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COUNSELLING SKILLS

Counselling Skills by Chickli7e

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COUNSELLING SKILLS

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The Counselling Process

The medical consultation is a helping process.The relationship established is specific and

purposeful as it aims at dealing with theproblem that is presented.In this sense, it is a special relationship.

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STAGES of COUNSELLING

1. Relationship Building2. Exploration and Understanding

3. Rational Discussion

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Exploration and

UnderstandingGoal: Enabling the counsellee to gain a betterunderstanding of himself, his situation andthe problem he is presenting.Explore the counsellee's world.Counsellee is helped to deal with himself andbe motivated to engage in rational discussionfor problem-solving.

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Rational Discussion

Goal: helping the counsellee cope with theproblem in a healthy and rational way

1. Problem definition and assessment2. Therapeutic goal setting and

implementation

3. Termination and evaluation.

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LISTENING

When we listen, people begin to feel at easeand feel that someone cares.

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How to Be A Good Listener

Should be accepting, patient, caring,sympathetic, concerned, discreet,understanding, respectful, knowledgeable,encouraging, tolerant, warm, kind, andtrustworthy.Just say : "I am with you, tell me...” Sensitive to the feelings of others

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Several Barriers to be A Good

ListenerImpatienceForming premature opinions, criticisms, lack ofunderstanding and jumping to conclusions thatthe person is in the wrongGiving the impression that one is not taking thBeing passive, thus appearing to say "I'm bored"or "I'm not interested“. Inability to concentrate on person's problemseriouslyMaking noise, such as telephone ringing.

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The busy physician can help many patients by

applying BATHE (background, affect, trouble,handling empathy) method.Background : Ask about likely areas of psychologicalproblems

Affect : Ask about common areas generating strongfeelingsTroubling: Ask how much the patient’s problems botherhim or her

Handling: ask how he or she tries to solve the problemEmpathy: Express understanding of the patient’s distress,like say “I can understand that you would feel angry”

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Using Soap to Bathe

S upportNormalise problems as common dilemmas: Helpthe patient focus on strengths.

O bjectivityEncourage patients to ask themselves howrealistic their thoughts and feelings are. “What’s

the worse thing that could happen ?” “How likely isthat?”

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Acceptance

• Be as non-judgmental and accepting as possible• Encourage patients to feel better about themselves,

their parents, and other family members• Coach patients to think differently about themselves

more realistically, if they are overly self-critical• Urge patients to develop more of a sense of humor

about their issues• Acknowledge the patient’s values and priorities • Acknowledge the patient’s readiness for changes • Acknowledge the difficulty of making changes

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Present Focus

• Encourage focusing more on the present, less on the pastand future. Help patients identify, explore and evaluatedifferent attitudinal and behavioral options (includingdoing nothing):

Express guarded optimism that the patients can and will dobetter. Try to set up a positive self-fulfilling prophecy for theimmediate future:

• Suggest a “homework assignment” for the patient to carryout; for example:

a. Practice sending “I” messages: b. Practice asking for what you want, rather than justhoping for it:c. Practice telling others how you are responding to theirbehavior:

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PROBLEMS OF LIVING

Problems of living are life situations that affect the functioning of a person.When the limit tolerance is reached, the person may seek medical help.

• Relevance to Family Medicine – As a front-line doctor, the family doctor is likely to encounter patients with

problems of living. – Not all presentations will be explicit. – The depressed, the lonely or the hard-pressed often report tiredness, lack of

energy, sleeplessness, abdominal pain or headache rather than reveal theorigin of their difficulties.

– The patient presents his/her problem of living as a hidden agenda becausehe/she perceives as not a legitimate problem to trouble the doctor, theconversion to somatic symptoms make the problem "medical"and thereforelegitimate.

– The attending doctor is therefore not likely to resolve the problem that thepatient brings along, unless he explores beyond the somatic symptoms.

