counsellingskills

8/7/2019 CounsellingSkills

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Counselling SkillsCounselling Skills

Presented by Debbie FeatherstonePresented by Debbie Featherstone

East Lancashire Hearing and Balance ServicesEast Lancashire Hearing and Balance Services

30June200830June2008



Interested?Interested?

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Or are youOr are youthinking……thinking……

How long’s thisHow long’s thisgoing to take…..?going to take…..?

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??

Or are you……Or are you……zzzzzzzzzzZzzzz…Zzzzz… zzzzz…..zzzzz….. Zzzzz…….Zzzzz…….

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OverOver--eager……eager……

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WYSIWYGWYSIWYG

A picture says aA picture says a

thousandsthousandswords…words…

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You’re telling someone about somethingYou’re telling someone about somethingthat’s important … to YOUthat’s important … to YOU

You see:You see: You see:You see:

Youthink:“He’sboredoflisteningYouthink:“He’sboredoflisteningme”me”

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Iamnotinteresting– Idon’tmatter

Youthink:“Hewouldratherbesomewhereelse”



Does it feel like…..Does it feel like…..

A competitionA competition DisempoweredDisempowered

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Iamnotinteresting– Idon’tmatter



22 –– way trafficway traffic

ListeningListening RespondingResponding

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NVCNVC

•• NonNon--verbal communicationverbal communication

•• communicationcommunication

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Helping patientsHelping patients

•• Asking the rightAsking the rightquestionquestion

•• In the right wayIn the right way

•• “Actively” listening to“Actively” listening totheir answertheir answer

•• Using the right nonUsing the right non-- •• About the right thingAbout the right thing

•• At the right timeAt the right time

ver a commun ca onver a commun ca on

•• Responding in a wayResponding in a waythat will help themthat will help them

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The Talking CureThe Talking Cure

•• New publicationNew publication –– 19 May 200819 May 2008

•• Why conversation is the future of healthcareWhy conversation is the future of healthcare(Jack Stilgoe & Faizal Farooq)(Jack Stilgoe & Faizal Farooq)

•• How the Wanless Report (2002) can be takenHow the Wanless Report (2002) can be takenforwardforward

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•• Uses 2 case studies: Diabetes and Mental HealthUses 2 case studies: Diabetes and Mental Health

•• Patients are likely to have their own opinionsPatients are likely to have their own opinionsabout treatmentabout treatment

•• We can’t assume that professional and patientWe can’t assume that professional and patientwill agree on what counts as a successwill agree on what counts as a success

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•• In the future, conversation will be anIn the future, conversation will be anincreasingly important part of what healthincreasingly important part of what healthprofessionals do and it will become increasinglyprofessionals do and it will become increasingly

•• Cultures, communication skills andCultures, communication skills and

conversational styles will need to adapt andconversational styles will need to adapt andevolveevolve

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•• As medicine becomes more scientific and moreAs medicine becomes more scientific and morecomplex, conversation has paradoxically gonecomplex, conversation has paradoxically gonefrom being an optional extra to a core part of from being an optional extra to a core part of

..

•• There is a widening beyond biomedicalThere is a widening beyond biomedicalindicators to look at the degree to whichindicators to look at the degree to which

patients are able to lead the life they wishpatients are able to lead the life they wish

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•• It is not possible to say what all patients wantIt is not possible to say what all patients wantrelationships to look like or what they want fromrelationships to look like or what they want fromthemthem -- that is part of the process of negotiationthat is part of the process of negotiation

•• ome pa en s w pre er o rema n pass ve,ome pa en s w pre er o rema n pass ve,others will want to have more say, or may takeothers will want to have more say, or may takedifferent approaches at different stages of different approaches at different stages of

treatmenttreatment

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•• Building the NHS imagined by Wanless meansBuilding the NHS imagined by Wanless meansabandoning the conception of the patient asabandoning the conception of the patient asconsumerconsumer

•• Conversations and relationships provide the newConversations and relationships provide the newfocusfocus

•• The idea of patient experience is paramountThe idea of patient experience is paramount

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•• An instinctive response might be that all of thisAn instinctive response might be that all of thisdemands more of the NHS’s scarcest resourcedemands more of the NHS’s scarcest resource ––timetime

•• Healthy conversation asks professionals to talk Healthy conversation asks professionals to talk differently, not talk moredifferently, not talk more

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Thinking differentlyThinking differently

Task Skill

A piece of work to be done as part of one's duties

A practiced ability

A difficult or tedious undertaking An ability that has been acquired byra n ng

A function to be performed Special ability or expertise enablingone to perform an activity very well

An objective Something, such as a trade, requiring

special training or expertiseStatic Fluid and growing

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Counsel v use counselling skillsCounsel v use counselling skills

(To) counsel Counselling skills

The act of exchanging opinions andideas

The acquired verbal and nonverbalskills that enhance communication by

helping a medical professional to

Definitions:

establish a good rapport with a patientor clientAdvice or guidance especially as

solicited from a knowledgeable person

A plan of action

2020

AspracticingAudiologists,weoweittoourpatientstodevelopandusecounsellingskills.ThatdoesNOTturnAudiologistsinto“counsellors”.Professionalcounsellorsundertakelengthytrainingandworkunderclosesupervisionbeforebeing“letloose”onclients.



