MODULE 3

BASIC COMMUNICATION AND

COUNSELING SKILLS

GOAL
The goal of this module is to equip health
care providers with knowledge and skills in
communication and basic counseling

OBJECTIVE
At the end of this module the
participants will be able to:
Outline the meaning, types and importance of
effective communication and demonstrate
communication skills
Describe the meaning, process and
importance of effective counseling and
demonstrate basic counseling skills

UNIT 1
COMMUNICATION SKILLS

Definition of communication
This is the process of passing information
from one person to another, or one person
to a group and vice versa through a media
and a feedback is received

Basic elements in communication

The basic elements in communication are

Sender
Message
Channel
Recipient
Feedback

Types of communication
There are two types of communication
Non verbal communication
Verbal communication

Non verbal communication

This does not use words or sound it
involves: Proximity- Distance between two people
that expresses interest or detachment
Touch- Portrays love, attraction, and
aggression. It depends with the amount,
type, who we touch and where we touch
and in which context (consider cultural and
religious issues)

Non verbal communication

Body language in non verbal
communication include: Eye contact- how one looks at another
-Eye contact should be maintained

Facial expression- Smiling, frowning, fear,

anger, interest
Body posture- Refers to positioning of the
body
Head movement- Shows attending eg
nodding

Non verbal communication

Other forms of non verbal communication are
Gestures- Show body movement as a form of
communication. They include movement of the
head, hands, and any other body parts e.g.
placing hands across the mouth, waving,
pointing.
Conversational oil- Encourages, reinforces
(mmmh, I see, okay). These are minimal
prompts. However too much will dilute the
meaning ( or else it is verbal communication)

Verbal communication
Refers to words or phrases spoken
Message should be clear and relevant
It comprises of vocal aspects of our
communication which refers to
Quality of voice
Tone of voice
Pitch
Rate of speech

Verbal communication
The vocal aspect of verbal communication
These express emotional and convey
information about interpersonal attitudes
They can alter the meaning of what we intend
to communicate hence they need to be
consciously used by the sender of the
message.

The non-verbal and verbal

communication
These usually compliment each other
Discrepancy between the two can be
detected and interpreted by the recipient
Communication can be interfered with when
this happens

Barriers to effective communication

Group work: 10 minutes
Discuss barriers to effective
communication in the different age groups
Adults
Adolescents
Children

Barriers to effective communication

contd
Ineffective communication occurs when there is
no common understanding between the sender
(s) of a message (s) and the intended recipient
(s) for that message (s).
Reasons that would lead to ineffective
communication emerge from specific aspects of
the communication elements while others are
general, these are considered as barriers to
effective communication

Barrier to effective communication

contd
Barriers by sender
Not Qualified
Not understanding the subject
Not being perceived as belonging
Not presenting the message well
Using poor or inappropriate language
Lack of prior knowledge of the audience,
type or group dynamic

Barrier to effective communication

contd
Barrier by message
Complicated, long or unclear
For the wrong target
Inappropriate (culture, Religion, Gender,
Politics, Situation)

Barrier to effective communication

contd

Exercise on message (10 minutes)

Divide the participants into groups of more than
10 participants
Let one person whisper a message to one
participant and let the message be whispered
through the group
Compare the original message to the final
message to last group member
Discuss the differences in the two messages
(the original and the final message)

Barriers to effective communication

contd
Barriers by channel
Inaudible or distorted voice
Inappropriate visuals
Lack of alternatives
Lack of expert assistance e.g. interpreter

General barriers to effective

communication

Language
Age difference
Gender
Knowledge
Religion
Poor health
Mental status of
individuals

Culture
Attitude
Dressing
Lack of time
Physical impairment
e.g. deaf
Environmental
destructors

Communication tools
15 minutes discussion
Participants get into 3 groups for the
following exercises
Discuss the tools that can be used at different
ages i.e. Adults Adolescents, children
Role play: Use the communication tools
identified to pass the information to a client

Communication tools
These include
Demonstration models, reading materials (For adults)
Play therapy, psychodrama, posters, stories, music,
handouts (for adolescents)
Toys, dolls, plastacine / molding clay, Pencil, paper,
crayons, sand, mats, drawings( for children)

Some of them can be used across the ages

Age appropriate room set up

UNIT 2
BASIC COUNSELING

Definition of counseling
Counseling is a helping relationship
between a trained counselor and a client
in which a trusting relationship and the
skills of the counselor help the client
understand her/his problem situations
better and decide how best to solve those
situation or identify coping strategies.

