Communication Skills PDF

CHAPTER 2 COMMUNICATION SKILLS EFFECTIVE COUNSELOR-CLIENT RELATIONSHIPS  Communication skills form the foundation for nutrition counseling (Figure 2–1). Every step in the nutrition care process requires an ability to communicate. In step 1, the ability to assess nutrition problems would be im...

CHAPTER 2 COMMUNICATION SKILLS EFFECTIVE COUNSELOR-CLIENT RELATIONSHIPS  Communication skills form the foundation for nutrition counseling (Figure 2–1). Every step in the nutrition care process requires an ability to communicate. In step 1, the ability to assess nutrition problems would be impossible without communication skills. It is at this first point in the nutrition care process that the skill of engaging the client in discussion around eating habits is crucial to each of the three steps that follow.  The quality of the nutrition counselor’s communication skills allows the second step of determining a nutrition diagnosis to occur. No diagnosis will be accurate if communication is not occurring at the highest level during step 1, assessment. Step 3 involves negotiating a tailored intervention, and again, communication and counseling skills are crucial to client behavior change success. Finally, in Step 4, accurate information about whether goals were met will only occur if the client feels comfortable communicating with the nutrition counselor, who is the facilitator of client progress. EFFECTIVE COUNSELOR-CLIENT RELATIONSHIPS PERSONAL CHARACTERISTICS OF COUNSELORS  The way counselors respond to others can greatly infuence how clients think and act in the future. The mere act of encouraging clients to talk as opposed to ignoring what they say may infuence their lives greatly.  Many clients come to a counseling session feeling that no one has really ever listened to them. By finding someone who is focused on them and shows great interest in their past eating problems, they become more willing to discuss those parts of their lives that may be most connected to success and failure in the goal of eating in a healthy manner. PERSONAL CHARACTERISTICS OF COUNSELORS  A good relation between the nutrition counselor and client is essential to behavior change. From the moment of initial contact, the nutrition counselor make eforts to develop an open, positive relationship in which the client senses the counselor’s acceptance and understanding. To change their behavior, clients must feel comfortable freely relating to lifestyle details to the counselor.  PERSONAL CHARACTERISTICS OF COUNSELORS ‫ يدرك املمارسون بشكل حدسي أن التعاطف ونقل االحترام والتصرف بشكل طبيعي يساعد على إنشاء جلسة‬.‫مجموعة متنوعة من الخصائص الشخصية الالزمة لتكون مستشارا فعاال‬ ‫ الطريقة التي ينظرون بها إلى أنفسهم وأولوياتهم وقيمهم وتوقعاتهم يمكن أن تغير العملية بشكل إيجابي أو سلبي‬.‫موجهة بشكل أكثر إيجابية والحفاظ عليها‬  The variety of personal characteristics necessary to be an efective counselor. Practitioners recognize intuitively that being empathetic, conveying respect, and behaving naturally helps to create and maintain a more positively channeled session. The way they view themselves and their priorities, values, and expectations can alter the process positively or negatively.  Some characteristics that helpers bring to a nutrition interview. Nutrition counselors begin an interview with discussion of motives, learning history, thinking skills, capacity to feel, sense of worth, fears and anxieties, gender role identity and expectations, values, ethics, culture and cross cultural skills, race and racial attitudes and skills, and social class.  An association between the counselor and patient satisfaction resulting from the level of communication skills used by the counselor. ‫ يبدأ مستشارو التغذية مقابلة بمناقشة الدوافع‬.‫بعض الخصائص التي يجلبها املساعدون إلى مقابلة التغذية‬.‫العالقة بني املرشد ورضا املريض الناتج عن مستوى مهارات االتصال التي يستخدمها املرشد‬ ‫وتاريخ التعلم ومهارات التفكير والقدرة على الشعور والشعور بالقيمة واملخاوف والقلق وهوية دور الجنس‬ ‫ والطبقة‬،.‫والتوقعات والقيم واألخالق والثقافة واملهارات الثقافية واملواقف واملهارات العرقية والعنصرية‬.‫االجتماعية‬ PERSONAL CHARACTERISTICS OF COUNSELORS There are three problems with the Personal Characteristics of Counselors: ‫ يمكن أن تتضمن‬.‫ الكفاءة والقوة والحميمية‬:‫اإلمكانية األولى مع الصورة الذاتية التي يمكن أن تؤدي إلى عواقب سلبية أثناء املقابلة‬ ‫ يمكن أن تؤدي مشاعر عدم الكفاءة إلى تجنب القضايا املثيرة للجدل في جلسات املشورة‬.‫مواقف املستشارين مفهوم الكفاءة‬  The First potential with self-image that can result in negative consequences during an interview: competence, power, and intimacy. Counselors’ attitudes can involve the concept of competence. Feelings of incompetence can lead to avoidance of controversial issues in counseling sessions.  For example, an obese client who has lost weight says, “I really think you’re a terrific counselor.” A fearful counselor will reply, “Oh, no, I haven’t done that much” instead of simply thanking the client for the compliment: “Thank you. Keep in mind you have done all of the work.” PERSONAL CHARACTERISTICS OF COUNSELORS  The second potential self-image problem, power, can make counselors feel both omnipotent and fearful of losing control or being weak or unresourceful. In the authoritarian role, counselors try to persuade clients to obey suggestions without question. The nutrition counselor who has the need to always be in control may say, “This is the goal I have for you!” If clients resist or do not respond, the outcome for counselors is resentment and anger. PERSONAL CHARACTERISTICS OF COUNSELORS  The third potential self-image problem focuses on feelings about intimacy. These can involve two extremes, afection and rejection.  Counselors who are fearful of rejection try to extract only positive feelings from clients, avoiding confrontation at all costs and ignoring negative cues. This type of counselor may even get involved in doing clients favors. Counselors who try to do everything for their clients may be eliminating independent problem solving. FACILITATIVE LEVELS The levels below illustrate a gradual progression in the counselors’ ability to respond appropriately to clients’ problems.  