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7/28/2019 Ses 2- Counselling Skills
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Counselling Skills
(Listening and Learning & Building
Confidence and Support)
Source : Infant and Young Child Feeding : AnIntegrated Counselling Course (WHO October 2005)
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Listening and Learning
5/1
After completing this sessionparticipants will be able to:
List the 6 listening and learning skills
List the 6 building confidence skills
Give an example of each skillDemonstrate the appropriate use of theskills
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Counseling is a way of working with
people in which you try to understand howthey feel and help them to decide what
they think is best to do in their situation.
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Counseling mothers about feeding their
infants is not the only situation in which
counseling is useful.
Counseling skills are useful when you talk
to patients or clients in other situations.
You may find them useful with your family
and friends or your colleagues at work.
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A mother may not talk easily about her
feelings, especially if she is shy, and with
someone whom she does not know well.
You will need the skill to listen and tomake her feel that you are interested in
her. This will encourage her to tell you
more. She will be less likely to “turn off”and say nothing.
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SKILL 1.
USE HELPFUL NON-VERBALCOMMUNICATION
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Question:
What do you mean by ‘non-
verbal communication’?
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Non-verbal communication means
showing your attitude through your
posture, your expression, everything
except through speaking.
Demo 5
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Skill 1
With each demonstration say exactly the same few words, and try to say them
in the same way, for example:
“Good morning, Susan. How is feeding going for you and you baby?”
•Posture:
Hinders: Stand with your head higher than the other person‟s
Helps: Sit so that your head is level with hers.
•Eye contact:
Helps: Look at her and pay attention as she speaks
Hinders: Look away at something else, or down at your notes
•Barriers: Hinders: Sit behind a table, or write notes while you talk
Helps: remove the table or the notes
•Taking time:
Helps: Make her feel that you have time. Sit down and greet her without
hurrying; then; just stay quietly smiling at her, watching her breastfeed, and waiting for her to answer.
Hinders: Be in a hurry. Greet her quickly, show signs of impatience,
look at you watch.
•Touch:
Helps: Touch the mother appropriately.Hinders: Touch her in an inappropriately way.
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Helpful Non-verbal Communication
Keep your head level
Pay attentionRemove barriers
Take time
Touch appropriately
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Our non-verbal communication often
demonstrates to a mother or caregiver our
approval or disapproval of a situation. We
should be careful to avoid allowing our own views on certain subjects, e.g.
religion, to be expressed in a counselling
situation where it might appear as thoughwe are judging a mother.
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Verbal communication:
Tone of our voice is important. Always try tosound gentle and kind when talking to mothers.
Try to find out how people feel. We need tobe interested and to probe beneath the surface if we wish to learn their real worries and their concerns.
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SKILL 2
ASK OPEN QUESTIONS
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To start a discussion with a mother, or to take a
history from her, you need to ask some
questions.
It is important to ask questions in a way that
encourages a mother to talk to you and to give
you information. This saves you from asking too
many questions, and enables you to learn more
in the time available.
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Skill 2
2.1 Ask Open Questions:
Health Worker : “Good morning, (name). I am(name), the community midwife. How is (child‟s
name)?”
Mother : “He is well, and he is very hungry.” Health Worker : “Tell me, how are you feeding him?”
Mother : “He is breastfeeding. I just have to give
him one bottle feed in the evening.”
Health Worker : “What made you decide to do that?
Mother : “He wants to feed to much at that time, so
I thought that my milk is not enough.”
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Open questions are usually the most helpful.
To answer them a mother must give you some
information.Open questions usually start with
How
What
Why
Who
When
where
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2.2 Ask Closed Questions:
Health Worker: “Good morning, (name). I am (name), the
community midwife. Is (child‟s name) well?”
Mother: “Yes, thank you,”
Health Worker: “ Are you breastfeeding him?”
Mother: “Yes” Health Worker: “ Are you having difficulties?”
Mother: “ No.”
