horrible–a character flaw, a failure, a disappointment. Making a mistake can lead to catastrophe.

Many folks know that making mistakes is a natural part of life and that this does not make them a failure or disappointment. Folks who are perfectionists tend to believe that making mistakes (not meeting their high expectations) means they are a failure or disappointment. Approaching life with this mindset can be scary and anxiety-inducing for a perfectionist. Over time, a perfectionist may start to believe they aren’t as capable as others.

This art activity involves loosening those high standards we set for ourselves and practicing self-compassion.

Therapy Type: Individual

Materials Needed:

Various colors of construction paper
Glue stick
Coloring page
- Choose a coloring page that has less details. Here are some templates I’ve used:

Process:

Provide the client with the selected coloring page. (You can provide many so they can choose the one they want.) Tell them they are going to color in the picture using only color construction paper. The catch? No scissors allowed. This means the client colors in the picture by tearing the construction paper.
The client may become distressed (my client sure did!). Explore that distress. Ask them why they feel anxious about the activity. Their answer will likely include something along the lines of: “I can’t make it perfect without the scissors.” Encourage them to try practicing creating art without the ultimate goal of the “perfect picture.”
Direct the client to pay attention to their thoughts, feelings, and physical sensations during the creative process.
- Thoughts: what specific phrases are they thinking about?
- Feelings: what feelings are coming up for them?
- Physical sensations: any somatic symptoms?
Direct the client to create in silence.
Observe the client as they create.
- Notice their body responses. Are they fidgeting, sweating, etc.?
- Pay attention to their process. How is the client approaching tearing the paper? Does it seem difficult? Easy?
- Notice their affect. What mood do they seem to be in? Does this change over time?
When the client is finished creating, reflect on the process.
- “What was it like for you to do this activity?”
- “Any specific thoughts that came up?”
- “What feelings came up for you during this activity?”
- “Did you notice any physical sensations?”
Provide CBT psychoeducation to the client about perfectionism and its effects on daily life functioning. (taken from this source)
- Perfectionistic feelings include anxiety, anger, depression, frustration.
- Perfectionistic thinking
  - Black-and-white thinking
  - Catastrophic thinking
  - Probability estimation
  - Should statements
- Perfectionistic behavior
  - procrastination, difficulty completing tasks, giving up easily
  - overly cautious in tasks
  - constantly trying to improve things by re-doing them
  - apologizing over small details
  - elaborate to-do lists
  - avoiding trying new things
Begin to practice changing perfectionistic thinking through the self-compassion. Replacing self-critical thoughts with self-compassionate statements is an excellent tool for changing perfectionistic thinking.
- Write down one thought the client reported from earlier that was self-critical.
  - e.g. “I felt like the picture wasn’t going to be good enough.”
- Direct the client to change the thought to a more self-compassionate thought. This can be difficult for clients to do, so I usually ask them what they would say to a friend who said the self-critical thought.
  - e.g. “Nobody is perfect!” “All I can do is my best!”
Close the session.

Optional: instead of using a coloring page template, the client can create a picture of their choice using only torn paper.

Happy creating!

*Images shown are not client work.

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Art Therapy Directive: Turning Anxiety to Calm

Art Therapy Directive: Turning Anxiety into Calm

I had a client who suffered from severe anxiety attacks. My first intervention objective was to assist the client in learning and practicing self-soothing skills to alleviate their anxiety symptoms. Specifically, how to self-soothe in the midst of a debilitating anxiety attack.

As a Clinical Social Work Intern working with children and families, I have weekly consultation with a treatment team. One of my colleagues told me about the intervention I’ll be writing about today.

Therapy Type: Individual

Materials Needed:

White computer paper, or other paper of the client’s choice
Markers, colored pencils, crayons

Process:

First things first: ask the client to rate their current anxiety on a scale of 1-10 (1 being completely calm, 10 being the most anxiety). Write this number down for your reference later.
Give the client a piece of paper and direct them to crumble it up into a ball. Tell them to focus on releasing all of their anxiety into crumbling the paper into a ball.
When the client seems finished crumbling the paper, direct them to unfold it on the table. Flatten it out.
Next, provide the client with markers, colored pencils, crayons, etc. and direct them to turn their anxiety into calm by tracing the lines and patterns of the crumbled paper.They can also color in the shapes they see or create a picture that they notice in the paper’s lines/shapes.

