Basic communication skills for HIV counsellors
Since HIV counselling is a conversation or dialogue between the counsellor and client, the counsellor needs certain communication skills in order to facilitate change.
The counsellor needs the following basic communication skills to do effective counselling:
Attending refers to the ways in which counsellors can be “with” their clients, both physically and psychologically. Effective attending tells clients that you are with them and that they can share their world with you. Effective attending also puts you in a position to listen carefully to what your clients are saying. The acronym SOLER can be used to help you to show your inner attitudes and values of respect and genuineness towards a client (Egan.)
S: Squarely face your client. Adopt a bodily posture that indicates involvement with your client. (A more angled position may be preferable for some clients - as long as you pay attention to the client.) A desk between you and your client may, for instance, create a psychological barrier between you.
O: Open posture. Ask yourself to what degree your posture communicates openness and availability to the client. Crossed legs and crossed arms may be interpreted as diminished involvement with the client or even unavailability or remoteness, while an open posture can be a sign that you are open to the client and to what he or she has to say.
L: Lean toward the client (when appropriate) to show your involvement and interest. To lean back from your client may convey the opposite message.
E: Eye contact with a client conveys the message that you are interested in what the client has to say. If you catch yourself looking away frequently, ask yourself why you are reluctant to get involved with this person or why you feel so uncomfortable in his or her presence. Be aware of the fact that direct eye contact is not regarded as acceptable in all cultures.
R: Try to be relaxed or natural with the client. Don't fidget nervously or engage in distracting facial expressions. The client may begin to wonder what it is in himself or herself that makes you so nervous! Being relaxed means that you are comfortable with using your body as a vehicle of personal contact and expression and for putting the client at ease.
Effective attending puts counsellors in a position to listen carefully to what their clients are saying or not saying.
Listening refers to the ability of counsellors to capture and understand the messages clients communicate as they tell their stories, whether those messages are transmitted verbally or nonverbally.
Active listening involves the following four skills:
- Listening to and understanding the client's verbal messages. When a client tells you his or her story, it usually comprises a mixture of experiences (what happened to him or her), behaviours (what the client did or failed to do), and affect (the feelings or emotions associated with the experiences and behaviour). The counsellor has to listen to the mix of experiences, behaviour and feelings the client uses to describe his or her problem situation. Also “hear” what the client is not saying.
- Listening to and interpreting the client's nonverbal messages. Counsellors should learn how to listen to and read nonverbal messages such as bodily behaviour (posture, body movement and gestures), facial expressions (smiles, frowns, raised eyebrows, twisted lips), voice?related behaviour (tone, pitch, voice level, intensity, inflection, spacing of words, emphases, pauses, silences and fluency), observable physiological responses (quickened breathing, a temporary rash, blushing, paleness, pupil dilation), general appearance (grooming and dress), and physical appearance (fitness, height, weight, complexion). Counsellors need to learn how to “read” these messages without distorting or over?interpreting them.
- Listening to and understanding the client in context. The counsellor should listen to the whole person in the context of his or her social settings.
- Listening with empathy. Empathic listening involves attending, observing and listening (“being with”) in such a way that the counsellor develops an understanding of the client and his or her world. The counsellor should put his or her own concerns aside to be fully “with” their clients.
Active listening is unfortunately not an easy skill to acquire. Counsellors should be aware of the following hindrances to effective listening (Egan, 1998):
- Inadequate listening: It is easy to be distracted from what other people are saying if one allows oneself to get lost in one's own thoughts or if one begins to think what one intends to say in reply. Counsellors are also often distracted because they have problems of their own, feel ill, or because they become distracted by social and cultural differences between themselves and their clients. All these factors make it difficult to listen to and understand their clients.
- Evaluative listening: Most people listen evaluatively to others. This means that they are judging and labelling what the other person is saying as either right/wrong, good/bad, acceptable/unacceptable, relevant/irrelevant etc. They then tend to respond evaluatively as well.
- Filtered listening: We tend to listen to ourselves, other people and the world around us through biased (often prejudiced) filters. Filtered listening distorts our understanding of our clients.
- Labels as filters: Diagnostic labels can prevent you from really listening to your client. If you see a client as “that women with Aids”, your ability to listen empathetically to her problems will be severely distorted and diminished.
