Developing a Trusting Relationship • Establishment of Rapport or Relationship Building
Non Verbal Communication These include: • Facial expression – smile and look friendly • Eye contact – look client in the face as he or she speaks without staring • Posture – be relaxed, lean towards the person to show acceptance and attentiveness • Nodding – nod when you are in agreement with what the person says to show you have heard what he or she is saying
Non Verbal Cont’d • Tone of voice – avoid a monotone and a low voice that is difficult to hear or a shrill aggressive tone • Touch – be willing to touch the client in order to examine him or her or to reassure and show concern when appropriate Be aware of cultural norms governing non- verbal behaviour
Verbal Communication These include: • Greetings and self introduction • A brief opening conversation on matters other than their problem or what brought them to see you helps put the person at ease e.g. asking for name, talking about the weather, commenting positively on the client’s attire • Indicating one’s willingness to help
Listening and Responding With Empathy In order for a counsellor to provide effective help he or she needs to listen effectively to the client. Listening is needed to learn what is going on in the person, what the symptoms are and how the person feels about the situation
Listening is a skill that has to be learned and practiced. Usually most people are too preoccupied with their own needs, thoughts and assumptions to listen effectively. • Listening involves putting aside one’s own self-interests and committing one’s self to understand how the client feels and what their needs are from their perspective
Listening and Resp’ding Cont’d • Just by listening the counsellor says without words “I care about what’s happening to you, you are important” • Listening is an active process that requires not just quietly paying attention but indicating that you are doing so through nonverbal and verbal ways. Most of the skills used in establishing rapport are also important in listening
There should be: • Eye contact-looking at the person when he or she is speaking • Attentive body language – sitting in a relaxed manner with an occasional leaning towards the person to show that you are attending. Responding with appropriate gestures e.g. Nodding head in agreement or frowning when one does not understand • Continuation responses – these are responses that encourage the person to keep talking e.g. nodding or saying “is that so”, “tell me more” e.t.c.
Paraphrasing This involves stating in your own words what you think the client has said. This helps you keep track of what the client is saying. It also acts as feedback to the client. If you did not hear right then he/she can correct you. Moreover, it helps clients realize that you are really listening and this encourages them to communicate their needs, e.g.
Paraph’sing Cont’d “Let me see if I understand. You are saying that the pain you have in your head was there two weeks ago but was not so painful. Right now it has a sharp quality. Is that right?
Summarizing This is similar to paraphrasing but usually follows a lengthier piece of communication from the patient. The counsellor condenses, restates and highlights the contents and feelings of what the client has communicated
Summarizing Cont’d This can be done at the end of the time spent together or during the interaction whenever the counsellor realizes there is a need to go over what has been said so far to give feedback, structure and direction. It is especially needed when the patient’s communication have been confusing or lengthy and rambling
Questioning/Focusing/Clarifying Ask questions to help you fully understand. Use open ended questions that encourage the patient to express self e.g. what happened? How do you feel? Closed questions elicit yes and no answers and should be avoided when you want more information
Questioning/Focusing/Clarifying Cont’d You can also use questioning to seek more information about particular relevant areas or issues. E.g. “Could you tell me more about the accident you had two days ago?” This is called focusing
The following are types of open-ended questions recommended in a counselling session. They often begin with How, What, and Why: How? “How do you think the virus is passed from one person to another?” “How much do you know about the risk factors or lifestyles of the people you are having sex with?”
WHAT? “What do you understand by the word confidentiality?” “What do you know about HIV infection?” “What do you know about how HIV is transmitted? What do do you think about the use of condoms?” WHO? “Who have you spoken to about taking the HIV test”
WHY? Why questions must be chosen carefully because many are negative and tend to imply judgement of behaviour, making a client feel defensive. Instead it is recommended that counsellors ask positive why questions that will help clients explore the dynamics of their success, rather than their failures
WHY? Cont’d The following are some examples of positive “why” questions: “That’s terrific! Why do you think you were able to use them that one time?” “Why do you want to be tested?”
Although it is recommended that counsellors use open-ended questioning as much as possible, they should recognise that there are instances where closed questions may be appropriate. For example, obtaining a client’s consent for an HIV test or partner notification requires the client to provide the counsellor with a simple “yes” or “no” answer
Reflection of Feelings This involves sensing, observing and making known the feelings that underline a person’s words and non-verbal behaviour. The person may or may not express these feelings directly but the care giver reflects back what is sensed or observed to communicate to the person that not only
Reflection of Feeling Cont’d does he or she understand what is being said but is also aware of the feelings behind it. When feelings are reflected correctly, it often produces profound feelings or being understood and supported and usually encourages further revealing and discussing of feelings
Counsellor: says to patient who is fidgeting and has his head bowed, “It looks like you are worried about something would you like to talk about it?
A client’s mother: says “I can’t get him to tell me why he came to see the counsellor, but after all I am his mother
Counsellor: says “It sounds like you are feeling frustrated at not being able to communicate with him and also hurt and sad that he is not willing to confide in you”
After listening actively to a person there is need to respond with empathy to the needs he or she has expressed
Confronting Sometimes as you listen there is a need to gently point out that there are inconsistencies in what a person is saying or in what is said and what is actually done. E.g.
Counsellor: “You say you are not anxious but you look frightened and tense whenever you talk about your serostatus”
Counsellor: “Please help me understand, you just told me you live at home but now you talk of having moved in with a friend. I’m not sure what the situation is now”
Using Impersonal Statements (third person technique) This is used to acknowledge, reflect and normalize feelings that are expressed verbally or non-verbally.
It can be used by counsellors to: • Avoid creating defensiveness in clients • Allow clients to choose to respond or not respond to identified feelings • Help client understand that it is normal to feel that way • Present choices
For Example Counsellor: • “People often feel uncomfortable and guilty when you talk to them about HIV/ AIDS” • “Some people decide to abstain from sex, while others choose to remain faithful to one partner
Counsellor Cont’d There are still others who prefer to use condoms and some who never use them. to avoid becoming infected with HIV you must decide which of these options suit you best”
Repeating At times of stress and crises, people do not always comprehend everything they are told. As they may be in a state of denial or feel overwhelmed. Counsellors should not hesitate to repeat important information and points, if they believe that a client has not adequately absorbed the meaning
Repeating Cont’d Counsellors should repeat statements of support or fact as often as necessary to ensure that clients understand issues relating to risk illness and health management
Connecting Many clients become so preoccupied with their fears that they cannot see the connection between their behaviour and its consequences. For example, a counsellor might point out: “Have you noticed that when you withdraw and do not speak to your family, they get very irritated with you?”
Self-Disclosure This technique involves a counsellor sharing his/her own pertinent life experiences with a client. A counsellor can use this technique when he/she knows the client well. Since it involves revealing the counsellor’s own feeling, life experiences and emotional concerns.
Self-Disclosure Cont’d The counsellor should use his/her discretions. There is a risk of shifting the focus from the adolescent on to the counsellor. The counsellor should ensure that this does not happen