Re- visiting Councelling

I often organise joint sessions with our psychotherapist/ councellor early on in patients' therapy pathway. I feel that the sudden disability, loss and change of life role is traumatic for all patients let alone those with communication impariments who will find it even more difficult to express themselves. Jumping straight into assessments...... may infact be detrimental to building a therapeutic relationship. I feel that showing that you care about the patient and are willing to help them communicate the things which are most important to them is of the upmost importance.

I know that we are not trained councellors but i felt that i needed to re-fresh my councelling skills so that i can better deal with emotional therapy sessions. I also feel that i need t be carefull and to recognise the limitations of my expertise.



What is councelling?

• A relationship involving listening and communicating.
• Based on the principle of Enpowerment.
• Helps people clarify and address their problems (outside SLT's expertise)

Why is it important to SLT?

1. Often people open up to an SLT.
2. To open up channels of communication.
3. To validate how people feel.
4. Helps to build a lasting relationship.
5. We are likely to encounter emotional needs e.g. dealing with loss (emotions may bloc therapy work and need to be addressed when considering the client as a whole).

Carl Rogers' Core Conditions

1. Empathy - trying to have the imagination to have a sense of someones feelings.
2. Unconditional positive regard - non judgemental acceptace
3. Genuineness/ congruence - being open about your own feelings.

Key counselling skills:

• Genuineness/congruence - be open to your own feelings. Be your real self without acting like an 'expert'. E.g. its o.k to say that you don't know the answer to the question. E.g. You've been late to the last four sessions, and i'm concerned about that and how it affects you (to a client who is late). Use 'we' e.g. shall we see if we can.....
• Be empathetic - listen sensitively without probing. Try to make sense of what you hear. Check that you've got the meaning right in all its subtleties. Try 'bing' instead of 'doing' e.g. letting a client be upset.
• Active listening (Hough, 1998) -
•  Reflecting - restate feelings and or content of what the speaker has communicated in a slightly different way. Demonstrates understanding and acceptance e.g. you are feeling angry and frustrated because it is difficult to communicate.
• Summarising -  tying together points after a longish description. Can be done throughout a session and at the end. Leave space for the client to correct/reject the information. Can help make sure the client has understood the sesison. How to wrap up: So we've talked about ..... we have .... mins left. Is there anything else you would like to discuss?
• Questions - can take emphasis form the client, and usually come from what the helper thinks is important. Forced alternatives give more choice than yes/no questions. Try to rephrase questions as empathetic statements e.g. You seem to be feeling ...... Try ti use comments as questions e.g. Client: terrible SLT: Terrible (rising intonation).

Useful phrases:

• 'what i've understood from today is ........'
• We've got ..... mins left lets see if we can pick up on what seem to be the key issues for you.
• This sounds like an important issue and we haven't done it justice, shall we come back to it?