Basic Counselling Skills

 The

most important thing in communication is to hear what isn't being said.

Peter Drucker

Purpose of Presentation
help participants understand the concept and importance of counselling  To help participants understand the process of counselling  To impart the skills of counselling  To help participants to be more aware of using counselling techniques appropriately and effectively
 To

Basics of Counselling
 Listening

is not passive. It is important to indicate that the person is being heard  Good counselling skills means listening before acting to solve problems

Basics of Counselling
 Verbal

listening skills

     

Show interest Gather information Encourage speaker to develop ideas Communicate our understanding of ideas Request clarification of understanding Build the therapeutic alliance

Listening Skills
 Using

good verbal listening skills, you increase the chances that:

 You will understand what the other is saying and they will understand you  You will create a situation where you will be able to develop a helping relationship

Looking Like You're Listening is Not Enough

Listening skills
 Ask

open and closed questions  Use encouragers  Paraphrase what you have heard  Reflect on feeling  Summarize

Open Questions
 Open

questions

 Generally start with what, how, why or could

 Questions

serve to:

 Gather lots of general information  Encourage discussion

Example: Open Questions

 Nurse:

How has the baby been eating?  Nurse: What is the bedtime routine?  Nurse: Could you tell me about giving the baby medicine in the morning?

Closed Questions
 Generally  Serve

start with is, are, or do

to:

 Gather lots of specific information quickly  Tend to close down discussion

Example: Closed Questions

 Nurse:

Are you giving the medicine every day?  Nurse: Is the baby able to tolerate the medicine in the morning?

Encouragers
 Ex:

Yes, I understand or repeat a word or two of what was said to:  Encourage further discussion

 Serves

Example: Encouragers
 Patient:

I missed my appointment last week because of transportation problems.  Nurse: Transportation problems?

Differentiating
 Understanding

whether:

 Is the person is asking for information OR is the person is expressing concern? Ex: Patient: My baby vomited the medicine this morning Nurse: Are you worried the baby is sick?

Paraphrasing
 Briefly

summarize the content of the discussion  Reflective listening

 Check your understanding  Show that you heard what was said
 Acknowledge

and accept feelings without judging

Example:Paraphrasing
 Patient:

I am worried that the medicine is making my baby sick  Nurse: It sounds like you are worried about how the baby is reacting to the medicine.

Reflection of Feelings
 Focus

on feelings (stated and unstated)  Serves to:

 Communicate understanding of emotions  When combined with a paraphrase, confirms the accuracy of understanding
(Check out the the other person)

 Encourages discussion of feelings

Example: Reflection of Feelings

 Patient:

I dont see many changes in the baby since I started the medicine  Nurse: It sounds like you are worried that the medicine is not helping the baby get better

Summarizations
 Succinctly

pull together ideas from a an

interview  Serves to
 Organize the structure of the interview  Check the accuracy of understanding,

Example: Summarizations
 Nurse:

During the time we have had together we have talked about issues with giving the baby medicine, problems with transportation, and your worries about the baby reacting to the medicine and getting better. Is that right?

Attend to Nonverbal Communication

 Increase

awareness of nonverbal communications (yours & theirs)  Notice body language a persons stance, posture, physical tension  Acknowledge what you observe be open and candid

Example: Nonverbal Communication

 

Nurse: You appear a little uncomfortable. Is there something I can do about that? Discussion point: What other examples of non-verbal communication can you identify

Non Verbal Communication

 Remember

culture and context

 Most nonverbal behaviors have multiple meanings  Some nonverbal behaviors have different meanings in different cultures

A Good Listener
      

Maintains eye contact Makes few distracting movements Leans forward, faces speaker Has an open posture Allows few interruptions Signals interest with encouragers and facial expressions What are other examples of good listening?

Bad listening
       

Makes little eye contact Makes distracting movements Faces away from speaker Has a closed posture (ex.: arms crossed) Interrupts speaker Does too many other things while listening Has a flat affect, speaks in a monotone, gives few signals of interest What are other examples of a bad listener?

Listening Practice Scenarios

 

 

Get into a group of three people One person begins by talking about a troublesome situation. Be brief but allow your partner opportunities to practice listening skills. Listening partner: Provide at least three different types of listening responses as your partner talks Third person is the Observer: Use checklist to identify different listening skills Switch roles so that each person has a chance to fill each role

Listening Practice Scenarios



Remember the goals of listening skills

 Help the speaker feel understood  Keep the speaker talking

  

Think carefully about the thoughts and feelings the individual stated or implied Try to imagine yourself in their place in order to understand their message Make a brief verbal statement communicating what you heard
 No questions  No opinions

Check to see if you are correct

Influencing or Changing Behavior

Influencing or Changing Behavior

 Directives  Reframes  Advice  Feedback  Logical

and interpretations

consequences

Directive
a person what to do (can be direct or indirect)  Works best if clear and concrete  Serves to:
 Tells

 Move a person to take a specific act

Example: Directive
 Patient:

I am not sure when to take my medicine  Nurse: You should take your medicine once in the morning and once in the evening

Reframing and Interpretations

 Attempts

to replace an old, maladaptive response with a newer, more useful (usually positive) one  Serves to
 Increase insight and understanding  Shift emotional or intellectual response

Example: Reframing and Interpretations

 Patient:

There is so much going on I dont think I can take my medicine  Nurse: Sometimes you feel overwhelmed and you are not sure that you can get everything done so you can take your medicine

Advice
 

Provides information to help client make a decision. Can be very directive or less so Serves to:  Share information that would be relevant for a persons decisions, actions, or understanding Disadvantages of advice  Its often disempowering (You cant solve this on your own)  People may say (but not really mean) that they want advice

Example: Advice
 Nurse:

Try stirring the medicine in milk and then giving it to the baby  Nurse: Let me show you how to swallow the pill  Nurse: Marking a calendar is a good idea for keeping track of giving medicine, and it will help you feel good about giving every dose

Feedback
 

Gives information about how the person is experienced by others Serves to:  Help client see self more objectively (as others see him or her) Feedback works best when  It is requested or desired  It is concrete  It is positive  If negative, it addresses something changeable or controllable

Example: Feedback
 Patient:

Last week I gave almost all of the doses of the medicine  Nurse: You have really worked hard to make improvements in giving the medicine. Lets think about how we can help you so that you can give all of the doses of medicine

Logical Consequences
 Focuses

on the logical consequences of a persons behavior, actions, thoughts, or feelings  Serves to:
 Increase awareness of consequences

Example: Logical Consequences

 Patient:

It is really hard to start the medicine, and the side effects are really hard for the baby  Nurse: If you can make it thorough the first few weeks of taking the medicine than the side effects will get better and the baby will start to improve

Counselling
goal of counselling is to help a person tell their story  With effective listening skills you can assist a person in communicating their thoughts and feelings  When you understand where a person is starting from, it is easier to help them reach their goal
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