Psychological first aid is certainly steeped in history and perhaps even philosophy. It must be applicable to be of any value. So to assist in your ability to actually apply these techniques let's try one. Let me describe a situation, what someone may say to you, and let's see if you can identify which response is most reflective. Person in distress, I've been told I can't live in my house anymore after the flood. Something about mold. I just don't understand. House is it solid as a rock? So, having heard that how would you formulate a reflective response? Let's see some responses. Number 1, let's find someone to explain all this. Or number 2, have you spoken with someone from the health department? How about number 3. These things really can be confusing. You sound pretty angry right now. Or number 4. What have you done so far to get an explanation? Now, you may say all four are applicable, but that wasn't the question. Remember R in RAPID, establishing or reflective listening. Which of these is most reflective? Let's go through each one. Let's find someone to explain all this. This is a solution directive. It attempts to solve the problem but ignores the obvious frustration and perhaps anger in the voice. Number 2. Have you spoken with someone from the health department? This is a closed ended question and while it is just another attempt to solve the problem. It again misses the emotional content. Number 3. These things can be confusing. You sound pretty angry right now This indeed is a reflective paraphrase. It captures both content and emotion. It can validate both aspects of the person's comment and their experience. It is an example of an attempt to develop empathy. Remember? Understanding. But how about number four? What have you done so far to get an explanation? Now this is an open-ended question. It's a good attempt to gather further information. But, again misses the psychological context of anger and frustration. Well, all of these can be seen as steps toward solving the problem. We reflect on our earlier comments. That understanding empathy is the platform for assisting someone else in the healing process. Hopefully, that example is clear but if not let's try another one. Person in distress says I lost my home in the fire. I lost a lot of things of value to me. Not just financial value but personal value. What responses are available. Well let's take a look at four. Number one. You should contact your insurance company as soon as possible. Number two. Have you contacted your insurance company yet? Number three. How are you coping with all these loses? Number four. Sounds like this fire was devastating on so many levels. So, which one was most reflective? Let's take a look. They all have value. Number one, you should contact your insurance company as soon as possible. This is a solution directive statement designed to fix the problem. Remember, a lot of us are fix it people. And, we just want to to rush in, fix the problem. It assumes the house was insured, though. It ignores any personal impact issues and it's really not reflective. Imagine the problem if the house wasn't insured. Number two, have you contacted your insurance company yet? This is a closed end question. Again it tries to fix the problem. It makes an assumption, it illicits information but it is not reflective. Again it ignores any personal impact. Number three, how are you coping with all these losses? Now this is a good open end question. It recognizes the human aspect of the disaster. And it certainly implies concern for the person as well. But it's just not reflective. Is it acceptable? Sure. It's just not reflective. So let's take a look at number four. Sounds like this fire was devastating on so many levels. This reflective paraphrase acknowledges and validates both the impact of the loss. And further opens the door for the person in distress to discuss personal losses beyond just the tangible. So while number three is certainly acceptable, number four is far more powerful. It gives the person the opportunity to talk about things. Beyond the house. It does not constrain them. It's a good way of learning about other aspects. Other variations of impact perhaps, that were felt by the person. Let's try one more. Which response is most reflective? Person in distress. When the flood waters came it washed my car away, but it didn't even touch my neighbor's car. I don't get it. Why me? What responses do you think would be most appropriate? Number 1, you know, sometimes bad things just happen. Number 2, have you thought about how you're going to get around? Number three. How do you think something like that happened? Or number four. I'm so sorry it really doesn't seem fair does it? Well let's take a closer look at each. Number one. You know sometimes bad things just happen. This solution statement is an attempt to be helpful, but ignores the most salient aspect of the person's comment. Number two, have you thought about how you're going to get around? This close-end question is another attempt at solution by gaining relevant information. But it really ignores the real issue being raised. Number 3, how do you think something like that happened? This open-end question focuses on the objective reality but ignores the emotional impact of the unfairness. That seems to be present in the voice. Number 4, I'm so sorry; it really doesn't seem fair does it? This reflective paraphrase addresses the core issue of fairness raised by the person's comment of, why me? So, we've reviewed three examples, three scenarios, where reflective listening may be applicable. Hopefully, you were able to recognize the most reflective, while still recognizing the value of the other comments. One question that is raised is well how do reflective listening techniques gain their effectiveness? What makes them different? Well, let's review some previous comments. It demonstrates a willingness to be present, a willingness to listen. As long as someone is medically stable and physically safe, time Is usually an advantage, the passage of time. These techniques communicate an effort at establishing repore, alignment to borrow from Aristotle again. It avoids arguments. It avoids provocative statements. Again, we sit beside the person in distress, metaphorically, not across from them. It suggests, these techniques suggest value in what the other person has to say, rather than rushing in. Especially, if you are a stranger, rushing in to a stranger and saying well I know best. Well, maybe you don't. Maybe you need some information to assist someone. So, it values what the other person has to say. In some instances, perhaps the person will say nothing and that's fine. But, you've at least given them the opportunity. These techniques communicate a desire to assist in problem solving. These techniques provide a sense of interpersonal support. And interpersonal support research tells us is the single best predictor of human resilience. And lastly remember our discussion on empathy. These techniques communicate empathy, they are empathic techniques. We attempt to identify how the other person feels, we try to align with that. And remember the cascade, the empathic cascade. Empathy leads to understanding, which leads to trust, which leads to compliance. All of these things, from a public health perspective, are very very important. When speaking to someone in distress. Paraphrases, are usually best inserted into the conversation. At a point at which the person in distress has expressed a complete thought or emotion and then pauses. However, paraphrases can also be used to redirect a conversation. In a respectful way, you can actually insert them, almost interrupting a flow if you feel the flow is either tangential, non-productive or counterproductive. These techniques have great flexibility. But let's remember the overall context of rapport. These techniques are just that; techniques. We must first and foremost be present. Now, that's different than showing up. Have you ever shown up some place, but you weren't present? I think back of my undergraduate career, I think I showed up a lot, but I wasn't actually present.&nbsp;Hopefully that's not happening during this presentation. So show up, but be present. If you ever have to say to someone, go ahead, I'm listening, Your really not. Be present. Be there. Listen to someone. Allow catharsis. What is catharsis? Let them vent. These reflective listening techniques as you've seen. Allow people to express frustration, allow people to express a sense of grief and loss. And you are present for that. Don't rush to solve a complicated problem with a simplistic solution, unless the resolution seems quite evident. Don't try to make the person feel better by diminishing or trivializing their concerns. How many times have you been prompted to say is that all? Or is that it? It may be minimal to you but it may be everything to the other person. And first and foremost, don't argue. Argument get's us nothing. Find a way to align, find a way to sit beside someone. So, looking back I promised a stroll a stroll through r a p i d. And that's what we've just started. I've tried to emphasis the importance of being present. Gaining rapport through listening and the application of techniques that we've called reflective listening techniques. These techniques are designed to quickly and effectively establish a sense of understanding. What we've called empathy. And let people know that there is a sincere initiative, a sincere effort to assist them in what may be one of the worst days of their life. These techniques are useful in and of themselves but our stroll is not done. In fact it's just begun. As we move forward. We're going to look at the other elements of rapid and in the end show how they can all be blended together. In what we hope is not a technique, but a conversation. A conversation designed to help people ultimately recover from tragedy or adversity.