socp121 sn03 lecture microskills · noises, body postures or repetitions of key words that indicate...

© Endeavour College of Natural Health endeavour.edu.au 1

SOCP121

Session 3

Intensive Skills Workshop

Department of Social Science


Session Aim:

This session allows students to practice

counselling microskills and interviewing

techniques in preparation for working

directly with clients in clinics.

Microskills Intensive Workshop


Microskills Intensive Workshop

Learning Objectives:

At the end of this session, you should:

o Be able to understand and differentiate between the key counselling microskills

o Have practiced each microskill in class to a level where you can continue to practice developing your skills outside of class

o Understand the format of a basic initial patient interview


What are microskills?

o Microskills are practical techniques common across all

therapeutic frameworks

o They were developed by observing client-practitioner

interactions and quantifying which skills were helpful and

worked

o They are helpful in breaking counselling down into

smaller learnable dimensions


Microskills

Hierarchy

(Ivey & Ivey, 2010)

• Skills get harder as you move

up the hierarchy

• In this subject we will assess you on

the lower level skills


Where do microskills fit in an

interview?

o Attending

• Observation

• Eye contact

• Encouragers

• Posture and physical space

o Listening

• Summarizing

• Questioning

• Reflecting content

• Reflecting affect

• Reflecting meaning


Where do microskills fit in an interview?

o Defining the problem

o Setting goals

o Managing the session• Pacing & leading

• Structuring

• Challenging clients’ stories

• Perspective taking

7


Attending Reference: Ivey & Ivey, 2010

o Showing the client you’re paying attention by using

individually and culturally appropriate:

• Body language

– Leaning slightly forward

– Facing the person

– Handshake to welcome

• Eye contact

– Direct when listening

– Direct less frequently when talking

• Vocal qualities

– Warm vs. Cold

– Interested vs. Bored


Attending References: Brammer & MacDonald 2003, p70 and Ivey & Ivey 2010

o Body language

o Posture

o Eye contact

o Facial expression

o Which do you prefer?

o Which is less threatening?

o What is the therapist’s attitude to the client?

Figure 3.2 from Ivey & Ivey 2010


Attending Activity

1. Get into groups of three or four

• Have one person act as a mock practitioner, one act as a mock

patient, and remaining group members act as observers

2. The practitioner should conduct a session using the

worst attending skills that they can • Body language

• Posture

• Eye contact

• Facial expression

3. Then repeat the activity using better attending skills

4. Discuss in the group the differences between the

approaches and how effective they were at establishing

a working alliance and gathering information.


Active Listening

o Encouraging, Paraphrasing, and Summarising are all

components of Active Listening

o Active listening also includes the Person-Centered

attribute of empathy. If done correctly:

• The client should feel heard

• The client should feel like you are trying to walk in their shoes

• The client should feel safe / non-judged

• The therapist should not add their ideas to the communication

• The client should hear their thoughts and feelings reflected in the

therapist’s own words


Components of Active Listening

1. Therapist should listen to client (verbal & nonverbal)

and encourage client to talk

• Listening

• Minimal Encouragers

• Observing

2. Client should hear the therapist reflect an understanding

of what they are saying, or ask for clarification of what

they are saying

• Questioning

• Paraphrasing

• Summarizing

• Reflecting


Listening vs Hearing

o Listening is what is happening when nothing

else is happening. Listening is a very simple act

and yet not so easy to do.

o An important aspect is that it is very much a

deliberate action and does not occur passively

(which is what we call hearing).

o When one really listens to another it becomes

very clear how that person is feeling and what

are the important points to their story.


LISTEN, LISTENSources Unknown My Future, My Choice

o When I ask you to listen to me and you• start giving advice, you have not done what I asked.

• begin to tell me why I shouldn't feel that way, you are trampling on my feelings.

• you feel you have to do something to solve my problem, you have failed me, strange as that may seem.

o LISTEN! All I asked was that you listen - not talk or do -just hear me. I'm not helpless; maybe discouraged and faltering, but not helpless.

o When you do something for me that I can and need to do for myself, you contribute to my fear and weakness.

o But when you accept as a simple fact that I do feel what I feel, no matter how irrational, then I can quit trying to convince you and can get about the business of understanding what's behind this irrational feeling.

o When that's clear, the answers are obvious and I don't need advice. Irrational feelings make sense when we understand what's behind them.

o So please, listen and hear me, and if you want to talk, wait a minute for your turn, and I will listen to you.


Individual Activity

12 Main Blocks to Listening

Each student to rate themselves on scale of 0-10,

where 0 is none and 10 is total, the degree to

which they use each of these blocks. Try to

improve your listening skills and evaluate this in a

week, fortnight, month etc.


