1. COMMUNICATION: Core Counselling Skills
NICKY BROSNAN AND GAYLE WATTS

2. NECVN Stroke Competencies
This session has covered an awareness of the following stroke specific competencies:
1.1.1 Describe and demonstrate the components of effective communication e.g. listening skills, verbal and non-verbal skills, negotiation and influencing.
Demonstrate rapport building, empathy and personalising communication for the individual during interactions with person/carer.
5.1.1 Select and complete appropriate standardised and non-standardised clinical assessments within the parameters of own role.

3. An ice-breaker!!
The purpose of this exercise is to demonstrate that communication is a two way process:
You are going to draw a picture. You want to know what it is but need to listen to my instructions. You can not ask me any questions during the exercise and I can’t repeat instructions.

4. Does your drawing look like this?

5. What is Communication
COMMUNICATION IS THE ART OF TRANSMITTING INFORMATION, IDEAS AND ATTITUDES FROM ONE PERSON TO ANOTHER.
COMMUNICATION IS THE PROCESS OF MEANINGFUL INTERACTION AMONG HUMAN BEINGS
7% WORDS Words are only labels and the listeners put their own interpretation on speakers words
38% PARALINGUISTIC The way in which something is said - the accent, tone and voice modulation is important to the listener
55% BODY LANGUAGE What a speaker looks like while delivering a message affects the listener’s understanding most.
Listening to others is an elegant art.
Good listening reflects courtesy and good manners.
The result of poor listening skill could be disastrous for our patients (patients experience).
Good listening can eliminate a number of misinterpretations.
Good listening skill can improve social relations and conversation.
Listening is a positive activity rather than a passive or negative activity.
Control (getting what you want/need/like)
Motivation (resistance speak)
Emotional Expression (I am feeling… I am frustrated…)
Information (sharing a diagnosis, prognosis, long term care, major life changes, bad news, good news)
Listening is Hard Work
Competition
The Rush for Action
Lack of Training
You have to choose to begin to participate in listening

6. Essence of Communication?
PERSONAL PROCESS
OCCURS BETWEEN PEOPLE
INVOLVES CHANGE IN BEHAVIOUR
MEANS TO INFLUENCE OTHERS
EXPRESSION OF THOUGHTS AND
EMOTIONS THROUGH WORDS & ACTIONS.
TOOLS FOR CONTROLLING AND MOTIVATING PEOPLE.
IT IS A SOCIAL AND EMOTIONAL PROCESS.

7. The Communication Process
Medium
Barrier
SENDER
(encodes)
Barrier
RECEIVER
(decodes)
The entire process starts with the sender of the communication having a thought in mind which needs to be communicated. This thought then is coded - that is converted in a form which can be sent or transmitted from sender of communication to the receiver, The process of coding typically involves representing the thoughts of information to be communicated in some form of language. This is first done mentally then represented in some physical form like written or spoken word or some other method physically representing and transmitting data. The coded data is then transmitted or sent to the receiver of the communication.
The message transmitted thus teaches the recipient in the form of some physical representation of data. This physical form of message is perceived by the recipient through sensory organs. Typically this involves some activity like hearing, reading, or seeing. Whatever is perceived by the receiver of the message is then mentally decoded back in the form of thoughts in the mind of the receiver. The thoughts created in the process of decoding makes up the understanding of the message by the receiver.
Ineffective communication
Disguised messages
Conflicting messages
Unclear meanings
Clichés
Environment
The venue
The effect of noise
Temperature in the room
Other People – Status, Education
Time
Feedback/Response

8. Reflect on barriers to communication
Think about your job role, and some of the barriers you face when to communicating with patients.
What difficulties have you come up against?
How did you manage these difficulties?
Can you think of another way around the barriers you have faced?

9. Barriers to communication
Environmental barriers
Communication difficulties (aphasia)
Low motivation
Lack of insight/awareness
Language
Cognitive Difficulties (e.g. attention/concentration)
Poor listening skills
Embarrassment/shyness
Shame
Guilt
Fear
Interruptions

