The Top Ten Basic Counseling Skills

---

  Research is increasingly finding that the type of therapy used is not a important to outcomes as are specific counselor behaviors such as (1) Enthusiasm, (2) Confidence, (3) Belief in the patient’s ability to change.  Although there is nothing which will ensure change, it would appear that clients are more likely to achieve their goals when a good and positive relationship exists between them and their therapist. In essence the counselor’s interactions with the client are a powerful tool in the helping relationship. 

1. Listening 

a. Attending - orienting oneself physically to the patient (pt) to indicate one is aware of the patient, and, in fact, that the client has your full, undivided attention and that you care. Methods include eye contact; nods; not moving around, being distracted, eye contact, encouraging verbalizations; mirroring body postures and language; leaning forward, etc. Researchers estimate that about 80 percent of communication takes place non-verbally. 

b. Listening/observing - capturing and understanding the verbal and nonverbal information communicated by that pt.  

Two primary sources of information: 

• CONTENT

 - what is specifically said. Listen carefully for, not only what a person says, but also the words, expressions and patterns the person is using, which may give you a deeper insight. Counselors should develop their ability to remember what was said, as well as to clarify what was said or finding out what was not said. 

• PROCESS 

- all nonverbal phenomena, including how content is conveyed, themes, body language, interactions, etc. Smiling 

2. Empathy

 The ability to perceive another's experience and then to communicate that perception back to the individual to clarify and amplify their own experiencing and meaning. It is not identifying with the pt or sharing similar experiences-- not "I know how you feel"!  

Primary skills associated with the communication of empathy include: 

a. nonverbal and verbal attending

b. paraphrasing content of client communications 

c. reflecting patient feelings and implicit messages 

a. ATTENDING – involves our behaviors which reflect our paying full attention, in an accepting and supportive way, to the client. 

b. PARAPHRASING - Selective focusing on the cognitive part of the message – with the client’s key words and ideas being communicated back to the patient in a rephrased, and shortened form. There are four steps in effective [paraphrasing: 

I. Listen and recall. The entire client message to ensure you recalled it in its entirety and do not omit any significant parts. 

II. Identify the content part of the message by deciding what event, situation, idea, or person the client is talking about. 

III. Rephrase, in as concise a manner as possible, the key words and ideas the client has used to communicate their concerns in a fresh or different perspective. 

IV. Perception check is usually in the form of a brief question, e., “It sounds like...,” “Let me see if I understand this,” which allows the client to agree or disagree with the accuracy of your paraphrasing. 

c. REFLECTING PT'S FEELINGS- Affective reflection in an open-ended, respectful manner of what the client is communicating verbally and nonverbally, both directly through words and nonverbal behaviors as well as reasonable inferences about what the client might be experiencing emotionally It is important for the helper to think carefully about which words he/she chooses to communicate these feelings back to the client. The skill lies in choosing words which use different words that convey the same or similar. For example, if a poorly skilled helper reflected to the client that he/she was “very angry and depressed,” when the client had only said they were irritated by a certain event, and had felt very sad over the death of a family pet, the result could be counterproductive to the process of change. 

3. Genuiness  

Ability of counselor to be freely themselves. Includes congruence between outer words/behaviors and inner feelings; nondefensiveness; non-role-playing; and being unpretentious. For example, if the helper claims that they are comfortable helping a client explore a drug or sexual issue, but their behavior (verbally and nonverbally) shows signs of discomfort with the topic this will become an obstacle to progress and often lead to client confusion about and mistrust of the helper. 

4. Unconditional positive regard

An expression of caring and nurturance as well as acceptance. 

• Includes conveying warmth through: 

• Also conveying acceptance by responding to the pt's messages (verbal and nonverbal) with nonjudgmental or noncritical verbal & nonverbal reactions. 

• Respect - ability to communicate to the pt the counselor's sincere belief that every person possesses the inherent strength and capacity to make it in life, and that each person has the right to choose his own alternatives and make his own decisions. 

5. Concreteness

  Keeping communications specific -- focused on facts and feelings of relevant concerns, while avoiding tangents, generalizations, abstract discussions, or talking about counselor rather then the client. Includes the following functions: 

a. Assisting client to identify and work on a specific problem from the various ones presented. 

b. Reminding the client of the task and redescribing intent and structure of the session. 

c. Using questions and suggestions to help the client clarify facts, terms, feelings, and goals. 

d. Use a here-and-now focus to emphasize process and content occurring in current session, which may of help to elucidate the problem being worked on or improving the problem-solving process. 

