Download COMMUNICATION

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 nonstandardised 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
Writing
9%
Speaking
30%
Reading
16%
Listening
45%
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
Medium
Barrier
SENDER
(encodes)
Barrier
Feedback/Response
RECEIVER
(decodes)
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
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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
Reflections
Demonstrates you are listening
closely
So are there any worries you
would like to discuss today? …
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
Deepens understanding of patient
issues
So it sounds like you’ve been quite
worried about your stroke. Have I
got that right?
You mentioned finding this tough.
Could you tell me what you mean
by that? What has been touch for
you?
Shows understanding of how
patient is feeling
Opens up communication and
allow patient to introduce their
own ideas and concerns
You seem quite sad today
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
……………………..
Clarifying
Empathy
Open Q
How have you been since we last
met?
How do you feel about what we
have been discussing
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:
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1 x Patient
1 x Therapist
2 x listener
1 x feedback
Fallacies about Listening
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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.