Qualities of an effective
counselor
5 minutes
Discus the qualities of an effective
counselor

Examples of the qualities of an

effective counselor:
These include
Warmth
Empathy
Genuineness
Unconditional Positive
Regards (UPR)

Good listener
Patient
Tolerant
Observant
Confidential
Attractiveness

Counseling skills
Attending
Involves listening to and observing clients
It also includes physical characteristics
that provide environmental comfort e.g.
room, lighting, ventilation, seats etc
Attending places the counselor in a good
position to listen to both verbal and nonverbal messages
Attending communicates acceptance

Counseling skills contd

Illustrating the attending skills
(demonstration 5 minutes)
Attending expressed by the body posture
can be described by the acronym SOLER
i.e.
S- Sit squarely
O- Open posture
L- Lean forward appropriately
E- Eye contact and observation
R- Relaxed naturally

Counseling skills contd

Active Listening
This involves attending to, hearing and
understanding the clients messages
It includes listening to what they say and how it
is said
It involves observing what one does while
speaking and using minimal prompt to
encourage clients
It facilitates understanding between two people

Counseling skills contd

Attending and listening skills
Attending and listening skills are
interrelated skills which compliment and
affect each other. It is not easy to attend
fully to a client without active listening,
neither can one claim to be using the
active listening skill without attending to
the client.

Counseling skills contd

Reflecting
Helps to communicate the counselors
understanding of the clients perspective- how
they view themselves/their concerns
Reflecting involves:

Restating- repeating back clients words

Paraphrasing- rephrasing the core message
Clarifying- making clear
Summarizing- Bringing together in few words what
the client has said for a while.

Counseling skills contd

Focusing
Used after all the details of the clients issues
have been identified
Directing clients attention to specific areas of the
conversation
Enables the client appreciate the priority areas
While focusing the client, Avoid the following;
Controlling the discussion
Being judgmental
Encouraging dependency

Counseling skills contd

Questioning
Asking questioning to help identify, clarify
and understand the problem
Open-ended questions are the most ideal
including; sexual life, How they are dealing
with the problem, Friends views
They are aimed at propelling the
conversation and leading to further
discussion on an issue

Importance of mastering effective

questioning skills.
The questioning skills is mastered by a counselor
in order to avoid;
Closed ended questions. These leads to short
answer, yes/no responses that do not allow
discussions
Questions that begin with why?. These cause
an individual to feel attacked leading to
defensive answers. The client begins to develop
an attitude that the counselor questions the
behavior rather than understand the situation at
hand

Role play: 5 minutes

Questioning skills
Demonstrate and practice the use of
questioning skills

Counseling skills contd

Challenging skills
These are used after a number of
sessions with the client- they are avoided
at the beginning of a counseling
relationship
They enable the client to question their
own beliefs and dispute irrational thoughts
They need to be used carefully to avoid
the sense of attack, lack of understanding

Counseling skills contd

Components of challenging skills
These include:
Confrontation- engaging client to think critically
Probing- gathering detail that may be avoided
Silence- Being quite even when client is not
talking
Immediacy- giving opinion of the session in the
here and now

Counseling skills contd

Challenging and supporting skills
Challenging skills must be used concurrently
with support skills to express genuine interest in
helping the client
Support skills are drawn from application of
Core- conditions, listening, Understanding skills
Using constructive comments
Using encouraging statements rather than criticism,
teasing, confronting.

