Monthly MH training

Ways of asking questions.

• Open-ended questions are questions that can bring out many different answers. Some examples: ‘How can I
help you?’ ‘What is your most important problem at this moment?’, ‘What is the reason that your wife left
you?’. These questions are sometimes a bit difficult to answer for the client; he must think before he can
answer. They often result, after some hesitation, in long answers. But they may also bring about an
uncomfortable silence.
• Directive questions leave the client only few possibilities to answer, like ‘yes’ or ‘no’. Examples: ‘What is your
age?’ ‘Are you married?’ ‘Are your children going to school?’ ‘Did that happen in prison, or after your escape?’.
For some clients these questions are easier to answer; they can help a client to mention important facts he
hardly dares to describe (for example: ‘Did they torture you?”). They can also help the client to talk about
other matters highly emotionally charged for him. The client will then be able to tell the facts.
• Sometimes suggestive additions to open-ended questions ('‘How did you feel when this happened? Didn't
you become very angry? Or were you just stunned?'’ can be stimulating. This is a way for the counsellor to
help the client to express his emotions in words. But these questions are helpful only if they are empathetic,
not accusing, not morally judging. And only if they allow alternative answers.
• An additional form of asking questions is making a statement that ends in a question (‘I think this must have
been a very difficult decision for you … am I right? Or have I misunderstood?’)
Restating:

Restating what you have just heard often helps the person to carry on
talking, without distracting their train of thought.
• e.g.
• Patient: "…and I didn’t know what to do.
• Doctor: "You didn’t know what to do?"
• Patient: "No, so I just stood there and screamed at them."
Invitations to talk

• Sometimes it is useful to make an encouraging remark like:

• "Would you like to talk about that?"
• "Could you tell me some more about the holiday?"
Acknowledgement responses.

We need to make generally encouraging noises, etc. MSF OCBA – Basic

Training of Counsellors 59

• "Yes." "Yes, go on." "I’m with you. "Uh-huh.

• "I see." "Of course." "Mmm-mm."
• Your facial expressions and head nodding should show you are
following what is being said and will be encouraging.
Paraphrasing:

• Paraphrasing is a brief rephrasing of information provided by the client. It provides a

restatement of the essence of the information in your own words. The use of
paraphrasing demonstrates you are listening and it helps you make sure your
understanding is correct. It lets the speaker explore the issues, but does not suggest you
agree, and encourages the speaker to analyse and discuss the subject matter more fully.
• Paraphrasing helps you listen for the main points. It is not uncommon for people to be
somewhat vague or have trouble coming to the point when discussing sensitive issues.
By restating the speaker’s main points in your own words, you not only assist your own
understanding, but also help the speaker to clarify his or her main points and concerns.
The purpose is also to test your understanding of what you heard and to communicate
that you are trying to understand what is being said. If you’re successful, paraphrasing
indicates that you are following the speaker’s verbal explorations and that you’re
beginning to understand the basic message.
• Paraphrasing focuses on your listening and ensures clear, two-way communication. If your restatement is
not quite on target, the other will usually clarify what they have just said.
• E.g. It sounds like.., Let me see if I heard you right… Are you saying that… In other words, what you mean
is…
• Client: "I can’t figure out what to do with this student. She can do the job, but it seems like she always
wants to do things her way, as opposed to our way."
• Paraphrasing response: "It sounds like you see her as having difficulty following the methods?"
• One step further is paraphrasing of the emotional content. Here paraphrasing is not only rephrasing of
information provided by the client, but focusing and paraphrasing of emotions behind these statements. If
the client says "I am very unhappy because.." or " it makes me very anxious if he…" then he expressed the
emotions direct and it is sufficient to attend. In paraphrasing emotional content of the counsellor tries to
detect the emotions behind the story. In paraphrasing these emotions the client learns to accept these
emotions and to express his emotions more direct (that benefits his relationships).
• In paraphrasing the emotional content the counsellor should be very careful not to interpret and impose
emotions
• Client: "Since I’ve become a shift supervisor, I’m not sure how I’m
doing. I don’t know if I’m really in control. Sometimes I think I made
the wrong decision to accept the promotion.".
• Paraphrasing response: "You’re afraid d you won’t make it in your new
position?"
Clarifying

• Clarifying means asking questions until you are both confident that
you have understood. "I’m not sure what you mean. Can you explain a
bit more?" "Do you mean that ?" "What do you mean by .."
• You will need to be clear about the problem and the feelings and
check your understanding with the patient at various points
throughout the conversation. Do not hesitate to ask the client if you
did not understand a certain point of the story.
Talking about feelings

Talking about the feelings and emotions of the client is very important
in all forms of counselling. If the counsellor understands the feelings of
the client, he may better understand behaviour of the client that at first
might strike him as disturbing or strange or foolish. If the client behaves
in ways that are illogical or contradictory, this may be the result of
conflicting feelings of which the client is hardly aware. The counsellor
can help the client by sorting out these contradictory feelings.
Summarising

Summarising is pulling together, organizing and integrating the major aspects of your
dialogue, briefly going over it together, agreeing on the problem or the next course of
action. Remember to pay attention to various themes and emotional overtones and to put
key ideas and feelings into broad statements. DO NOT add new ideas. This gives a sense of
movement and accomplishment in the exchange and establishes a basis for further
discussion. It pulls together major ideas, facts, and feelings and helps to sort them.