6. Open Questions

 -- A questioning process to assist the client in clarifying or exploring thoughts or feelings. Counselor id not requesting specific information and not purposively limiting the nature of the response to only a yes or no, or very brief answer. 

a. Goal is to facilitate exploration – not needed if the client is already doing this. 

b. Have an intention or therapeutic purpose for every question you ask. 

c. Avoid asking too many questions, or assuming an interrogatory role. 

d. Best approach is to follow a response to an open-ended question with a paraphrase or reflection which encourages the client to share more and avoids repetitive patterns of question/answer/question/answer, etc.

 

This is when the counselor shares personal feelings, life experiences, or certain reactions to the client. As a common practice, it is safer not to self-disclose unless for some reason there is no other way to meet a clinical need. In which case, it should only include relevant content intended to build them up. But recall, empathy does not mean sharing the same experiences but being able to communicate what the client is feeling and thinking in a caring and understanding way.

 8. Counselor Self-Disclosure  

The counselor shares personal feelings, experiences, or reactions to the client. Should include relevant content intended to help them. As a rule, it is better to not self-disclose unless there is a pressing clinical need which cannot be met in any other way. Remember empathy is not sharing similar experiences but conveying in a caring and understanding manner what the client is feeling and thinking 

9. Interpretation  

Any statement to the client which goes beyond what they have said or are aware of. In interpretation the counselor is providing new meaning, reason, or explanation for behaviors, thoughts, or feelings so that pt can see problems in a new way. Interpretations can help the client make connections between seemingly isolated statements of events, can point out themes or patterns, or can offer a new framework for understanding. An interpretation may be used to help a pt focus on a specific aspect of their problem, or provide a goal. 

• Keep interpretations short, concrete (see concreteness), and deliver them tentatively and with empathy. 

• Use interpretations sparingly and do not assume a pt's rejection of your insight means they are resistant or that you are right. 

10. Information Giving and Removing Obstacles to Change

  Supplying data, opinions, facts, resources or answers to questions. Explore with client possible problems which may delay or prevent their change process. In collaboration with the client identify possible solutions and alternatives.  

__________________________________________________________________________

 

Research is continually proving that positive outcomes are less predicated on a certain type of therapy, as they are on the counselor’s ability to be enthusiastic, confident, and present a belief in the patient’s ability to change.

We can’t change people. However, we can be helpful in encouraging our clients to move towards change. It would appear that clients are more likely to achieve their goals when there is a healthy and trusting relationship that exists between the client and their therapist. So, naturally, the way in which the counselor engages the client can be a very effective tool in the helping relationship.

Today we will talk about the 9 most important basic counseling skills.

Think about the people who you feel most heard, and understood by. Generally, the reason we feel as though they are listening has a lot to do with their body language, or posture towards us. In counseling, this is called attending. Attending just means to position yourself to the patient in a way that lets the patient know that you are aware of them, that they have your full undivided attention, and that you care about what they have to say; and, in general, them as a person.

Here are some important things to be aware of to make sure that you are attending:

Make eye contact.
Remove anything from the room that may distract you from focusing on your patient.
Nod your head at appropriate times to confirm that you are hearing what they are saying, or that you identify with what they are saying.
Try not to move around a ton. Though you may not mean to, moving around can suggest that you are antsy and ready for them to stop talking; you never want them to feel like you don’t want them to be there, or that you have better things to do.
Make encouraging verbalizations.
Try even to mirror their posture, and language; this can make your client feel more comfortable, and free.
Lean forward. This shows your client that you are engaged. There are many other aspects of body language that may depend on that specific patient.

Researchers suggest that eighty percent of communication actually takes place non-verbally. So, attending is an important way that you communicate to your patient that you care about them. But, just like with anything, we can go through the motions, do all the right things, but our minds and hearts can be far off. We need to be sure that we are retaining and understanding the verbal and nonverbal information being conveyed by that patient. This is called observing, or actually listening.

Content, and process are the two main sources of information to draw from to make sure that we are understanding what our patient is communicating. Content refers to what is actually said. Be careful to listen to, not only what a person says, but also the words, expressions and patterns the person is using, which can give you deeper insight. It may also be important to recognize what is not said.

Counselors should also develop an ability to remember what was said, and to clarify with the patient what was said.

“Process” refers to all nonverbal communication, including how the content is being presented. You don’t just want to be conscious about your nonverbal communication, but an important part of listening is being aware of the patients as well. This can be recurring themes, body language, interactions, etc.