Health Worker: “Is he breastfeeding very often?” Mother: “Yes”
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Closed questions are usually less helpful.
They tell a mother the answer that youexpect ,and she can answer them with a
„Yes‟ or „No‟.
Closed questions usually start with wordslike “Are you?‟ or „Did he?‟ or „Has he?‟ or „Does he?‟
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If a mother says „Yes‟ to this question, you still
need to know if she breastfed exclusively, or if
she also gave some artificial feeds.
If you continue to ask questions to which the
mother can only answer „yes‟ or „no‟ you
become frustrated, and think that the mother is
not willing to talk, or that she is not telling the
truth.
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How to use questions to start and to
continue a conversation:
A very general open question is useful to start aconversation. This gives the mother anopportunity to say what is important to her. For example, you might ask a mother of a nine-
month-old baby : “How is your child feeding?”
Sometimes a general question like this receivesan answer such as, “Oh, very well thank you”.
So then you need to ask questions to continuethe conversation.
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For this, more specific questions are helpful. For example: “Can you tell me what your child atefor the main meal yesterday?”
Sometimes you might need to ask a closedquestion. For example: “Did your child have anyfruit yesterday?”
After you have received an answer to thisquestion try to follow up with another openquestion.
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SKILL 3.
USE RESPONSES AND GESTURES
WHICH SHOW INTEREST
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Skill 3
Using Response and Gestures Which Show Interest
Health Worker: “Good morning, (name). How is (child‟sname) now that he has started solids?”
Mother: “Good morning. He is fine, I think.”
Health Worker: “ Mmm.” (nods, smiles)
Mother: “Well, I was a bit worried the other day,because he vomited.”
Health Worker: “Oh dear!” (raises eyebrows, looks
interested.)
Mother: “I wondered if it was something in the
stew that I gave him.”
Health Worker: “ Aha!” (nods Sympathetically).
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If you want a mother to continue talking, you
must show that you are listening and that youare interested in what she is saying.
Important ways to show that you are listeningand interested are:
With gestures, for example, look at her, nodand smile.
With simple responses, for example, you say„Aha‟, „Mmm‟, „Oh dear!‟.
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SKILL 4.
REFLECT BACK WHAT THE
MOTHER SAYS
R fl ti B k
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Reflecting Back
Health Worker: “Good morning, (name). How are you
and (child‟s name) today?”
Mother: “He wants to feed too much – he istaking my breast all the time!”
Health Worker: “(Child‟s name) is feeding very often?”
Mother: “Yes. This week he is so hungry. I think
that my milk is drying up.” Health Worker: “He seems hungrier this week?”
Mother: “Yes, and my sister is telling me that I
should give him some bottle feeds as
well”
Health Worker: “Your sister says that he needs
something more?”
Mother: “Yes. Which formula is best?”
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Health workers usually ask mothers a lot of factual questions. However, the answer tofactual questions are often not helpful. Themother may say less and less in reply to eachquestion.
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It is more useful to repeat back or reflect what amother says. This is another way to show youare listening and encourages the mother or caregiver to continue talking and to say what is
important to her. It is best to say it in a slightlydifferent way, so that it does not sound asthough you are copying her.
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SKILL 5.
EMPATHIZE- SHOW THAT YOUUNDERSTAND HOW SHE FEELS
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Empathy is a difficult skill to learn. It is difficult
for people to talk about feelings. It is easier to
talk about facts.
When a mother says something which shows
how she feels, it is useful to respond in a way
which shows that you heard what she said, and
that you understand her feelings from her point
of view.
S th
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Sympathy:
Health Worker: “Good morning, (name). How are you and
(child‟s name) today?”
Mother: “(Child‟s name) is not feeding well. I am worried
he is ill.” Health Worker: “I understand how you feel. When my
child was ill, I was so worried. I know exactly
how you feel.” Mother: “What was wrong with your child?”
