Basic Counselling Skills
The most important thing in communication is to hear what isn't being said.
Peter Drucker
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
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
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
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
Looking Like You're Listening is Not Enough
Listening skills
Ask open and closed questions Use “encouragers” Paraphrase what you have heard Reflect on feeling Summarize
Open Questions
Open questions Generally start with “what”, “how”, “why” or
“could “ Questions serve to:
Gather lots of general information Encourage discussion
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?”
Closed Questions
Generally start with “is”, “are”, or “do” Serve to:
Gather lots of specific information quickly Tend to close down discussion
Example: Closed Questions
Nurse: “Are you giving the medicine every day?”
Nurse: “Is the baby able to tolerate the medicine in the morning?”
Encouragers
Ex: “Yes, I understand” or repeat a word or two of what was said
Serves to: Encourage further discussion
Example: Encouragers
Patient: “I missed my appointment last week because of transportation problems.”
Nurse: “Transportation problems…?”
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?”
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
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.”
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
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”
Summarizations
Succinctly pull together ideas from a an interview
Serves to Organize the structure of the interview Check the accuracy of understanding,
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?”
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
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
Non Verbal Communication
Remember culture and context Most nonverbal behaviors have multiple
meanings Some nonverbal behaviors have different
meanings in different cultures
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?
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?
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
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
Influencing or Changing Behavior
Influencing or Changing Behavior
Directives Reframes and interpretations Advice Feedback Logical consequences
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
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”
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
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”
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
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”
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
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”
Logical Consequences
Focuses on the logical consequences of a person’s behavior, actions, thoughts, or feelings
Serves to: Increase awareness of consequences
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”
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