THERAPEUTIC MICRO-SKILLS: ○ Useful verbal counselling behaviour that has been shown to aid the counselling process. ○ Needs to be practised to become naturally part of the way a counsellor deals with a person seeking help. The First Session: ○ Collecting from the waiting room - coffee ○ Facilities: Signage, amenities, decor, reception staff, tea and coffee ○ Setting up counselling space ￫ Where to set up chair i.e., near door ￫ What effect might family photographs or graduation certificates have on the client? ￫ Graduation certificates create a power dynamic and depending on the person it can be beneficial or not ○ Noise/ Stimuli control ○ Comfort: a comfortable setting improves clients’ expression of feelings ○ It is important to note what you wear as it can have an effect on the therapeutic relationship Greeting→ ○ First impressions last ○ Be true to yourself rather than putting on an act ○ Friendly, open and informal Explain counselling to the client→ ○ What the process will look like ○ Confidentiality and its limits ○ Operate in a client-centred therapy (CCT)/ patient centred therapy (PCT) approach, e.g.: ￫ “Helping you to understand your situation, possibly seeing it in new ways” ￫ “Helping you understand and reflect upon your own experience, rather than asking you lots of questions”. ￫ “My role is to help you to understand your experience (thoughts, feelings and reactions) better” Opening questions→ ○ “What made you decide to come to see me today?” ○ “I’m wondering what’s troubling you?” ○ “What is it that you would like to talk to me about?” ○ “No need to hurry. Tell whatever it is that comes into your head even if it seems unimportant.” Tuning In→ ○ Joining is being on the wavelength ○ We are very good at this already, must be aware of the messages we are giving out as counsellors ○ How do you know when someone is on your ‘wavelength’ Observing the Person→ ○ What might you pick up from just looking at a person? (in the context of their cultural background) ○ Build a gradual picture Micro-Skill: Listening with Interest ○ ○ Minimal Response ￫ “Mmm” ￫ Lets client know explicitly they have your full attention ￫ Use tone of voice and non-verbal behaviour ￫ Empathy VS agreement Breif invitation to continue ￫ “Tell me more” ○ Speed/ clarity/ tone of voice ○ Non-verbal behaviour ￫ Matching/mirror client ￫ Physical closeness ￫ Facial expression/ eye contact Egan (2007) used the acronym SOLER to encapsulate the non-verbal skills required: S – sitting at a comfortable angle and distance O – open posture; arms and legs uncrossed L – leaning forward from time to time; looking genuinely interested, listening attentively E – effective eye contact without staring R – remaining relatively relaxed Micro-Skill: Attending ○ Always stay aware of how you are attending. ○ Your goal in interviewing is to be a good listener through the use of specific, observable behaviour which is culturally appropriate: ￫ Using varied eye contact to communicate with the client ￫ Using a natural relaxed posture and gestures. No need to sit rigid and “professional.” Use your body to communicate your involvement ￫ Use a natural vocal style ￫ If you get lost and can’t think of anything to say, simply hesitate a moment and think of something said earlier that interested you. Go back and make a comment, or ask a question about that topic. ○ Remember to use your posture, gesture and facial expressions and voice to send messages you want clients to hear such as ○ ￫ “I am listening to you very carefully” ￫ “I know what you’re saying is difficult for you”. Secondly, become aware of the messages your clients are sending to you through their non-verbal behaviours. Micro-Skill: Reflecting Content (Paraphrasing) ○ Encourages clients to continue exploring their own thoughts and ideas ○ Clearly and briefly reflect on the most important thing the client has just said. ○ Avoid interpretation yet do not parrot ○ Aim for genuine, own words. ○ Useful formats to state these reflections are: ￫ You’re saying........ ￫ In other words....... ￫ It sounds as if......... ￫ What I seem to be hearing is....... ￫ So what you’re saying is....... ￫ So it’s as though....... ￫ From listening to you, would it be correct to say that......’ Micro-Skill: Reflecting Feelings Some examples of how to structure a reflection are: ○ You’re...... ○ You feel......because...... ○ I sense that you feel..... ○ So you feel as though..... ○ The situation has left you feeling..... ○ I seem to be picking up you are feeling..... ○ Could it be that you are feeling....... ○ It seems as if you are feeling....... ○ Reflecting back the feelings within a statement/what the client says ○ Good way to help the client connect with their feelings as we often live in our heads (thoughts) ○ Catharsis involves releasing troubling emotional feelings ○ Some examples of how to structure a reflection are: ￫ You’re...... ￫ You feel......because...... ￫ I sense that you feel..... ￫ So you feel as though..... ￫ The situation has left you feeling..... ￫ I seem to be picking up you are feeling..... ￫ Could it be that you are feeling....... ￫ It seems as if you are feeling....... Basic Counselling Skills: Empathy: ○ Nonverbal and verbal communication ○ Parahraing content ○ ￫ “I heard you say…” ￫ “I’m getting the impression that…” Reflecting patient feelings and implicit messages Genuine: Unconditional Positive Regard: ○ Expression of caring, nurturance and acceptance ○ Non-judgemental/ non-critical verbal and/or nonverbal reaction ○ Respect Concreteness: ○ Keeping communications specific ○ Focus on feelings and facts of relevant concerns Open Questions: ○ Assists client clarify/ explore feelings Counsellor Self-Disclosure: ○ Shares personal feelings, experiences, or reactions to the client ○ Includes relevant content intended to help ○ Better to not self-disclose unless there’s a pressing clinical need that cannot be met in any other way Interpretation: ○ Keep interpretations short and concrete ○ Deliver with tentatively and empathy ○ Use interpretations sparingly Information Giving and Removing Obstacles to Change: ○ Supply data, opinions, facts, resources or answers to questions ○ Explore with the client possible problems which may delay/ prevent their change ○ In collaboration with the client, identify possible solutions and alternatives : ○ . ○ . ○ . ○ . ○ . ○ . ○ .
