Transcript C & C Skills

COUNSELING & COMMUNICATION SKILLS
PROBLEM SOLVING

Problem: a state or condition that requires
changing (does everyone involved agree that
something needs changing?)

Problem for a group: is a specific situation to
which members must respond if group is to
function effectively
COUNSELING & COMMUNICATION SKILLS
PROBLEM SOLVING
Problem solving involves many steps:
1.
Identify Issue/Problem
o
2.
Separate people from problem
Explore alternatives
o
Focus on interests not positions
o
Options for mutual gain
3.
Decision Point
4.
Evaluation
Active Listening Key Element in All Steps
COUNSELING & COMMUNICATION SKILLS
TURNING THE “DIFFICULT” CONVERSATION
INTO THE “LEARNING” CONVERSATION
The What
Happened
Conversation:
• Who, what, where, when, how,
why etc. and of course the
BLAME game
• Explore each other’s stories from
certainty to curiosity, both/and
• Disentangle intent from impact
and acknowledge the complexity
of human motivations
• Abandon blame, analyze
contribution
COUNSELING & COMMUNICATION SKILLS
TURNING THE “DIFFICULT” CONVERSATION
INTO THE “LEARNING” CONVERSATION
•Find your feelings
•Normal & natural,
good people bad
The Feelings
feelings, hidden
Conversation
feelings
•Don’t vent, describe
•Don’t evaluate, share
COUNSELING & COMMUNICATION SKILLS
TURNING THE “DIFFICULT” CONVERSATION
INTO THE “LEARNING” CONVERSATION
The Identity
Conversation
•Am I competent, good, worthy?
•Avoid all or nothing
•Ground your identity issues
•Awareness of your issues
•the “and” stance
•Mistakes OK, intentions complex, contribution to
problem
•Regain your balance
•Let go of controlling reaction
•It’s 3 months from now
•Their identity too
•Prepare for response
•Take a break
•Name it
•ASK FOR HELP
COUNSELING & COMMUNICATION SKILLS
RELATIONSHIP MODEL
(ADVERSARIAL – PARTNERING)
Coercion
• “You must
do this or
face pain.”
Confrontation
• “You must
do this.”
• “No, I
won’t!”
Coexistence
• “You stay on
your side
and I’ll stay
on mine.”
COUNSELING & COMMUNICATION SKILLS
RELATIONSHIP MODEL
(ADVERSARIAL – PARTNERING)
Cooperation
• “I’ll help you
when my
work is
done.”
Collaboration
• “Let’s worn
on this
together.”
Co-Ownership
• “We both
feel totally
responsible.”
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
Four Basic Steps:
1.
Identify a contradiction in client’s presentation.
2.
Determine that the contradiction is relevant to
HIV or other health risks, and deserves attention
in the counseling session.
3.
Formulate a non-judgmental response that
paraphrases and reflects the contradiction.
4.
Follow the client’s lead, using constructive
confrontation techniques.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
Signs of Ineffective Intervention:
A. Judgments
in counselor’s response
or non-verbal)
(verbal
B. Client
shuts down or becomes increasingly
hostile.
C. A
power struggle develops – counselor and client
begin arguing (directly or indirectly) about who is
right.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
1.
Identify A Contradiction In Client’s Behavior

A.
How client sees him/herself and how client behaves.

B.
Some common types if contradictions in HIV counseling
include:
Example: A client sees himself as being fully committed
to safer sex, but has slipped on several occasions in the
past three months and had unsafe sex.
A client’s long-term behavior patterns and his/her
commitments concerning future behaviors

Example: A client who has never enjoyed monogamous
relationships says she is going to find a committed
partner and be monogamous after her test. Note: While
people are capable of changing longstanding behaviors,
most people make these changes incrementally over a
period of time. Unrealistic plans can sometimes interfere
with achieving true behavior change.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
C.
Client’s verbal and non-verbal messages.