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Empathy:
Health Worker: “Good morning, (name). How are
you and (child‟s name) today?” Mother: “He is not feeding well, I am worried he is
ill.”
Health Worker: “You are worried about him?” Mother: “Yes, some of the other children in the
village are ill and I am frightened he may have
the same illness.” Health Worker: “It must be very frightening for
you.”
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For example, if a mother says: “My babywants to feed very often and it makes mefeel so tired!” you respond to what she
feels, perhaps like this: “You are feelingvery tired all the time then?”
Empathy is different from sympathy. Whenyou sympathize you are sorry for a person,but you look at it from your point of view.
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If you sympathize, you might say: “Oh I
know how you feel. My baby wanted to
feed often too, and I feel exhausted.”
This brings the attention back to you, and
does not make the mother feel that you
understand her.
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You could reflect back what the mother
says about the baby.
For example: “He wants to feed very
often? But this reflects back what the
mother said about the baby‟s behavior,
and it misses what she said about howshe feels. She feels tired.
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So empathy is more than reflecting back
what a mother says to you.
It is also helpful to empathize with a
mother‟s good feelings. Empathy is not
only to show you understand her bad
feelings.
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SKILL 6.
AVOID WORDS WHICH SOUND
JUDGING.
Using Judging Words:
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Using Judging Words:
Health Worker: “Good morning, (name). Is (name)
breastfeeding normally?”
Mother: “Well – I think so.” Health Worker: “Do you think that you have enough
breast milk for him?”
Mother: “I don‟t know.. I hope so, but maybe not..” (she looks worried)
Health Worker: “Has he gained weight well this
month?” Mother: “I don‟t know..”
Health Worker: “May I see his growth chart?”
Avoiding Judging Words:
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Avoiding Judging Words:
Health Worker: “Good morning, (name). How is
breastfeeding going for you and (child‟sname)?”
Mother: “It‟s going very well. I haven‟t needed to give
him anything else.” Health Worker: “How is his weight? Can I see his growth
chart?”
Mother: “Nurse said that he gained more than half a kilothis month. I was pleased.”
Health Worker: “He is obviously getting learned about the
mother ‟s feelings?”
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„Judging words‟ are words like: right, wrong,
well, badly, good, enough, properly.
If you use judging words when you talk to amother about feeding, especially when you ask
questions, you may make her feel that she is
wrong, or that there is something wrong with the
baby. A breastfeeding mother may feel there is
something wrong with her breast milk.
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Mothers may use judging words abouttheir own situation. You may sometimesneed to use them yourself, especially the
positive ones, when you are building amother‟s confidence.
You may have noticed that judgingquestions are often closed questions.Using open questions often helps to avoidusing a judging word.
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Summary
LISTENING AND LEARNING SKILLS
Use helpful non-verbal communication
Ask open questions
Use responses and gestures which showinterest
Reflect back what the mother says
Empathize- show that you understand howshe feels
Avoid words which sound judging.
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YOUR communication skills can help amother feel good about herself and
confident that she will be a goodmother.
Confidence can help a mother to carry outher decisions and to resist pressuresfrom other people.
To build confidence and support we needadditional skills…
Build Confidence and give support
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Accept mother’s ideas and feelingsWithout agreeing
Without disagreeing
ACCEPTING is NOT AGREEING that she
is right
ACCEPTING - helps her to trust you
1. Accept what a mother thinks and feels
Demo d-e
Skill 1 A i h h ‟ hi k
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Skill 1: Accepting what mother‟s thinks
A.Mother: “My milk is thin and weak, and so I
have to give bottle feeds.”
Health Worker: “Oh no! Milk is never thin and
weak. It‟s just looks that way.(nods, smiles)
Skill 1
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Skill 1
B.Mother: “My milk is thin and weak, and so I
have to give bottle feeds.”
Health Worker: “Yes – thin Milk can be a
problem”
Skill 1
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Skill 1
C.Mother: “My milk is thin and weak, and so I
have to give bottle feeds.”
