COMMUNICATION SKILLS

Developing a Trusting Relationship

A. Establishment of Rapport or Relationship Building

Non Verbal Communication

These include:• Facial expression – smile and look friendly• Eye contact – look client in the face as he

or she speaks without staring• Posture – be relaxed, lean towards the

person to show acceptance and attentiveness

• Nodding – nod when you are in agreement with what the person says to show you have heard what he or she is saying

Non Verbal Cont’d• Tone of voice – avoid a monotone and a

low voice that is difficult to hear or a shrill aggressive tone

• Touch – be willing to touch the client in order to examine him or her or to reassure and show concern when appropriate

Be aware of cultural norms governing non-verbal behaviour

Verbal CommunicationThese include:• Greetings and self introduction• A brief opening conversation on matters

other than their problem or what brought them to see you helps put the person at ease e.g. asking for name, talking about the weather, commenting positively on the client’s attire

• Indicating one’s willingness to help

B. Listening and Responding With Empathy

In order for a counsellor to provide effectivehelp he or she needs to listen effectively tothe client. Listening is needed to learn

whatis going on in the person, what the symptoms are and how the person feels about the situation

• Listening is a skill that has to be learned and practiced. Usually most people are too

preoccupied with their own needs, thoughts and assumptions to listen effectively.

• Listening involves putting aside one’s own self-interests and committing one’s self to understand how the client feels and what their needs are from their perspective

Listening and Resp’ding Cont’d• Just by listening the counsellor says

without words “I care about what’s happening to you, you are important”

• Listening is an active process that requires not just quietly paying attention but indicating that you are doing so through nonverbal and verbal ways. Most of the skills used in establishing rapport are also important in listening

There should be:• Eye contact-looking at the person when he or she

is speaking• Attentive body language – sitting in a relaxed

manner with an occasional leaning towards the person to show that you are attending. Responding with appropriate gestures e.g. Nodding head in agreement or frowning when one does not understand

• Continuation responses – these are responses that encourage the person to keep talking e.g. nodding or saying “is that so”, “tell me more” e.t.c.

ParaphrasingThis involves stating in your own words what you think the client has said. This helps you keep track of what the client is saying. It also acts as feedback to the client. If you did not hear right then he/shecan correct you. Moreover, it helps clients realize that you are really listening and thisencourages them to communicate their

needs, e.g.

Paraph’sing Cont’d“Let me see if I understand. You are

sayingthat the pain you have in your head was there two weeks ago but was not so painful. Right now it has a sharp

quality. Isthat right?

SummarizingThis is similar to paraphrasing but usually follows a lengthier piece of

communicationfrom the patient. The counsellor condenses, restates and highlights the contents and feelings of what the clienthas communicated

Summarizing Cont’dThis can be done at the end of the time spent together or during the interactionwhenever the counsellor realizes thereis a need to go over what has been said sofar to give feedback, structure anddirection. It is especially needed when the patient’s communication have been

confusing or lengthy and rambling

Questioning/Focusing/ClarifyingAsk questions to help you fully

understand.Use open ended questions that encouragethe patient to express self e.g. whathappened? How do you feel? Closed questions elicit yes and no answers and should be avoided when you want more information

Questioning/Focusing/ClarifyingCont’dYou can also use questioning to seek more information about particular relevant areasor issues. E.g. “Could you tell me more about the accident you had two days ago?”This is called focusing

The following are types of open-endedquestions recommended in a counsellingsession. They often begin with How, What,and Why:How? “How do you think the virus is passedfrom one person to another?” “How muchdo you know about the risk factors or lifestyles of the people you are having sex

with?”

WHAT? “What do you understand by the word confidentiality?” “What do you

knowabout HIV infection?” “What do you know about how HIC is transmitted? What dodo you think about the use of condoms?”WHO? “Who have you spoken to about taking the HIV test”

WHY? Why questions must be chosencarefully because many are negative andtend to imply judgement of behaviour, making a client feel defensive. Instead it is recommended that counsellors ask positivewhy questions that will help clients explorethe dynamics of their success, rather thantheir failures

WHY? Cont’dThe following are some examples of

positive“why” questions:“That’s terrific! Why do you think you

wereable to use them that one time?”“Why do you want to be tested?”

Although it is recommended that counsellors use open-ended questioning as much aspossible, they should recognise that thereare instances where closed questions maybe appropriate. For example, obtaining a client’s consent for an HIV test or partnernotification requires the client to provide the counsellor with a simple “yes” or “no”

answer

Reflection of FeelingsThis involves sensing, observing and makingknown the feelings that underline a person’swords and non-verbal behaviour. The person may or may not express these feelings directly but the care giver reflectsback what is sensed or observed to communicate to the person that not only

Reflection of Feeling Cont’ddoes he or she understand what is beingsaid but is also aware of the feelings behindit. When feelings are reflected correctly, itoften produces profound feelings or beingunderstood and supported and usuallyencourages further revealing and discussing of feelings

Counsellor: says to patient who is fidgeting and has his

head bowed, “It looks like you

are worried about something would you like to talk

about it?

A client’s mother: says “I can’t get him

to tell me why he came

to see the counsellor, but after all I am his

mother

Counsellor: says “It sounds like you are feeling frustrated at not being

able to communicate with him

and also hurt and sad that he is

not willing to confide in you”

After listening actively to a person there

is need to respond with empathy to the

needs he or she has expressed

ConfrontingSometimes as you listen there is a

need togently point out that there are inconsistencies in what a person is

sayingor in what is said and what is actually done. E.g.

Counsellor: “You say you are not anxious

but you look frightened and

tense whenever you talk about your serostatus”

Counsellor: “Please help me understand, you just told me you live at

home but now you talk of having moved in with a friend. I’m not sure what the situation is now”

Using Impersonal Statements(third person technique)This is used to acknowledge, reflect

and normalize feelings that are expressedverbally or non-verbally.

It can be used by counsellors to:• Avoid creating defensiveness in clients• Allow clients to choose to respond or not respond to identified feelings• Help client understand that it is normal to feel that way• Present choices

For ExampleCounsellor:• “People often feel uncomfortable and guilty when you talk to them about HIV/ AIDS”• “Some people decide to abstain from

sex, while others choose to remain faithful to

one partner

Counsellor Cont’dThere are still others who prefer to usecondoms and some who never use them.to avoid becoming infected with HIV youmust decide which of these options suit

youbest”

RepeatingAt times of stress and crises, people do notalways comprehend everything they aretold. As they may be in a state of denialor feel overwhelmed. Counsellors shouldnot hesitate to repeat important

informationand points, if they believe that a client hasnot adequately absorbed the meaning

Repeating Cont’dCounsellors should repeat statements

of support or fact as often as necessary

toensure that clients understand issues relating to risk illness and health management

ConnectingMany clients become so preoccupied withtheir fears that they cannot see the connection between their behaviour and its consequences. For example, a counsellor might point out: “Have younoticed that when you withdraw and do not speak to your family, they get very

irritatedwith you?”

Self-DisclosureThis technique involves a counsellor sharinghis/her own pertinent life experiences witha client. A counsellor can use this techniquewhen he/she knows the client well. Sinceit involves revealing the counsellor’s own feeling, life experiences and emotional concerns.

Self-Disclosure Cont’dThe counsellor should use his/her discretions. There is a risk of shifting

thefocus from the adolescent on to the counsellor. The counsellor should

ensure that this does not happen