D.
Two or more verbal messages.

E.
Example: A client says she is not really concerned about
HIV because her risk is very small, but her manner is
very anxious, she is blinking her eyes rapidly, and she
has a tremor in her voice and her hands.
Example: A client says he is comfortable following safer
sex guidelines, and then says he has a hard time asking
new sexual partners to use condoms.
Client’s expressed feelings and what most people tell
you the feel in a similar situation.

Example: A client says she is not really surprised to have
tested positive, nor is she especially upset about it. You
are aware that most people who test positive find the
news very upsetting, and many are surprised by the
result even if it was what they expected.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
F.
How client feels now and how most or many people
in a similar situation feel after a period of time.

G.
Example: A client who has tested positive feels
despondent, hopeless and unable to cope. Your own
experience is that over time, most people who have tested
positive find they are able to move on from this place of
despondency and continue to have productive,
meaningful lives.
A client’s expressed interpretation of a circumstance
and the true facts of the circumstance.

A heterosexual client says she believes heterosexuals do
not face any significant risk for HIV; in actual fact,
heterosexuals can and sometimes do contract HIV if they
engage in risky behaviors with others carrying the virus.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
2.
Determine That The Contradiction Is Relevant
To HIV Or Other Health Risks, And Deserves
Attention In The Counseling Session.

Not every contradiction presented by a client needs
to be addressed in an HIV counseling session.
However, a contradiction related to HIV risks could
be an appropriate focus in a session. The counselor’s
choice to address a contradiction should be guided
by the sense that doing so may help the client better
consider his or her risks and plan relevant risk
reduction strategies.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
3.
Formulate A Non-Judgmental Response That
Paraphrases And Reflects The Contradiction.

A.
Use language and tone of voice that present your
response in a neutral way. The following techniques
can be effective:
Link the contradictions, using “and” rather than
“but.” This form has a less judgmental tone
than contradictions linked with “but.”

Example: “You say you haven’t had any HIV-related
risks in the past year, and you also told me you
have had sex this year with several different
partners without using a condom.”
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
B.
Link the contradictions using the phrases, “if…, then….”

C.
D.
Example: “If you are committed to avoiding HIV, then how
does your decision not to use condoms fit into that
commitment?”
Use the technique of “third personing” to explore,
acknowledge or normalize feelings that may or may not
be expressed openly.
“Third Personing” is a technique where the counselor
describes in an indirect and general way the feelings or
responses a client may be having, by talking about
feelings people in general might have similar situations.


(“Third Personing” refers to the form of the statement. First
person statements are “I” statements. Second person
statements are “you” statements. Third person statements
are “he, she, they, everyone, people” statements- basically,
anything that isn’t “I” or “you”.)
Example: “Strong feelings often arise for people when they
learn their test results.” “It can be scary to go through this
process.”
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
D.
Express your confusion about the contradiction
directly (keep the focus on the situation, not the
client).

Example: “Something confuses me about your
situation….You see yourself as someone who is
absolutely honest in your relationship, and you also
have no intention of telling your girlfriend about
your dates with men. These seem kind of
contradictory to me. How do you make sense of it
for yourself?”
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
4.
Follow The Client’s Lead, Using Constructive
Confrontation Techniques.
A.
Discuss the contradiction in more depth with a
“willing” client. Use open-ended questions and
active listening techniques. Provide referrals or
other intervention.
B.
Keep working with an “ambivalent” client to raise
his or her awareness of the contradiction, and ways
it might contribute to HIV-related risks.
C.
Detach and move on with a “resistant” client.
COUNSELING & COMMUNICATION SKILLS
WORKING WITH CONTRADICTIONS
(IN MORE DETAIL)
Signs of Ineffective Intervention:
A.
Judgments in counselor’s response (verbal or nonverbal)
B.
Client shuts down or becomes increasingly hostile.
C.
A power struggle develops – counselor and client
begin arguing (directly or indirectly) about who is
right.