Level 1: The response shows no understanding and no direction in relation to the client’s position. When the client brings up a crucial personal topic, the counselor starts talking about his or her own personal problems.  Level 2: The response shows no understanding but some direction. The counselor presents only general advice: when the client expresses difculty with a weight-loss strategy, the response is, “Well, don’t worry about it.”  Level 3: The response shows understanding but no direction. The counselor might say, “You feel afraid because you’re not sure how to avoid food ofers from friends.” FACILITATIVE LEVELS  Level 4: The response shows understanding and some direction. The counselor reacts to the client’s deficits and provides details related to the problems, saying, “You feel afraid because you can’t say ‘no’ and you want to avoid eating high-calorie foods.”  Level 5: The response shows understanding and specific direction. It contains the deficit, the goal, and one clear step for overcoming the problem and reaching the objective: “?” You feel afraid because you can’t say ‘no’ and want to avoid eating high-calorie foods. How would you feel about exploring positive ways to say ‘no’.  There are no perfect “super counselors” who have all the characteristics to make all sessions successful. Even positive characteristics may not always enhance the interview. Beyond personal characteristics that afect the sessions are the skills that require practice. When these skills are mastered, counseling takes on the characteristics necessary to achieve behavioral change. NONVERBAL COMMUNICATION Client Nonverbal Behavior  Clients’ nonverbal behavior can afect the direction of the interview. Efective counselors can identify nonverbal cues as signals for unspoken feelings. There are three forms of client nonverbal behavior: kinesics, paralinguistics, and proxemics.  Kinesics includes a variety of physical behaviors (e.g., facial expressions, body language).  Paralinguistics refers to how the client’s message is delivered (e.g., tone of voice).  Proxemics involves environmental and personal space. NONVERBAL COMMUNICATION  European-North American, middle-class cultures consider direct eye contact as a sign of interest. However, even in that culture, people often maintain more eye contact while listening and less while talking. When clients are uncomfortable about a topic, they may avoid eye contact.  Some African Americans in the United States may have reverse patterns; they may look more when talking and slightly less when listening.  Among some American Indian groups, eye contact by the young is a sign of disrespect. Some cultural groups (American Indian, Inuit, or Aboriginal Australian groups) avoid eye contact when talking about serious subjects. NONVERBAL COMMUNICATION  Mixed messages. Is there a mixed message or contradiction between the verbal and nonverbal messages? For example, a client comes in after having followed a no-added-salt eating pattern for several weeks and states, “It’s going really [pause] well. I’ve had [pause] very few problems,” while looking down and leaning away. The nutrition counselor can deal with these contradiction in one of three ways:  (1) simply take mental note  (2) describe the contradiction to the client, for example, “You say the diet is really going well and that there are few problems but you were looking down and really spoke with a lot of hesitation”.  (3) reply, “I noticed you looked away and paused as you said that. What does that mean?” NONVERBAL COMMUNICATION  Silence. Are there nonverbal behaviors with silence? Silence does not mean that nothing is happening. It can have diferent meanings from one culture to another. In some cultures silence indicate respect.  For the Chinese and Japanese, silence means a desire to resume speaking after making a point. Once again, the nutrition counselor can mentally note the silence, describe it to the client, or ask the client to explain it. NONVERBAL COMMUNICATION  Changing cues: Is it necessary to distract or interrupt clients by focusing on nonverbal behavior? If continuation of the topic may be unproductive, interruption may be needed to change the fow of the interview. If clients are pouring out a lot of information, a change in the direction of the interview may be useful. In such instances, nutrition counselors can distract clients from the verbal content by refocusing on nonverbal behavior.  For example, for unproductive content in a client’s messages, a counselor might say, “Our conversation so far has been dealing with your inability to cope with your spouse’s unsupportive comments about your low-protein eating pattern. Are you aware that you have been gripping the sides of your chair with your hands while you speak?” Nutrition counselors must decide whether such distractions can be destructive or productive to the interview. If the change in fow makes the client feel unable to continue to air feelings, the distraction could be detrimental.  Experienced counselors probably will find that their own intuition helps in knowing when to interrupt. NONVERBAL COMMUNICATION  Refocusing for redirection: Are there pronounced changes in the client’s nonverbal behavior? Initially the client may sit with arms crossed, then become more relaxed, with arms unfolded. Once again, counselors can respond either overtly or covertly. A nutrition counselor might respond to a seemingly more relaxed client by saying, “You seem more relaxed now. Do you feel less tense?” COUNSELOR NONVERBAL COMMUNICATION  The counselor’s nonverbal communication can have a great impact on the relationship.  A study reported that the nonverbal counselor behaviors that seem to be most important include expressions in the eyes and face, head movements and smiles, body orientation, some vocal cues, and physical distance between practitioners and clients.  Counselors can determine whether they are demonstrating desirable behaviors by asking someone to observe their nonverbal behaviors.