Counselling SkillsCounselling SkillsAspects of using counselling skills Includes:Managing the Session Introduction/opening appropriate

Confidentiality explainedTiming accordinglyAppropriate ending

Non Verbal Communication Open body posture

Use of appropriate eye contact

Appropriate facial expression

Counselling Skills ListeningAttendingReflective responding

ParaphrasingOpen QuestionsSummarising

Core Conditions EmpathyNon JudgementalCongruenceUnconditional positive regard

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EmpathyEmpathy

“ ” “ ”

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Looking Out the Patient’s WindowLooking Out the Patient’s Window

,,

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A TwiceA Twice--Told TherapyTold Therapy

•• A. What a patient experiences in a consultationA. What a patient experiences in a consultationwith youwith you

•• B. What you experience in a consultation with aB. What you experience in a consultation with apatientpatient

•• Both experiences are from very differentBoth experiences are from very differentperspectivesperspectives

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ExperimentExperiment

•• IrvinIrvin YalomYalom conducted an informal experimentconducted an informal experimentwith a patientwith a patient

•• Patient was a gifted creative writer with writer’sPatient was a gifted creative writer with writer’soc an a oc n a orms o express onoc an a oc n a orms o express on

•• Each wrote accounts of their experience afterEach wrote accounts of their experience aftereach sessioneach session

•• Each valued very different parts of a sessionEach valued very different parts of a session

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Patients with tinnitusPatients with tinnitus

Who are our patients with tinnitus and whatWho are our patients with tinnitus and what

have their experiences been so far?have their experiences been so far?

•• GPs often tell patients nothing can be doneGPs often tell patients nothing can be doneabout tinnitusabout tinnitus

•• Cause often NOT knownCause often NOT known

•• Not treatable by medication or surgeryNot treatable by medication or surgery

•• Patients are often led to believe there is noPatients are often led to believe there is nohope!hope!

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Looking out through YOUR patient’s windowLooking out through YOUR patient’s window

Don’t assume that you know:Don’t assume that you know:

•• what your patient needswhat your patient needs

•• what his/her tinnitus is likewhat his/her tinnitus is like•• what his/her experiences are and have beenwhat his/her experiences are and have been

•• what he/she is going to saywhat he/she is going to say

•• what he/she is thinkingwhat he/she is thinking•• what he/she is feelingwhat he/she is feeling

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Johari WindowJohari Window

1. OPEN area. Known by SELFabout self and ALSO known byOTHERS.

2. BLIND area. Unknown by self but known by OTHERS

3. HIDDEN area. Known by SELF but 4. UNKNOWN area. Unknown by self

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TheaimshouldalwaysbetodeveloptheOPENareaforeveryperson.Whenwe

workinthisareawithothersweareatourmosteffectiveandproductive.TheOPENareaisthespacewheregoodcommunicationandco-operationoccur,

freefromdistractions,mistrust,confusion,conflictandmisunderstanding

not known by others and also unknown by others



Conscious Competence ModelConscious Competence Model

1. Unconscious Incompetence“I don’t know that I don’t know”

2. Conscious Incompetence“I know that I don’t know”

3. Conscious Competence

“I know that I know”

4. Unconscious Competence

I am expert”

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1. Unconscious Incompetence

a) thepersonisnotawareoftheexistenceorrelevanceoftheskillarea

b) thepersonisnotawarethattheyhaveaparticulardeficiencyintheareaconcerned

c) thepersonmightdenytherelevanceorusefulnessofthenewskill

d) thepersonmustbecomeconsciousoftheirincompetencebeforedevelopmentofthenewskillorlearningcanbegin

e) theaimofthetraineeorlearnerandthetrainerorteacheristomovethepersonintothe'consciouscompetence'stage,bydemonstratingtheskillorabilityandthebenefitthatitwillbringtotheperson'seffectiveness

2.ConsciousIncompetencea) thepersonbecomesawareoftheexistenceand

relevanceoftheskillb) thepersonisthereforealsoawareoftheirdeficiency

inthisarea,ideallybyattemptingortryingtousetheskill

c) thepersonrealisesthatbyimprovingtheirskillor

abilityinthisareatheireffectivenesswillimproved) ideallythepersonhasameasureoftheextentoftheir

deficiencyintherelevantskill,andameasureofwhatlevelofskillisrequiredfortheirowncompetence

e) thepersonideallymakesacommitmenttolearnandpracticethenewskill,andtomovetothe'consciouscompetence'stage

3.ConsciousCompetence ' '

4.UnconsciousCompetence

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whentheycanperformitreliablyatwill

b) thepersonwillneedtoconcentrateandthinkinordertoperformtheskill

c) thepersoncanperformtheskillwithoutassistanced) thepersonwillnotreliablyperformtheskillunlessthinking

aboutit- theskillisnotyet'secondnature'or'automatic'e) thepersonshouldbeabletodemonstratetheskillto

another,butisunlikelytobeabletoteachitwelltoanother

personf) thepersonshouldideallycontinuetopractisethenewskill,

andifappropriatecommittobecoming'unconsciouslycompetent'atthenewskill

g) practiceisthesinglemosteffectivewaytomovefromstage3to4

unconsciouspartsofthebrain- itbecomes'secondnature'

b) commonexamplesaredriving,sportsactivities,typing,manualdexteritytasks,listeningandcommunicating

c) itbecomespossibleforcertainskillstobeperformedwhiledoingsomethingelse,forexample,knittingwhilereadingabook

d) thepersonmightnowbeabletoteachothersintheskillconcerned,althoughaftersometimeofbeing

unconsciouslycompetentthepersonmightactuallyhavedifficultyinexplainingexactlyhowtheydoit- theskillhasbecomelargelyinstinctual

e) thisarguablygivesrisetotheneedforlong-standingunconsciouscompetencetobecheckedperiodicallyagainstnewstandards



Thank youThank you

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