Interviewing and Counseling Skills (Our text, chap 4) Counseling and Interviewing Interchangeable? They do overlap, but there is also a difference between them. Interviewing The most basic process for: information gathering problem solving info and advice giving Interviewers may be guidance and counseling staff, medical personnel, business people or members of a wide variety of other professions. Counseling Is usually more intensive and includes a personal process that is geared to help people deal with issues. Counselors are generally associated with professional fields such as social work, psychology, pastoral counseling. e.g. social worker may interview client to obtain financial data and then move to counseling about personal relationships. Many health professionals find themselves functioning as both interviewers and counselors. Interviewing and counseling should be distinguished from psychotherapy, which is a more intense process focusing on deep-seated personality and behavioral difficulties. Counseling has also been described as (or includes): Internal process for the client It should cause systematic change during which the client begins to see herself and the world differently As sessions continue, self esteem rises, attitude changes, more maturity in reported behavior Counseling is also: Sequence of events Client-counselor discuss what they want to do and outline the process by which they will incorporate new behavior This change occurs in response to manipulation of the environment Ultimately, with behavior modification, one behavior is eliminated and another instituted Counseling also includes Elements of the interpersonal relationship between the counselor and client Focuses on dynamics of communication Essential element is establishing trust between two individuals Research shows that caring, sincere, lay person can be successful as a highly trained professional in guiding people to make changes in their lives Counseling Since counseling is a complex process, it is necessary for the health professional to know not only specific health issues (nutrition, genetics, physical therapy) but also to have a basic understanding in psychology and communication skills. Counseling as Problem -Solving Is scientific, practical, systemic approach Can be used to guide people toward healthy habits Encourage lifestyle for wellness Disease prevention and/or treatment Counseling Interview/Counseling Session Has 5 stages: Build Foundation Gather Data Determining goals/Education Selecting Alternative Solutions/Resolving Closing-Reaching Commitment Stage #1 Build Foundation Greeting Introduce self to client Includes your full name, title Address client Depends on setting Can use courtesy title and last name (Mr. Mrs., unless otherwise directed Less formal settings such as a health center or rehab program calling clients by first name may be more appropriate If in doubt start out by using formal name. Inquire how the client would like to be addressed. Greeting Greeting should indicate a sense of warmth and caring. Voice tone and body language should convey message of happy to meet Especially important in initial session First impression can be a lasting impression Be sure to introduce anyone accompanying you or if client brings family member, acknowledge and greet. Build Foundation Stage (cont) Establish Rapport May include small talk Generally limited to 1 question or comment Can help to develop a comfortable atmosphere Use client?s name May start conversation with a casual observation ?Did you find your way here easily? It?s so nice to finally have a sunny day.? Remain non-judgmental and non-confrontational Build Foundation Explain the counseling process Description of assessment tools General statement of the issues to be discussed Review frequency of meetings, how to contact Discuss confidentiality Partnership type process- work collaboratively Build Foundation Can set tentative agenda Establish what will be covered in the counseling session Explain assessment process Reviewing preliminary results Addressing readiness to take action Setting a goal and plan of action Stage #2 Gathering Data Includes defining the problem and identifying assets Explain/discuss purpose or allow client to state reason for visit e.g. I?m going to talk with you about foods you normally eat: this is called a diet history. I?m going to write it down, so that we can refer to it later. Determine readiness of client to begin session e.g. this might take 30 minutes. Is that OK with you? Gathering Data Obtain accurate info from client E.g. one slice of wheat toast with 1 teaspoon of grape jelly vs. toast and jam Obtain complete info from client as needed Ask all questions needed to help clarify problem Ask only pertinent questions related to the problem E.g. detailed questions about fruit intake may not be important for a person on a sodium restricted diet Gathering Data Defining the Problem Allow client to state problem in her/his words and then paraphrase/empathize E.g. What I?m hearing from you is that you think you are 50# overweight. Is that right? How do you see this as a problem in your life?? Allow client to state feelings as well as factual aspects of problem E.g. I feel that I?m out of control with my food intake Stage #3 Determining Goals/Education Allow client to state his/her own short and long term goals E.g. What would you like the outcome of counseling to be? Client: I want to lose 6# this week, 20# this month and 45# in 3 months Offer own idea of goals and/or state agreement with client In my experience, a weight loss of 1-2# per week is more realistic and healthy for most people. To lose 45# in 3 months you cause you to make drastic changes that I probably can?t support Determining Goals/Education Specific goals are needed for outcomes If client comes in with vague goal ?I want to feel better.? ?I want to improve my diet.? Need to collaborate with client to establish more specific goals that can be evaluated Be sure to listen very carefully to what your client says is important to him or her. Determining Goals/Education Keep client from avoiding the issue by changing the subject Do you like the way you look now? Client: Are we almost done now? We have 15 more minutes; do you like the way you look now? Determine the knowledge of the client Tell me what you know about an ACL tear. What has your doctor explained to you? Education Provide information Client should be able to understand why change is important. Capable of making informed decision to change Clarify problems and identify strengths Assess readiness to change Stage #4 Selecting Alternative Solutions/Resolving Allow client to think of his/her own alternatives E.g. Maybe I can count calories and ignore my weight on the scale. Offer alternative suggestions E.g. How about increasing exercise in some way? What about portion sizes? Selecting Alternative Solutions/Resolving Chosen alternative should be ?ownable? by client Alternatives must be reasonable and appropriate for client?s life style Alternatives can be fine-tunes. Pick one and think of ways to implement it. Tailor alternative to the client?s motivational level Indicate that the client is the best judge of what will work Stage #5 Closing-Reaching Commitment Support self-efficacy Provide support Review issues and strengths Introduce agreement Agreement client may make with themselves toward changing a specific behavior Determine client?s willingness to execute the agreement, obtain feedback Closing-Reaching Commitment Express optimism about the future Signal ending of session E.g. We are almost finished for today? before we finish? Summarize the session E.g. Do you have any questions? What have we decided? Get feedback that the client is satisfied with the recommendations Make agreement for follow-up How do you know when you?ve got it right? You are speaking slowly The patient is doing more talking than you The patient is actively talking about change You are listening very carefully and directing the interview/counseling session at appropriate moments The patient appears to be ?working hard?, often realizing things for the first time The patient is actively asking for information and advice It feels as if you are holding up a canvas, and the patient is filling it with paint, in places sometimes selected by you, and sometimes by the patient Source: Health Behavior Change: A Guide for Practitioners Good Practice Roles Counselor/practitioner Provides structure, direction and support Provides information wanted by the patient Elicits and respects the patient?s views and aspirations Negotiates change sensitively Client/Patient Is an active decision maker
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