Counseling

Dr. B.K.R. Batuwanthudawe

Consultant Community Physician
Health Education Bureau
 What is counseling
• Counseling is an interactive process of a unique relationship
enabling the client/patient express feelings and create
physical and psychological environment in which client feels
confident enough to take own decisions in
– Beliefs, behavior, emotional concerns, perceptions

• Discuss:
– Actual need, suitable choices, advantages, disadvantages

• Empowering client and assist to take own decisions for

positive change.
 Types of counseling
• Pre-marriage
• Marriage
• Family
• Career
• Education
• Adolescent problems
• Sexual health
• Reproductive health
• Family planning
• Job relates
• HIV/AIDS
 Components of the mind

Thoughts Inter-
related
Emotions Behaviour

Inter-
Body
dependent
 Benefits of counselling
- Helps to understand thoughts and feelings
- Support to make positive choices and decisions
to cope better/adapt with the situations they
are facing

- Assist to reduce initial distress resulting from a

difficult situation

- Encourage short and long-term adaptive

functioning (positive coping)
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 Qualities
• Genuineness
• Empathy
• Acceptance
• Unconditional positive regard
• Knowledgeable
• Maturity
• Ability to relate
• Professionalism
• Confidentiality
Listening
 2. Active listening skills

Active listening includes the following skills:

1. Attending
2. Paraphrasing
3. Reflection of feelings
4. Summarising

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 Attending
Expressing awareness and interest – in what client is
communicating both verbally and nonverbally.

- appropriate eye contact and facial expressions

- head nodding,
- leaning forward & relaxed posture
- Verbally following – “Hm!-hm” “yes” “please
continue”

 Developing a trusting relationship

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 Example of attending……..
I am so tired, but I
cannot sleep…so I
drink some wine.
Um-hm.

…When I wake
Please continue... up…it is too late
already…

I see. Too late for

work…my boss
fired me.

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 Paraphrasing
Restating the content of what client previously
said in your own words.
• Paraphrasing uses words that are similar to the
client’s, but fewer.
• This helps to let the client know that you
understand what he or she is saying and to
clarify your understanding.

 Focus on what’s important and relevant

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 Example of paraphrasing……….

My mom irritates me. She picks

on me for no reason at all. We
do not like each other.

So…you are having

problems getting along
with your mother. You
are concerned about
your relationship with
her.
Yes!

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 Reflection of feelings

The clinician expresses the client’s feelings, either

stated or implied.

The counsellor tries to perceive the emotional

state of the client and respond in a way that
demonstrates an understanding of the client’s
emotional state.

 Better understanding and empathy

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Example of reflection of feelings
When I get home in the
evening, my house is a mess.
The kids are dirty… My husband
does not care about dinner...I
do not feel like going home at
all.
You are not satisfied
with the way the house
chores are organized.
That irritates you.

Yes!

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 Summarising
Summarising is an important way for the
clinician to gather together what has already
been said, make sure that the client has been
understood correctly, and prepare the client to
move on.

Summarising is putting together a group of

reflections.
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 Summarising cont.

Summarising helps the clinician

 Provide focus for the session
 Confirm the client’s perceptions
 Focus on one issue while acknowledging the existence
of others
 Terminate a session in a logical way

Summarising helps the client

 Clarify what they mean
 Realise that the counsellor understands
 Have a sense of movement and progress

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 Example of summarising………..
We discussed your relationship with your
husband. You said there were conflicts
right from the start related to the way
money was handled, and that he often
felt you gave more importance to your
friends. Yet on the whole, things went
well and you were quite happy until 3
years ago. Then the conflicts became
more frequent and more intense, so much
so that he left you twice and talked of Yes, that is
it!
divorce, too. This was also the time when
your drinking was at its peak. Have I
understood the situation properly?

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 Listening
• Listening is not passive.
• It is important to show that the person is
being heard
• Good counselor has the skill to listen before
giving a solution.
 A good listener
• Maintains eye contact
• Makes minimal distracting movements.
• Leans forward, faces speaker.
• Has an open posture.
• Allows few interruptions.
• Signals interest with encouragers and facial
expressions.
• Don’t do other things while listening.
Looking like listening is not enough
• Responding:
– Ask questions – open ended, closed ended
– Use “encouragers”
– Paraphrase what you heard
– Reflect on feeling
– Summarize
Talking
 Open questions
• Generally starts with
– What, how, could, why….
• Gathers a lot of general information
• Encourages discussion
 Closed questions
• Gather a lot of specific information
• Quicker
• Tends to close the discussion
• Specific answers expected: Yes or No
 Encouragers
• A category of responses falling between non
verbal attending and actual responses
– Uh-huh
– Hmmm
– And
– Then
 Inappropriate responses in Counseling
Judging: For example, “You wouldn’t have these problems if
you had acted differently!”

Attacking: For example, “How could you be that

irresponsible?

Denial: For example, “Don’t worry. I’m sure that it’s

nothing important.”

Pity: For example, “Poor thing! How terrible that happened!”

Advice : “You should spend your money on something

more useful”
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 Before closing down
• What else would be important you to know?

• Do you have any questions to me?