12 Main Blocks to ListeningFrom McKay, Davis & Fanning, “Messages – The Communication Skills Book"

1. Comparing – Trying to assess who is smarter, more competent, luckier, has suffered more, etc.

2. Mind reading – Distrusting what people are saying, feeling that you know better and can figure out what is really going on in the other person. Often involves making assumptions.

3. Rehearsing – Using the time the other person is speaking to think about or rehearse what you want to say. Pretending to look interested at the same time.

4. Filtering – Listening to some things and not others. Not hearing things you don’t want to hear.

5. Judging – Writing the other person off. Hastily getting involved in your own knee jerk reaction.

6. Dreaming – You are half listening until something the other person says triggers a chain of private associations.


12 Main Blocks to ListeningFrom McKay, Davis & Fanning, “Messages – The Communication Skills Book"

7. Identifying – Taking everything a person tells you and referring it to your own experience. Often requiring the conversation to revolve around you.

8. Advising – Coming up with problem solving ideas before you have fully heard the other person’s story or pain. Coming up with suggestions so as not to have to be with the person’s pain.

9. Sparring – Arguing and debating with what the other person says before fully listening. Quick to disagree before hearing the whole story. Often using the word “but”.

10. Being right – You will go to any lengths to avoid being wrong. You have difficulty listening to criticism.

11. Derailing – Changing the subject or joking away the situation.

12. Placating – You want to be nice, pleasant. You often only half-listen.


Encouraging

An aim of active listening is to encourage a client to talk

more and to elaborate on their situation. This can be

achieved non-directively through verbal and non verbal

cues:

o Verbal (repeat key words)

o Nonverbal (head nods) to support continued talking


Minimal Encouragers

o Minimal encouragers are gestures, nods, single words or

noises, body postures or repetitions of key words that

indicate that the practitioner is interested and involved,

but that the client is in control of deciding which way the

discussion will go.

o Minimal encouragers are a way to let the client know that

you are listening and are with them.

• Examples include: mmm, yes, aha, oh


Listening Activity

o In pairs or as a large group conduct a conversation or

group interview where members utilise blocks to

listening.

• How effective was the communication?

• How would you feel as a patient if your practitioner wasn’t

listening to you?

– Would you feel confident in their ability to treat you if they weren’t

listening?

– If they were student practitioners and not listening?

o Now get into pairs and listen to your partner for 2

minutes using only minimal encouragers, and then

switch roles and repeat.

• How effective is listening only?


Open Questions

Open questions encourage others to talk, provide you with maximum information and let the client head in the direction they want or need to take. They often relate to feelings, thoughts and understandings and they tend to open the discussion up in a way that new aspects can be considered.


Open Questions (cont.)

Open questions usually start with:

o What (facts)

o How (process or feeling)

o Why (reasons)

o Could (general picture)

Examples of open questions are:

o How do you feel after what happened to you this week?

o What have you experienced since our last meeting?

o What does it mean to you to have started this new job?


Closed Questions

o Closed questions direct the client along a path chosen by the practitioner. They focus the content of the conversation and can contain a fragmented or confused client. They require only a few words to answer and they often relate to events or specific situations.


Closed Questions (cont.)

Closed questions usually start with:

o How ___ (quantity)

o Do

o Is

o Are

Examples of closed questions are:

o Are you feeling okay today?

o Do you have children?

o How many children do you have?

o How long have you been in this relationship?


Questioning in Interviews

From Broad Specific

• Start with Open Questions

• Have the client elaborate with Open Questions

• Focus the interview with Open Questions

• Clarify and Confirm with specific Closed Questions


Interview Process 1

o Start with Open Questions

• “What would you like to talk about today?”

• “So what brings you in here to see me today?”

• “Last week we talked about . . . How did that work out?”

o Have the client elaborate with Open Questions

• Leave client in charge / talking

• “Could you tell me a bit more about…”

• “What might we have missed so far?”

• “What else comes to mind?”


Interview Process 2

o Focus the interview with Open Questions

• Could you give me a specific example?

• What do you mean by . . .?

o Clarify and Confirm with specific Closed Questions

• “Do you mean...?”

• “So the stool was ____ coloured?”


Cross Cultural Issues with Questions(Ivey & Ivey, 2010)

o In some cultures individuals want to “save face” and may

pretend to understand you or give you misleading

answers

o Some clients may distrust so many questions, feel

grilled, or feel “stupid” if unable to answer

o Be aware of the client’s body language and look for

incongruent behaviors


Revision Questions

o Can you listen when talking?

o What’s the difference between listening and active listening?

o What types of questions should be used at what times in an interview?

socp121 sn03 lecture microskills · noises, body postures or repetitions of key words that indicate...

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