C OUNSELING & C OMMUNICATION S KILLS P ROBLEM S OLVING Problem: a state or condition that requires changing (does everyone involved agree that something needs changing?) Problem for a group: is a specific situation to which members must respond if group is to function effectively

C OUNSELING & C OMMUNICATION S KILLS P ROBLEM S OLVING Problem solving involves many steps: 1. Identify Issue/Problem o Separate people from problem 2. Explore alternatives o Focus on interests not positions o Options for mutual gain 3. Decision Point 4. Evaluation Active Listening Key Element in All Steps

C OUNSELING & C OMMUNICATION S KILLS T URNING THE “D IFFICULT ” C ONVERSATION I NTO T HE “L EARNING ” C ONVERSATION Who, what, where, when, how, why etc. and of course the BLAME game Explore each other’s stories from certainty to curiosity, both/and Disentangle intent from impact and acknowledge the complexity of human motivations Abandon blame, analyze contribution The What Happened Conversation:

C OUNSELING & C OMMUNICATION S KILLS T URNING THE “D IFFICULT ” C ONVERSATION I NTO T HE “L EARNING ” C ONVERSATION Find your feelings Normal & natural, good people bad feelings, hidden feelings Don’t vent, describe Don’t evaluate, share The Feelings Conversation

C OUNSELING & C OMMUNICATION S KILLS T URNING THE “D IFFICULT ” C ONVERSATION I NTO T HE “L EARNING ” C ONVERSATION Am I competent, good, worthy? Avoid all or nothing Ground your identity issues Awareness of your issues the “and” stance Mistakes OK, intentions complex, contribution to problem Regain your balance Let go of controlling reaction It’s 3 months from now Their identity too Prepare for response Take a break Name it ASK FOR HELP The Identity Conversation

C OUNSELING & C OMMUNICATION S KILLS R ELATIONSHIP M ODEL (A DVERSARIAL – P ARTNERING ) Coercion “You must do this or face pain.” Confrontation “You must do this.” “No, I won’t!” Coexistence “You stay on your side and I’ll stay on mine.”

C OUNSELING & C OMMUNICATION S KILLS R ELATIONSHIP M ODEL (A DVERSARIAL – P ARTNERING ) Cooperation “I’ll help you when my work is done.” Collaboration “Let’s worn on this together.” Co-Ownership “We both feel totally responsible.”

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS Four Basic Steps: 1. Identify a contradiction in client’s presentation. 2. Determine that the contradiction is relevant to HIV or other health risks, and deserves attention in the counseling session. 3. Formulate a non-judgmental response that paraphrases and reflects the contradiction. 4. Follow the client’s lead, using constructive confrontation techniques.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS Signs of Ineffective Intervention: A. Judgments in counselor’s response (verbal or non-verbal) B. Client shuts down or becomes increasingly hostile. C. A power struggle develops – counselor and client begin arguing (directly or indirectly) about who is right.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) 1. Identify A Contradiction In Client’s Behavior Some common types if contradictions in HIV counseling include: A. How client sees him/herself and how client behaves. Example : A client sees himself as being fully committed to safer sex, but has slipped on several occasions in the past three months and had unsafe sex. B. A client’s long-term behavior patterns and his/her commitments concerning future behaviors Example : A client who has never enjoyed monogamous relationships says she is going to find a committed partner and be monogamous after her test. Note: While people are capable of changing longstanding behaviors, most people make these changes incrementally over a period of time. Unrealistic plans can sometimes interfere with achieving true behavior change.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) C. Client’s verbal and non-verbal messages. Example: A client says she is not really concerned about HIV because her risk is very small, but her manner is very anxious, she is blinking her eyes rapidly, and she has a tremor in her voice and her hands. D. Two or more verbal messages. Example : A client says he is comfortable following safer sex guidelines, and then says he has a hard time asking new sexual partners to use condoms. E. Client’s expressed feelings and what most people tell you the feel in a similar situation. Example : A client says she is not really surprised to have tested positive, nor is she especially upset about it. You are aware that most people who test positive find the news very upsetting, and many are surprised by the result even if it was what they expected.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) F. How client feels now and how most or many people in a similar situation feel after a period of time. Example : A client who has tested positive feels despondent, hopeless and unable to cope. Your own experience is that over time, most people who have tested positive find they are able to move on from this place of despondency and continue to have productive, meaningful lives. G. A client’s expressed interpretation of a circumstance and the true facts of the circumstance. A heterosexual client says she believes heterosexuals do not face any significant risk for HIV; in actual fact, heterosexuals can and sometimes do contract HIV if they engage in risky behaviors with others carrying the virus.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) 2. Determine That The Contradiction Is Relevant To HIV Or Other Health Risks, And Deserves Attention In The Counseling Session. Not every contradiction presented by a client needs to be addressed in an HIV counseling session. However, a contradiction related to HIV risks could be an appropriate focus in a session. The counselor’s choice to address a contradiction should be guided by the sense that doing so may help the client better consider his or her risks and plan relevant risk reduction strategies.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) 3. Formulate A Non-Judgmental Response That Paraphrases And Reflects The Contradiction. Use language and tone of voice that present your response in a neutral way. The following techniques can be effective: A. Link the contradictions, using “and” rather than “but.” This form has a less judgmental tone than contradictions linked with “but.” Example : “You say you haven’t had any HIV-related risks in the past year, and you also told me you have had sex this year with several different partners without using a condom.”

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) B. Link the contradictions using the phrases, “if…, then….” Example : “If you are committed to avoiding HIV, then how does your decision not to use condoms fit into that commitment?” C. Use the technique of “third personing” to explore, acknowledge or normalize feelings that may or may not be expressed openly. D. “Third Personing” is a technique where the counselor describes in an indirect and general way the feelings or responses a client may be having, by talking about feelings people in general might have similar situations. (“Third Personing” refers to the form of the statement. First person statements are “I” statements. Second person statements are “you” statements. Third person statements are “he, she, they, everyone, people” statements- basically, anything that isn’t “I” or “you”.) Example : “Strong feelings often arise for people when they learn their test results.” “It can be scary to go through this process.”

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) D. Express your confusion about the contradiction directly (keep the focus on the situation, not the client ). Example : “Something confuses me about your situation….You see yourself as someone who is absolutely honest in your relationship, and you also have no intention of telling your girlfriend about your dates with men. These seem kind of contradictory to me. How do you make sense of it for yourself?”

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) 4. Follow The Client’s Lead, Using Constructive Confrontation Techniques. A. Discuss the contradiction in more depth with a “willing” client. Use open-ended questions and active listening techniques. Provide referrals or other intervention. B. Keep working with an “ambivalent” client to raise his or her awareness of the contradiction, and ways it might contribute to HIV-related risks. C. Detach and move on with a “resistant” client.

C OUNSELING & C OMMUNICATION S KILLS W ORKING WITH C ONTRADICTIONS (I N MORE DETAIL ) Signs of Ineffective Intervention: A. Judgments in counselor’s response (verbal or non- verbal) B. Client shuts down or becomes increasingly hostile. C. A power struggle develops – counselor and client begin arguing (directly or indirectly) about who is right.