Basic Counselling Skills

1. Basic Counselling Skills

2. The most important thing in communication is to hear what isn't being said. Peter Drucker

3. Purpose of Presentation • To 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

4. 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

5. 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

6. 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

7. Looking Like You're Listening is Not Enough

8. Listening skills • Ask open and closed questions • Use “encouragers” • Paraphrase what you have heard • Reflect on feeling • Summarize

9. Open Questions • Open questions • Generally start with “what”, “how”, “why” or “could “ • Questions serve to: • Gather lots of general information • Encourage discussion

10. 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?”

11. Closed Questions • Generally start with “is”, “are”, or “do” • Serve to: • Gather lots of specific information quickly • Tend to close down discussion

12. Example: Closed Questions • Nurse: “Are you giving the medicine every day?” • Nurse: “Is the baby able to tolerate the medicine in the morning?”

13. Encouragers • Ex: “Yes, I understand” or repeat a word or two of what was said • Serves to: • Encourage further discussion

14. Example: Encouragers • Patient: “I missed my appointment last week because of transportation problems.” • Nurse: “Transportation problems…?”

15. 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?”

16. 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

17. 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.”

18. 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

19. Example: Reflection of Feelings • Patient: I don’t 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”

20. Summarizations • Succinctly pull together ideas from a an interview • Serves to • Organize the structure of the interview • Check the accuracy of understanding,

21. 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?”

22. Attend to Nonverbal Communication • Increase awareness of nonverbal communications (yours & theirs) • Notice body language – a person’s stance, posture, physical tension • Acknowledge what you observe – be open and candid

23. 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

24. Non Verbal Communication • Remember culture and context • Most nonverbal behaviors have multiple meanings • Some nonverbal behaviors have different meanings in different cultures

25. 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?

26. 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?

27. 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

28. 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

29. Influencing or Changing Behavior

30. Influencing or Changing Behavior • Directives • Reframes and interpretations • Advice • Feedback • Logical consequences

31. Directive • Tells a person what to do (can be direct or indirect) • Works best if clear and concrete • Serves to: • Move a person to take a specific act

32. 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”

33. 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

34. Example: Reframing and Interpretations • Patient: “There is so much going on I don’t 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”

35. 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 person’s decisions, actions, or understanding • Disadvantages of advice • It’s often disempowering (You can’t solve this on your own) • People may say (but not really mean) that they want advice

36. 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”

37. 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

38. 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. Let’s think about how we can help you so that you can give all of the doses of medicine”

39. Logical Consequences • Focuses on the logical consequences of a person’s behavior, actions, thoughts, or feelings • Serves to: • Increase awareness of consequences

40. 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”

41. Counselling • The 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