Empathy does not mean that you have to identify with the patient or share similar experiences. You may not actually know how they feel, but it’s important to develop the ability to discern another’s experience and then to communicate that perception back to the individual to clarify what they have said.

The main skills involved in communicating empathy are:

Nonverbal and verbal attending
Paraphrasing what the patient has communicated
Reflecting on how the patient feels, and also on implied messages.

Now, we already talked about attending but, just to review, this involves our conduct which communicates to the patient that we are paying full attention to what they are saying in a caring and helpful way.

Paraphrasing: You want to focus on the keywords and main ideas that the client has communicated and communicate them back to your patient in a rephrased, and shortened form. This not only communicates to your client that you heard what they are saying, but also that you are trying to really understand them more deeply.

Here are four tools to help you paraphrase:

Listen and recall everything that the client expressed to make sure that you recalled everything, and did not miss any significant details.
Identify the content aspect of the information the client has shared by deciding what event, situation, idea, or person the client is talking about. Remember content refers to what is actually being said through words, expressions, and patterns; and oftentimes even through what they omit.Rephrase the entirety of what they have communicated yet as briefly as possible. Use the keywords and main ideas that the patient has used to repeat back to them in a fresh way.Perception Check. This allows for the client to confirm or deny the precision of you paraphrase. You never want to put words into their mouth so a helpful way make a perception check is to do it in the form of a question. For example “it sounds like______,”or “let me see if I understand this.”

Reflect on the patient’s feelings. You want to go back over what the client has communicated directly through words as well as through nonverbal behaviors in a respectful open-ended approach. You also want to make a fair deduction about what your client may be feeling emotionally. It is imperative for you, the counselor, to choose, cautiously, the words you choose to communicate back to your client. That is why it is important to use the same or similar words that your client has used.

You have to remember that what your client is feeling is very real, and often time very deep. Wrong word choice can often time be harmful to the process.

Be honest. Be yourself. Be comfortable. Your actions need to reflect the words you are saying. I talked about this briefly when we walked through listening. Oftentimes, we can say all the right things, but our hearts and minds are far off. We need to be genuine in the things that we say. What we say should be paired with our behavior. For instance, if you have expressed that you are comfortable with helping them navigate through all issues, and you act surprised or uncomfortable when they talk about a more private, or even intimate issue this can be a stumbling block in the growth progress.

Regardless of what is said, there needs to be an endless amount of kindness, and expression of caring. You may disagree, or see flaws in their reasoning, but your job is not to argue them to your side, but to gently encourage them to see things through the scope of reality. We all need encouragement, and guidance to help us see things through the scope of reality.

Affirming the patient in their hurt, happiness, or confusion is a good way to convey to your patient that it is okay to be experiencing these emotions.

It is important to stay focused on specific and relevant facts and feelings; and to avoid getting off-topic, making sweeping statements, or talking about the counselor rather than the client.

Help the client to recognize and pursue growth in one specific area of the several presented.
Reiterate the goal to the client, and also the intent and structure of that specific session.
Present questions and propositions to help the client clarify facts, terms, feelings, and goals. Like a perception check!

Adapt a here-and-now focus. This means that addressing the material that emerges in the room becomes the focus.

This is a helpful questioning method to get your client to clarify or explore thoughts, and feelings. When asking open-ended questions, you don’t want to request a specific bit of information or limit the question to a brief answer, or yes or no.

The goal is to guide deep explorative thought. If the client is already doing this, you would not need to assist them with an open question.
Ask intentional, and purposeful questions.
The goal is not to drill them. You don’t want them to feel like they are being interrogated, but to help them work through the issue.
You may want to follow up the patient’s response with a paraphrase, which may encourage the client to share more.

This is when the counselor shares personal feelings, life experiences, or certain reactions to the client. As a common practice, it is safer not to self-disclose unless for some reason there is no other way to meet a clinical need. In which case, it should only include relevant content intended to build them up. But recall, empathy does not mean sharing the same experiences but being able to communicate what the client is feeling and thinking in a caring and understanding way.

This is any statement outside of what the patient has actually said or may even be aware of. When interpreting the counselor is able to provide a new perspective, provoke thoughts or feelings, or present an explanation for behaviors. Interpretations may help patients connect things that they have compartmentalized, reveal patterns or themes, and it can offer a fresh way of thinking. You want to be sure not to overuse interpretation; because this can come across as assuming or even accusatory.

You want to humbly present data, facts, wisdom, resources, or answers to questions. Together, with your patient, identify possible problems that may be hindering their growth process, and think through possible solutions and alternatives.