- Fact?centred rather than person?centred listening: Asking only informational or factual questions won't solve the client's problems. Listen to the client's whole context and focus on themes and core messages.
- Rehearsing: If you mentally rehearse your answers, you are also not listening attentively. Counsellors who listen carefully to the themes and core messages in a client's story always know how to respond. The response may not be a fluent, eloquent or “practised” one, but it will at least be sincere and appropriate.
- Sympathetic listening: Although sympathy has it's place in human transactions, the “use” of sympathy is limited in the helping relationship because it can distort the counsellor's listening to the client's story. To sympathise with someone is to become that person's “accomplice”. Sympathy conveys pity and even complicity, and pity for the client can diminish the extent to which you can help the client.
3. Basic empathy
- Basic empathy involves listening to clients, understanding them and their concerns as best as we can, and communicating this understanding to them in such a way that they might understand themselves more fully and act on their understanding (Egan, 1998).
- To listen with empathy means that the counsellor must temporarily forget about his or her own frame of reference and try to see the client's world and the way the client sees him or herself as though he or she were seeing it through the eyes of the client.
- Empathy is thus the ability to recognise and acknowledge the feelings of another person without experiencing those same emotions. It is an attempt to understand the world of the client by temporarily “stepping into his or her shoes”.
- This understanding of the client's world must then be shared with the client in either a verbal or non-verbal way.
Some of the stumbling blocks to effective empathy are the following:
- Avoid distracting questions. Counsellors often ask questions to get more information from the client in order to pursue their own agendas. They do this at the expense of the client, i.e. they ignore the feelings that the client expressed about his or her experiences.
- Avoid using clichés. Clichés are hollow, and they communicate the message to the client that his or her problems are not serious. Avoid saying: “I know how you feel” because you don't.
- Empathy is not interpreting. The counsellor should respond to the client's feelings and should not distort the content of what the client is telling the counsellor.
- Although giving advice has its place in counselling, it should be used sparingly to honour the value of self?responsibility.
- To merely repeat what the client has said is not empathy but parroting. Counsellors who “parrot” what the client said, do not understand the client, are not “with” the client, and show no respect for the client. Empathy should always add something to the conversation.
- Empathy is not the same as sympathy. To sympathise with a client is to show pity, condolence and compassion - all well?intentioned traits but not very helpful in counselling.
- Avoid confrontation and arguments with the client.
4. Probing or questioning
Probing involves statements and questions from the counsellor that enable clients to explore more fully any relevant issue of their lives. Probes can take the form of statements, questions, requests, single word or phrases and non-verbal prompts.
Probes or questions serve the following purposes:
- to encourage non-assertive or reluctant clients to tell their stories
- to help clients to remain focussed on relevant and important issues
- to help clients to identify experiences, behaviours and feelings that give a fuller picture to their story, in other words, to fill in missing pieces of the picture
- to help clients to move forward in the helping process
- to help clients understand themselves and their problem situations more fully
Keep the following in mind when you use probes or questions:
- Use questions with caution.
- Don't ask too many questions. They make clients feel “grilled”, and they often serve as fillers when counsellors don't know what else to do.
- Don't ask a question if you don't really want to know the answer!
- If you ask two questions in a row, it is probably one question too much.
- Although close-ended questions have there place, avoid asking too many close-ended questions that begin with “does”, “did”, or “is”.
- Ask open-ended questions - that is, questions that require more than a simple yes or no answer. Start sentences with: “how”, “tell me about”, or “what”. Open-ended questions are non-threatening and they encourage description.
It is sometimes useful for the counsellor to summarise what was said in a session so as to provide a focus to what was previously discussed, and so as to challenge the client to move forward. Summaries are particularly helpful under the following circumstances:
- At the beginning of a new session. A summary of this point can give direction to clients who do not know where to start; it can prevent clients from merely repeating what they have already said, and it can pressure a client to move forwards.
- When a session seems to be going nowhere. In such circumstances, a summary may help to focus the client.
- When a client gets stuck. In such a situation, a summary may help to move the client forward so that he or she can investigate other parts of his or her story.
6. Integrating communication skills
Communication skills should be integrated in a natural way in the counselling process. Skilled counsellors continually attend and listen, and use a mix of empathy and probes to help the client to come to grips with their problems. Which communication skills will be used and how they will be used depends on the client, the needs of the client and the problem situation.