COMMUNICATION: Core Counselling Skills

NICKY BROSNAN AND GAYLE WATTS

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.

1.1.10 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.

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.

Does your drawing look like this?

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

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.

The Communication Process

SENDER(encodes)

RECEIVER(decodes)

Barrier

Barrier

Medium

Feedback/Response

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?

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

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 soT. 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

……………………..

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

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

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

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.

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?

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.