10. Allows patient to raise concerns
Technique
Effect
Example
Eliciting concerns
Allows patient to raise concerns
So are there any worries you would like to discuss today? …
Reflections
Demonstrates you are listening closely
P. I’ve been feeling a bit down over the past week or so
T. You’ve been feeling a bit down?
Checking understanding
Shows you want an authentic understanding of the patients thoughts and feelings
So it sounds like you’ve been quite worried about your stroke. Have I got that right?
Clarifying
Deepens understanding of patient issues
You mentioned finding this tough. Could you tell me what you mean by that? What has been touch for you?
Empathy
Shows understanding of how patient is feeling
You seem quite sad today
Open Q
Opens up communication and allow patient to introduce their own ideas and concerns
How have you been since we last met?
How do you feel about what we have been discussing
Picking up on cues
Demonstrates really close attention and listening
You mentioned something about your son being upset. Was that something you wanted to talk about
Pausing allowing silence
Gives time for the patient to reflect on something important
……………………..
Photocopy the forms for listening skills

11. MI and confrontational approaches
Motivational Interviewing
Explores clients own concerns and perceptions
Elicits client concern regarding behaviour
Denial seen as interpersonal behaviour pattern, influenced by the therapist
Denial met by reflection
Objective data met with factual data without imposing interpretation
Goal negotiated
Label unimportant (i.e. alcoholic)
Individual seen as in control over their behaviour, able to chose, responsible
Confrontational
Focus is on correcting the clients perceptions and overcoming denial
Interview attempts to convince client of diagnosis/behaviour
Denial seen as a personality trait requiring confrontation from the therapist
Denial met with argumentation
Objective data of impairment presented in a directive manner as proof of disease
Treatment goal prescribed
Emphasis on acceptance of label (i.e. alcohol or addict)
Individual seen as helpless over their behaviour, out of control

12. Listening exercise
In groups of 4/5 read the scenario provided and chose one person to be the patient, one to be the therapist two to observe and make comment and one to feedback:
1 x Patient
1 x Therapist
2 x listener
1 x feedback
Even in this task the observer has had a task on his/her hands to really listen to what is being said and to then summarise the thoughts/feelings that were reflected in this exercise and in some ways had the most difficult job.
(P)OSTURES & GESTURES
How do you use hand gestures? Stance?
(E)YE CONTACT
How’s your “Lighthouse”?
(O)RIENTATION
How do you position yourself?
(P)RESENTATION
How do you deliver your message?
(L)OOKS
Are your looks, appearance, dress important?
(E)PRESSIONS OF EMOTION
Are you using facial expressions to express emotion?
Encouraging As A Part of Attending
Verbal and nonverbal ways of encouraging the client to continue to share his or her thoughts, feelings or behaviors.
“Umhum”
“Tell me more.”
“He yelled at you?”
“Can you give me an example?”
“And that means…?”
Or simply nodding your head.

13. Fallacies about Listening
Listening is not my problem!
Listening and hearing are the same
Good readers are good listeners
Smarter people are better listeners
Listening improves with age
Learning not to listen
Thinking about what we are going to say rather than listening to a speaker
Talking when we should be listening
Hearing what we expect to hear rather than what is actually said
Not paying attention
( preoccupation, prejudice, self-centeredness, stero-type)
Listening skills are difficult to learn

14. Using the distress scale to aid communication
The distress scale is used to identify distress in patients and to find out specifically what they are feeling distressed about.
However, it can also be used as a way of opening up communication with a patient.
Some topics are hard for people to bring up without prompting – e.g. sex and relationships.

16. How to administer the distress scale
How you deliver the distress scale is very important if you want it to be valuable in aiding communication with a patient – don’t just give it to them and let them get on with it.
Talk through the different items listed, give examples of what kind of things the items would cover.
If they tick several items, get them to rate from 1-10 how distressing each of those items is.
Talk about how you could help, what exactly is troubling them? How can you get their rating down? You might not be able to get rid of their distress completely, but is there something you can do to alleviate it to some degree?
Talk about why you are giving them the scale, let them know that you want to find out more about how they are feeling after their stroke, and you want to know about any worries they might have so that you can make positive changes to help alleviate them. Explain how you will use the information you get from the scale.
If they tick something which isn’t your area of expertise, don’t just ignore it. Find out more information about the problem and talk to someone who might be able to help.
Make notes of things which come up.
Mark the date next to the scale (where the patient has put a mark to indicate their level of distress) and the next time you see them, you can use the same scale and see how things have changed.

17. Take home message
Although good listening takes time and effort, the impact is significant and can make a big difference.
Every interaction with a patient is an opportunity to practice and to use good communication skills.
Spend some time reflecting on your own style of communication and the impact it has on others around you.
Don’t be afraid to give / receive feedback on communication.
Manage and think about the impact of the personal information you give away to patients.
Look for signals, adapt to individual differences, think about how someone is likely to take the things you say.