Process of counseling

The process of counseling involves the

following steps;
Joining/Rapport
Exploration
Understanding
Action

Process of counseling contd

Joining/Rapport phase
This involves social and structuring skills
The socialization skills;
Make the client comfortable
Begins before, and extends to the first encounter with
the client
Requires counselor to employ the relationship
enhancement variables
Create a friendly physical environment appropriate for
the age of the client

Process of counseling contd

The structuring skills;
They are applied at the beginning of your
encounter, Together with the client.
Identify reasons for referral
Establish the language clients prefer to
use
Assure client of confidentiality
Develop a working contract e.g. length of
session, frequency of visit

Process of counseling contd

Exploration phase
Express acceptance and understanding while
gathering clients presenting complaints and
history
Listen to the client as they describe in their own
terms the issues they are experiencing
Work with the client to identify the actual
problem and its root causes ( take note of the
perceived and real causes)

Process of counseling contd

Understanding phase
This is a working phase
Once the client has determined the real or
main problem, the counselor can now help
the client understand the definite issue
surrounding the problem
Help the client gain his/her insight by
identifying the various barriers, options,
solutions

Process of counseling contd

Action phase
Having identified the actual problem.
The counselor helps the client to prepare
the plan of action.
Identify the pros and cons of each option
The client selects the preferred option
The counselor empowers the client to
choose steps that will enable him/her to
achieve the selected option

Core conditions of counseling

During the session there are three core
conditions of counseling that arwe applied
by the counselor. Namely;
Genuineness
Empathy
Unconditional positive regard

These creates an environment ideal for

effective interaction and growth.

Core conditions
Genuineness
Being real, honest, open minded, congruent
showing ones feelings outwardly) and fruitful
A counselor should be aware of his/her
experiences and be able to communicate it
Genuineness will make a client to be more
authentic and realistic in their life
It builds a trusting relationship between a
counselor and client

Core conditions contd

Empathy
A counselors ability to tune in the clients
wave length without losing ones wave
length
Understanding the clients feeling, reasons
for the feelings and the meaning
Communicating that understanding to the
client to confirm it
N/B Empathy is not sympathy

Core conditions contd

Unconditional Positive Regard
Ability to be warm, accepting, considering the
client as an independent being
Not being judgmental to the clients, without
imposing own values
One should show commitment in accepting a
client
Respect helps build a trusting relationship
enabling the client to be free to express
him/herself

Importance of counseling
Counseling is important in adherence. It: Promotes self awareness
Creates better communication with counselors
Helps client understand their issues better
Empowers client to adhere better, to confront
anxieties and fears of the unknown
Creates a sense of safety
Offers peer support in group therapy

Techniques of counseling
These are different for each age group
Adults
Adolescents
Children

Techniques of counseling an adult

Face to face observing the following; Empathy,
genuineness, warmth, dialogue, non-judgment
Use of demonstration/model
Role play

Techniques of counseling an
adolescent
Techniques of counseling an adolescent
May be face to face and also observing the
above as for adults
Create a safe/ adolescent friendly environment
Get to know client and help the adolescent to
feel comfortable
Discuss reasons for the session
Assess risks including emergent psychological
symptoms
Provide relevant information
Discuss next course of action

Techniques of counseling children

Techniques of counseling children
Introduce self as the person who talks to and
helps children
Take sometime to get to know the child (play a
game, talk a bit)
Health care providers can use previously
mentioned communication tools (e.g. dolls,
puppets, art supplies)
Story telling by age

Use simple language

Techniques of counseling children

contd
When counseling children;
If the child is not verbalizing, divert and
introduce child to other materials in the
room that can be used for communication
Ask open ended questions regarding the
toys and regarding what you observe the
child doing with the toys

Techniques of counseling children

contd
Ask about the demographic data of child
(name age, no of siblings. School, favorite
food, the parent, best friend)
Dont feel rushed when working with the
child. If you are impatient the child will
realize this!

Techniques of counseling children

contd
During the counseling session with children
Allow child to pick/choose what to do and what
to play with at their own pace. Observe this and
interpret with the child the meaning
Sit on a similar height e.g. on mat, on a low seat
etc
Actively participate with the child in playing with
the toys
Note the theme of the childs play e.g. themes of
nurturing, aggression, etc

Techniques of counseling children

contd
Remember when dealing with the children:
Children take time to warm up
Learn about the child and what
toys/games and activities they like. Use
these tools in your sessions
Make sure to design your clinic space in a
child friendly manner and have the
necessary games/toys/activities available
to use

Application of counseling in work

station
10 minutes
In view of counseling skills and techniques
discussed, ponder and share with other
participants;
The current counseling situation in your work
stations
The various changes that may be required in
order to achieve effective counseling

Summary
There are different techniques of
counseling and communicating with each
age group
Heath care workers need to apply the
appropriate techniques in order to
effectively counsel and communicate with
client