• E.g. A number of points have been made about rules for the classroom. Let’s take a few
minutes to go over them and write them on the board
• E.g. We’re going over the map this morning. If I understand you correctly, the three major
points of the story are
5.4. Active listening
Active Listening (also known as reflective listening):

• Establish eye contact with the person while talking to him/her

• Listen attentively
• Use short phrases (along with gestures) to indicate that you are listening, but do not
interrupt frequently
• Try to encourage the person to talk more by repeating his/her words/phrases
• Reflect upon the contents and clarify wherever necessary
• Reflect upon your own feelings and emotions while listening to other’s experience
• Summarize the contents in between and at the end of the talk
• Empathize with the person by sharing the experience of others
• Reassure the person but do not make false promises
5.5. Empathy
Empathy
(1) I can understand what you are going
through.
(2) I can understand that you are feeling
angry at what has happened to you
(3) I accept that you are very scared
(4) Simply sitting in silence while the
survivor expresses his/ her feelings or
weeps.
Sympathy
(1) Poor you, it is really bad that this
happened to you
(2) It is horrible that this has happened to
you
(3) Don’t be scared, I am here to help you
however I can
(4) I am so sorry for you, don’t worry
everything will be all right.
5.6. Questioning skills

• Do not ask too many questions

• Avoid leading question (Questions that put the answer into the other person's mouth:
for instance, 'Your dad's a great guy, isn't he?' In asking questions, keep the focus on the
client. Questions should keep the focus on clients and their interests, not on the
theories of helpers.)
• Ask open questions
• Ask questions that serve a purpose
• Elaboration questions
• Specification questions
• Focusing on feelings’ questions
Role of the counsellor
• to help the client to use their personal and social capacities to solve the problem they face and to regain power in their life.
• The counsellor helps the client to identify the factors of stress in their social environment and to decrease its symptoms.
• This helping process is done according to the needs of the client and with the respect for their values. Therefore, the
counsellor helps the clients to help themselves.
• In psychosocial support, there are no magic recipes or set responses.
• One does not have to have answers for all problems to be a good counsellor.
• The counsellor is there to guide the client who seeks assistance, in a way that they will find realistic and practical solutions to
their problem.
• The counsellor makes the client aware that they are capable to go through this difficult period and that they have the key to
their problem.
• The counsellor will help the client to clarify thoughts and feelings by using examples, explaining concepts and by pointing out
important aspects of the counselling process. However, the counsellor won't give solutions to the client.
• We can compare the work of a counsellor to that of a tourist guide.
• A client wants to go somewhere but doesn't know how to get there.
• The guide will help him by getting a map and will show him several ways to get there. The guide won't drive the car for the
client. Accordingly, the counsellor won't do the work for the client.
Typical presenting complaints of PTSD

• People with PTSD may be hard to distinguish from those suffering

from other problems because they may initially present with non-
specific symptoms, such as:sleep problems» (e.g. lack of
sleep)irritability, persistent anxious or depressed mood»multiple
persistent physical symptoms with no clear »physical cause(e.g.
headaches, pounding heart).However, on further questioning they
may reveal that they are suffering from characteristic PTSD symptoms.
Typical presenting complaints of psychosis

• Abnormal behaviour (e.g. strange appearance, self-neglect,

incoherent speech, wandering aimlessly, mumbling or laughing to
self)
• Strange beliefs
• Hearing voices or seeing things that are not there
• Extreme suspicion
• Lack of desire to be with or talk with others;
• lack of motivation to do daily chores and work.
• Physical complaints are the most common reason for seeking help from a
health worker or doctor. However,
• some of those complaints don t always have a medical explanation and
are rather a sign of emotional
• disturbances (mainly anxiety and depression).
Examples of such complaints: headaches, aches and pains all over the body,
chest pain, heart beating fast,
• dizziness, low back pain, abdominal pain, difficulty in breathing, etc.
Complaints may be single or multiple, and
• may change over time.
Typical presenting complaints of moderate-severe depressive disorder:

• Low energy, fatigue, sleep problems

• Multiple persistent physical symptoms with no clear cause (e.g. aches
and pains)Persistent sadness or depressed mood, anxiety Little
interest in or pleasure from activities.
• Imagine acute grief as a deep and fresh wound. You feel intense pain,
but that's part of your body's healing process. Without the pain, you
might ignore the wound and let it fester.
• As time passes, the wound slowly heals, and turns into a scar. This is
integrated grief. The deep wound has closed, but the scar will always
be there, raw to the touch.
• Sometimes, our wounds become infected and fail to heal. This is
complicated grief. The wound continues to cause immense pain, and
only seems to get worse. At this point, professional help may be
needed
SLEEPING PROBLEMS?
• Diagnostic features:
• Difficulty falling asleep
• Waking up early in the morning
• Restless or non-restful sleep
• Interrupted sleep: frequent or prolonged periods of being awake throughout
the night
Patients are distressed and sometimes disabled by the daytime effects of poor
sleep:
• Difficulties at work, social and family life
• Difficulties carrying out routine or desired tasks
Mental relaxation

• Sit comfortably, preferably in quiet place, with your feet flat on the floor
• Close your eyes
• Breathe easily through the nose
• Fix your attention on your muscles and feel how they become a little more relaxed every time you breathe out. Do this for 2
or 3 minutes
• Now imagine that each time you breathe in you take in energy and health. Every time you breathe out you get rid of some
tension and stress. Do this for 2 or 3 minutes.
• Now remember some pleasant and beautiful place you have visited in the past. Imagine you are there now. Let your mind
rest easily in this place.
• When other thought comes into your mind just watch them come and go by themselves. Even worrying or unpleasant
thoughts will go if you don’t peruse them.
• You are sitting deeply in a pleasant place. Remember what it looks like, sounds like, and feels like. Let other thoughts come
and go on the surface of your mind.
• After about 10 minutes say goodbye to this pleasant place, but remember that you will return again.
• Take three deep breaths and open your eyes.