Health Worker: “I see. You are worried about
your milk”
Skill 1 A ti h t th f l
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Skill 1: Accepting what mother feels
D.Mother(crying): “It is terrible,(child‟s name) has
a cold and his nose is completely blocked
and he can‟t breastfeed. He just cries and Idon‟t know what to d.”
Health Worker: “Don‟t cry – it‟s notserious.(child‟s name) will soon be better”
Skill 1
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Skill 1
E.Mother(crying): “It is terrible,(child‟s name) has
a cold and his nose is completely blocked
and he can‟t breastfeed. He just cries and Idon‟t know what to d.”
Health Worker: “You are upset about (child‟sname) aren‟t you.”
2 Recognize and acknowledge what is
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2. Recognize and acknowledge what is
right
Case study
A baby being weighed, and his mother.
The baby is exclusively breatfed. Beside themother and baby is the baby‟s growth chart. His
growth chart shows that he has gained a little
weight over the last month. However, his growth
line is not following the reference curves. It is
rising too slowly. This shows that the baby‟s
growth is slow.
Which of these remarks will help to
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Which of these remarks will help to
build the mother’s confidence?
•“your baby‟s growth line is going up too
slowly.”
•“I don‟t think your baby is gaining enoughweight.”
•“your baby gained weight last month just
on your breast milk.”
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3. Give Practical help
Case study
“This mother is lying in bed soon
after delivery. She looks miserable anddepressed. She is saying to the health
worker: “no, I haven’t breastfed him
yet. My breasts are empty and it is toopainful to sit up.”
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Which response is more appropriate
•“you should let your baby suckle now
to help your breast milk to come in.”
•Let me try to make you more
comfortable, and then I’ll bring you a
drink.
4 Provide relevant information
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Find out what she needs to know at
this time.
• Use suitable words that the mother
understands
• Do not overwhelm her with
information
4. Provide relevant information
using suitable language
Case study
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This baby is three months old. Hismother has recently started giving
some formula feeds in the bottle in
addition to breastfeeding. The babyhas developed diarrhea. The mother
is saying to the health worker: “He
has started to have loose stools.Should I stop breastfeedings?”
Case study
Which response gives positive
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• “it is good that you asked before
deciding. Diarrhea usually stops
sooner if you continue tobreastfeed.”
• “oh no, don’t stop breastfeeding. He
may get worse if you do that.”
Which response gives positive
information
5 Make suggestions rather than
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Provide choices and let her
decide what will work for her.
• Do not tell her what she shoulddo or must not do.
• Limit your suggestions to oneor two suggestions that are
relevant to her situation.
5. Make suggestions rather than
commands
Case study
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Health worker: “good morning
(name). What can I do for youtoday?
Mother: “can you tell me what you
asked me what foods to give my
baby, now that she is six months
old.”
Case study
H lth k I l d th t k d W ll
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Health worker: I am glad that you asked. Well
now, the situation is this. Most children need
more nutrients than breast milk alone when
they are six months old because breast milkhas less than 1 milligram of absorbable iron
and breast milk has about 450 calories, so
less than the 700 calories that are needed.
The vitamin, a needs are higher than are
provided by breast milk and also the zinc and
other micronutrients.”
“However, if you add foods that aren’tprepared in a clean way it can increase the
risk of diarrhea and if you give too many poor
quality foods the child won’t get enough
calories to grow well.
6 Arrange follow up and on-going
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- Learn what help may be available
- Offer a time to see her / talk with her
- Encourage her to see you if she hasdoubts or questions.
- Refer her to a community support group
- Refer her for more specializedcounseling.
- Many women are not able to do what they want
to do or what you may suggest they do.
6. Arrange follow up and on going
support
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Summary
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• Accept what a mother thinks and feels
• Recognize and praise what a mother and baby are doing right
• Give practical help
• Give a little, relevant information• Use simple language
• Make one or two suggestion, not
commands
Summary
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