1.2
Basic Counseling Skills

Open questions are questions that do not have a "yes" or "no" answer. The counsellor uses open questions to clarify his or her understanding of what the client is feeling.

Open questions:

• may begin with how, what or who

• require an answer other than 'yes' or 'no'

• may be used to gain information (what happened as a result?); explore thoughts, feelings, attitudes and opinions (what were you hoping to achieve?); or consider hypothetical situations (how might you deal with. ..?)

• When thinking about asking a client a question, first ask yourself whether the question is necessary.

A basic rule here is to ask a question only if you feel it will:

• clarify your understanding

• help the patient to explore their own process

Examples of open questions include: “What do you understand about your illness? or “What have your doctor’s told you about your illness?” "What are your goals?”; “What do you hope for?”; “What do you fear about your illness?”

One final observation: Be very careful with the 'why' question, as sometimes this can feel very judgmental and might make you sound like a teacher questioning a child. Try swapping the word 'why' for 'what'. So instead of saying, 'Why did you do that?', ask, 'What made you do that?' You will be surprised how much better the conversation flows, and how much more you will both find out!

Clarifying questions are open questions used by the counsellor to make sure they fully understand what the patient means. Clarification is used so the counsellor does not misunderstand the patient's frame of reference.

Begin question by repeating or rephrasing what the person said.

Avoid making assumptions. Begin clarifying questions with these statements:

• “Do you mean…”

• “ I’m not sure what you meant….”

• “ Are you saying…”

• “You said you are having frequent fevers. Is that once a day, or more?”

Paraphrasing occurs when the counselor states what the patient has just said, using fewer words but without changing the meaning of what the patient said. When utilizing this skill, you attempt to feed back the essence of what the person has just said. And if you do that accurately and correctly, and it matches what the patient meant, the patient is going to recognise that and to feel heard: ‘Finally, somebody is there really listening, really understanding what it is that I am bringing.

This skill is very helpful when you want to:

• let the patient know that you are listening and understand what they are saying,

• clarify confusing content,

• highlight issues by stating them more concisely, and

• check out the accuracy of your perceptions as the counselor.

Example

Patient: I hate giving my children so much trouble - having to spend so much money and time on my illness.

Nurse: It appears you feel that you are a burden to your children.

Patient's family member: “I don’t understand what she wants me to do. One minute she treats me like crap and the next minute she expects me to dote on her. I can never tell if she wants me around or away. I’m getting exhausted of guessing all the time.”

Nurse: “You find her behaviour inconsistent so it confuses you.”

Reflection in counselling is like holding up a mirror: repeating the client's words back to them exactly as they said them. You might reflect back the whole sentence, or you might select a few words – or even one single word – from what the client has brought. Useful to help the patient identify and process the emotions they are experiencing.

Example:
Patient's family member: I just don't understand Maya. One minute she says one thing and the next minute she says the opposite.

Nurse: You feel confused by your Maya's inconsistencies.

Asking specific questions. Zooming in on the problems. Help the person to focus on important issues.

Example
“There are so many issues that concern you right now. What worries you the most?”

A summary integrates elements of what the person has been discussing and serves at least three

major functions.

1. It may help crystallize in a more coherent and integrated manner what the person has been talking about, and thus helps the person put facts and feelings together.

2. It may serve as a stimulus for further exploration of a particular topic or area.

3. It frequently serves as a necessary perception check for you because it pulls together materials discussed over an extended period of time and allows the client the opportunity to clarify any misconceptions you have in your thinking about him or her.

Summarizations are frequently used when:
- You wish to structure the beginning of a session by recalling the high points of a previous session.
-The patient's presentation of a topic has been either confusing or just plain lengthy and rambling.
- The patient seems to have expressed everything of importance to her or him on a particular topic, and summarizing provides closure so you can move on.

Plans for taking the next step in counseling require mutual assessment and agreement on what been learned so far.

This video by Consultations 4 Health can be found in Youtube via this link: https://www.youtube.com/watch?v=nogoxMP0SNE

We will now move on to take a closer look at the counseling stages.