Concepts of Counseling for Saksham Counselors Dr Satish

Concepts of Counseling for Saksham Counselors Dr Satish Pandya MD Ped PGDAP PGDGC Consultant Pediatrician & Counselor, Varun Children Hospital and Kalpanam Counseling Centre. Vadodara

Some Case Scenarios Think of situations when you feel that you are ill-equipped and unable to deal with them? 2

The Challenging Moments • You are trying to measure the length of child but he is scared and cries a lot • You are trying to explain the diet and father is busy with his mobile • The grand mother argues with you on certain dietary issues e. g. Bottle feeding • The parents argue about : – Cost of vaccine – Brand of vaccine – Need for vaccine Parents talk about their better experiences with other hospital Parents shout at you The grandfather complaints about poor facilities in your set up The relatives express unhappiness about long waiting The relatives are not happy with the nurse who gave injection and child cried a lot • ………. and so on. . • • • 3

Some case scenarios where you get frustrated and start blaming your own self, the parents, doctors, your set up, your costaff… 4

What Has Gone Wrong? • • No – Please do not assume otherwise! You indeed are a good person Your intentions are right You made the efforts to do your job well So where is the problem? 5

Probably We Could Have Done Better With Some Counseling Skills! 6

Example: Parents are arguing about cost • On detailed discussion it was found that they can not afford the “painless” vaccine and are happy that you told them about free vaccines available at Government set up • Now they are more than willing to get rest of the vaccines at your set up only 7

Example: Parents’ Unreasonable Behaviours On little more patient listening it was found that • The father had issues at his job place and was in a great hurry to finish this visit • There was fight between mother and father • The mother is very uncomfortable with her in-laws around • The previous sib had bad reaction to vaccine • They have heard about some body having some disease following vaccination • They have some very strongly ingrained beliefs about diet 8

How did these facts come out? • It was not an accidental revelation • It was not mere advise which led to this • There was a back ground of good listening skills, empathy, non hurriedness and an approach of empowering the parents to take control of themselves 9

Objectives ØTerminology ØImportance of counseling in pediatric OPD ØBasic principles of counseling 10

Terminology • Advice • Guidance • Counseling 11

Advice • You are sharing some knowledge, information or wisdom • A passive process with uni-directional flow • A connotation of superiority of one over other 12

Guidance Counseling • A dynamic process to help an individual to be able to self analyze his problems and find his own solutions. It is helping a person to realize his full potential. • A term used more in a general sense • EMPOWERING a person to analyze his or her own problems , finding own solutions and working on them • More specific , more elaborate • Two way flow • Counselor and counselee work towards set goals as a team. 13

Some Salient Tips for Successful Counseling 1. General tips 2. The Counseling Skills 3. The process 14

General Tips: Lesson 1. Counseling Is Not Advising • Advice does not work unless the recipient has internalized it. • It leads to frustration when it seems to be falling on deaf ears! 15

General Tips: Lesson 2. You Can Not Change Someone • Only one himself / herself can bring in the change in behavior and attitude • You can only help through a process of counseling 16

General Tips: Lesson 3. Time factor • Within the same time or little more , you can do better if you keep simple principles of counseling in mind • It is doable! 17

General Tips: Lesson 4 Grooming and Mannerisms You need to be presentable Etiquettes are of paramount importance Your mannerisms convey a lot Some gestures may convey indifference – eg. Munching on some thing while talking, putting fingers in ears …. • Big NO to talking on mobile • Talking loudly with other staff • Cracking jokes or laughing at wrong moment • • 18

Some Salient Tips for Successful Counseling 1. General 2. The Counseling Skills 3. The process 19

Counseling Skills 1. Speak less, listen more! • • Be an active listener Art of listening is an acquired skill The counselee feels that you are interested in her issues e. g. The mother taking recourse to bottle feeding may have numerous reasons to do so in spite of your “expert advice” 20

Counseling Skills 2. Empathy • Make counselee realize that you actually feel his /her dilemmas and emotions • It connects • It opens up channels of communication • e. g. parents refusal for multiple pricks • “I understand how you may be feeling that your child has to take so many pricks” 21

Counseling Skills 3. Develop Good Communication Skills ØUse appropriate language, avoid medical jargon e. g. AEFI ØGive privacy and assure confidentiality( e. g. counseling a grand father in presence of daughter in law is a recipe for disaster at home!) ØLearn nuances of body language; tone of speech, gestures, eye contact Øe. g. A father smiling gently at your advise for some costly vaccine may convey that you are talking non sense in his view of situation ØParadoxically you may actually be wrongly reading the body language- he may be having related concerns e. g monetary aspects 22

Counseling Skills 4. Use Reflection and Paraphrasing • “ OK so you are not getting along well with your mother in law and hence you take out your anger on the little one while eating ” • “ You mean you feel that your wife is responsible for all the problems with your child” 23

Counseling Skills 5. Share Appropriate Information • Scientific facts in a gentle and not overwhelming manner – not ridiculing for lack of apparently simple knowledge • E. g. • Vaccines • Feeding issues • Range of growth in children 24

Counseling Skills 6. Concreteness • Keeping the discussion on track • Deal with rambling: “ We could not come for vaccine because -there was wedding in family -then his grand father met with an accident - His aunty delivered - and ……. . ” 25

Counseling Skills 7. Acceptance • • Do not be judgmental Avoid speaking or even thinking such sentences as: “Oh, what a lack of scientific knowledge? ” “Oh, what a rubbish talk? ” üAccept the parents and their value system as it is üThen try to work upon making them realize the fault üAnd then help them to change it 26

Some Salient Tips for Successful Counseling 1. General 2. The Counseling Skills 3. The process 27

The Counseling Process: 1. 2. 3. 4. 5. Rapport building Establish the need for counseling e. g. diet , vaccines Set goals Summarizing Follow up review 28

Rapport building Break the ice : • Make the parents and children comfortable by greeting them in their style • Talk about something which will interest them 29

Establish the Need for Counseling • Some times parents may just not be interested in the topic of diet or growth • They have come only for a prescription • Here you have to apply all your skills to convince them about the benefit of our counseling 30

Set Goals • Goal setting helps to give a formal structure to whole process, otherwise it is just gossiping • The goals should be mutually agreeable • E. g. Understanding the need for vaccine and finalizing a schedule 31

Summarizing • When a session gets a bit lengthy both the parties may lose sight of what all they talked about • Summarize and get the parents to agree with what has been discussed 32

Home Work - Assignments • Between the session give tasks to work upon • It may be for parents or for older children themselves • E. g. Eating habit issues 33

Follow up • Review progress • Identify obstacles • Revise goals 34

Take Aways • Counseling is not advising (Mere advising is often futile) • Counseling is a learned skill • In day to day practice counseling is required to ensure compliance to immunization and nutrition • Counseling is doable in routine OPD Every Saksham staff needs to be and has a potential to be a good counselor 35

THIS WAS NOT AN ADVISE ON COUNSELING, BUT AN ATTEMPT AT GROUP COUNSELING! Thanks For Being Good Listener 36