Let the client do this until…
- they feel calm
- they appear considerably calmer
- they tell you their art is finished
At the end, they have a visual representation of their ability to self-soothe during anxious distress. It can serve as a reminder that they are strong and able to deal with their anxiety.
Close the session. Ask the client to rate their anxiety level on a scale of 1-10 (1 being completely calm, 10 being the most anxiety). Compare this rating with the initially reported rating from the start. Ask the client what it was like crumbling the paper and creating the art. Encourage the client to use this self-soothing skill outside of session to alleviate anxiety symptoms.

I’ve also used this intervention for clients who need a self-soothing skill for anger. Works so well!

Good luck!

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Art Therapy Directive: In Your Shoes

Art Therapy Directive: In Your Shoes

“Empathy is the art of seeing the world as someone else sees it. When you have empathy, it means you can understand what a person is feeling in a given moment, and understand why other people’s actions made sense to them.” Source

Recently, I was co-facilitating a family therapy session with two clients. One client shared their experience a a bullying victim, and the other was having a difficult time empathizing. And vice versa, except about a different experience. In short, both clients were having a difficult time empathizing with the other. One of my colleagues introduced a “walk in my shoes” activity to me. I loved the idea so much that I altered it to include art (naturally).

Therapy Type: Family (I could also see this being a great group activity)

Learning Objectives

Explore ways and learn how to offer empathy towards others.
Strengthen relationships with others to improve social and interpersonal daily functioning.

Materials Needed

Printable shoe handout (I use this one: BlankShoeTemplate)
Markers, colored pencils, crayons

Process

I like to introduce the activity by giving them this quote to discuss:
- “What do you think about this quote? What comes up for you?”
- “Can you think of a time when someone did not ‘take a walk in your shoes’? How did it make you feel when that happened?”
After brief discussion of the quote and initial thoughts, provide the BlankShoeTemplate (or other blank shoe template of your choice) to each client. Tell them you’ll be giving them twenty minutes or so to decorate their individual shoe.
I give at least twenty minutes so the clients have enough creative process time. You can chose to let the clients chat, have music playing in the background, etc…but I prefer to let the clients create their individual shoes in silence. I’ve found it can be more beneficial for silent work so as to reduce distraction or diversion from their creative processes.
Once time is up, direct the clients to exchange shoes. I don’t have them explain what they created because of this next step.
Have each client view the shoe and explain what they see and what they think it would be like to walk in those shoes. Don’t let the other person affirm or deny the explanations; they will get a chance to explain their process next.“Tell me what you see in this shoe. Based on what you see, what do you think it’d be like to walk in these shoes for a day? Why do you think that?”
After each client explains what they see, this is the part where each client practices communicating with each other using “I” statements.
- “Tell [the other client] what your shoe means.”
- Direct them to try using the following format when applicable:
  - “I feel __________ when ___________ because _____________.”
Once each client has explained what their individual shoes mean, it’s time for the clients to practice empathy skills through communication. (I found this awesome article about empathic communication; it is a great tool and worth the read!) This article brings up some great points about empathic communication and listening you can bring up to your clients.
- Direct each client to face each other. Each client takes a turn practicing communicating the meaning behind their created shoe. When one client is talking, the other client needs to practice empathic listening. Those skills are:
  - Paying attention to what is being said
  - Making eye contact
  - No interrupting
  - No giving advice, just listening
  - The goal: having the intention to connect with the other person.
- “Tell [the other client] what your shoe means.”
- Direct them to practice using the following format when applicable:
  - “I feel __________ when ___________ because _____________.”
  - “I need ____________.”
- When a client shares what they need, have the other client respond with this format:
  - “I hear you saying __________ and that you need ____________.”
Close the session.
- “What was this activity like for you? What emotions came up for you? Thoughts?”
- “How did it feel walking in [the other client’s] shoes?”
- “How did it feel when [the other client] was being empathetic towards you?”
- “How did it feel when you were practicing being empathetic to [the other client]?”
- “In what ways can you bring what you learned to your typical day and/or life?”