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• Recognising Problems of Living (Signature Cues or Signal Behaviour)The following are a dozen of signature cues that help us recognise problems of living:

• Attendances for a symptom that has been present for a long time before and until now fairly quiescent. The cue is to ask the questions: "whyagain?" and "why now?"• Attendances for a chronic disease that does not appear to have changed e.g., osteoarthritis of the knee. The cue is again to ask the questions: "why again?"and"why now?"• Incongruity between the patient's distress and the comparatively minor nature of the symptoms.• Symptoms that have no physiological or pathological basis. Symptoms of this kind are also known as conversion symptoms.• An adult patient with an accompanying relative. • Failure of reassurance to satisfy the patient for more than a short period. • Frequent attendances with minor illnesses. • Frequent attendance with the same symptoms or with new symptoms

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Difficult Patient

A 'difficult patient' may be defined as one withwhom the physician has trouble forming aneffective working relationship

Some characteristics of problematic patients,from the doctor's perspective, include: frequentattenders with trivial illness, multiplesymptomatology, non-compliant, hostile or

angry, attending multiple therapists,manipulative, taciturn and uncommunicative, allknowingBiasanya problem psikis

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• Don’t!: allow feelings of hostility to affect ourcommunication with the difficult patient.

• Management: – 'feeling understood‘ includes a full history of symptoms,

exploration of psychosocial cues and health beliefs, and abrief focused physical examination – 'broadening the agenda', the basic aim is to involve

discussion of both emotional and physical aspects duringthe consultation

'making the link', simple patient education methods areused to explain the causation of somatic symptoms such asthe way in which stress, anxiety or depression cafiexaggerate symptoms.

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THE ANGRY PATIENT

• What is Anger? – Anger is a person's emotionat response to

provocation or to a threat to his or her equilibrium – Angry abusive behaviour may be a veiled

expression of frustration, fear, self-rejection oreven guilt.

Basically anger may be a communication of fearand insecurity

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• Source Anger – There are many source of anger e.g. they may have

feelings of frustration and anger because they are notgetting better, disappointment at unmet expectations,crisis situations, including grief, any illness, especiallyan unexpected one, the development of a fatal illness,iatrogenic illness, chronic illness, such as asthma,financial transactions, such as high cost for services,

etc.

.

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• The Correct Strategy – Remain calm, keep still and establish eye contact; ask the patient to sit

down and try to 139 adopt a similar position (the mirroring strategy)without any aggressive pose.

– Address the patient or relative with appropriate name, be it Mr or MrsTan or a first name.

– Be interested and concerned about the patient and the problem. – Use clear, firm, non-emotive language. – Listen intently. – Allow patients to ventilate their feelings and help to relieve their

burdens – Allow patients to 'be themselves .‘ – Give appropriate reassurance (do not go over-board to appease the

patient) – Allow time (at least 20 minutes).

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• Guidelines for Handling the Angry Patient – Do: Listen, be calm, be comfortable, show interest

and concern, be conciliatory, give time, arrange

follow-up, allay any guilt. – Do not: meet anger with anger, touch the patient,

Reject the patient, evade the situation, talk toomuch, be judgmental, and be patronizing.

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• Changing BehaviourProchaska and DiClemente help by indentifying four stagesin the process of making health behaviour change:

1) Precontemplation (when people are not interested and

are not thinking about change)2) Contemplation (when serious consideration is given tomaking a behavioural change);

3) Action (the 6-month period after an overt effort tochangehas been made); and

4) Maintenance (the period from 6 months after a behaviourchange has been made and the behavioural problem beenameliorated).

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TERIMA KASIH

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• Farah Ekawati Mulyadi C 111 08 009• Andi Rahmayanti C 111 08 256•

Andi Irhamnia Sakinah C 111 08 263• Ilma Khaerina Amaliyah C 111 08 274• Desi Dwi RNS C 111 08 275• Annisa Trie Anna C 111 08 280• Yunialthy Dwia Pertiwi C 111 08 303