1. Basic Counselling Skills

2. The most important thing in communication is to hear what isn't being said. Peter Drucker

3. 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

4. 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
We are problem solvers by nature…that is why we chose our profession

5. 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

6. 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

7. Looking Like You're Listening is Not Enough

8. Listening skills Ask open and closed questions Use “encouragers”
Paraphrase what you have heard
Reflect on feeling
Summarize

9. Open Questions Open questions Questions serve to:
Generally start with “what”, “how”, “why” or “could “
Questions serve to:
Gather lots of general information
Encourage discussion

10. 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?”

11. Closed Questions Generally start with “is”, “are”, or “do” Serve to:
Gather lots of specific information quickly
Tend to close down discussion

12. Example: Closed Questions
Nurse: “Are you giving the medicine every day?”
Nurse: “Is the baby able to tolerate the medicine in the morning?”

13. Encouragers
Ex: “Yes, I understand” or repeat a word or two of what was said
Serves to:
Encourage further discussion

14. Example: Encouragers
Patient: “I missed my appointment last week because of transportation problems.”
Nurse: “Transportation problems…?”

15. 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?”

16. 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

17. 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.”

18. 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
Stem + feeling + (context) + check out

19. 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”

20. Summarizations Succinctly pull together ideas from a an interview
Serves to
Organize the structure of the interview
Check the accuracy of understanding,

21. 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?”

22. 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

23. 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

24. Non Verbal Communication
Remember culture and context
Most nonverbal behaviors have multiple meanings
Some nonverbal behaviors have different meanings in different cultures

25. 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?

26. 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?

27. 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

28. 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

29. Influencing or Changing Behavior

30. Influencing or Changing Behavior
Directives
Reframes and interpretations
Advice
Feedback
Logical consequences

31. 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

32. 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”

33. 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

34. 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”

35. 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

36. 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”

37. 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

38. 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”

39. Logical Consequences
Focuses on the logical consequences of a person’s behavior, actions, thoughts, or feelings
Serves to:
Increase awareness of consequences

40. 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”

41. 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