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Micro SKILLS

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MY MICROSKILLS PRACTICE

ATTENDING

 Goal is to reduce interviewer talking and provide client to talk..


 let her/ him tell the story..

Be culturally aware

1. Visual/ Eye contact (look)


2. Vocal Qualities (tone, rate..)
3. Verbal tracking (don’t change subject..keep to ir or be aware if you change topic..)
4. Attentive body language (SOLER) Be authentic

QUESTIONS: OPEN COMMUNICATION

How do Qs help?

 Open (few words)


 Encourage person to talk G
 Gives you maximum information: what brings you here?
 Deeper exploration of issues..

Facilitative Qs

 What
 How
 Why
 Could

Closed Qs (helps focus interview/ quick with information BUT CAN OVERWHELM CLIENT)

 Is
 Are
 Do

Ask ‘WHAT ELSE’?

 ‘looking back, what else may be added to what we have been talking about? ..’
 ‘what else would your friend/ family add to what you have said? ‘
 ‘Have we missed anything...?’

FIND YOUR BALANCE....


Listen to the story carefully..but you can miss important things like issues underlying depression..
(Separation, job loss, mourning..)

Too much asking? Clients can make it up..

HOW Qs CAN HELP?

1. Qs help begin an interview


2. Open Qs help elaborate and enrich client’s story (open topics, keep session moving..’tell
me more’..)
3. Brings out concrete specifics of the client’s world (give an example?)
- from vagueness to particular
4. Qs are critical in assessment (for diagnosis and assessment
5. Certain open Qs can determine what the client will say next...
- What Qs lead to facts (what happened? )( what are you going to do?)
- How Qs help discussions (how do you feel about that? )
- Why Qs lead to reasons (why Qs can seem like a past event of being grilled; get them
defensive, feel attacked) ‘Why did you allow it to happen? ‘
- Could, would Qs are open and client is free to say “No I don’t want to talk about it”

6. Qs have potential problems


- Bombarding/ grilling
- Multiple Qs
- Questions as statements (selling your point of view..’ gyming is useful no?’ ). If you have a
statement..do not frame it as a Q.
- Some cultures may have a rapid fire Q style / or men may ask more than women
- Why (avoid..)
- Qs & control (who is on control? ); can destroy relationship; intrusive

7. Qs and distrust (culture’s role)

8. Qs help search for positive assets and wellness patterns (what are the strengths? ..draw it
out..). Clients talk about what they can’t do..so ASK
- What are the strengths?
- When were you successful?
- Who supported you?
- Support systems?
- Proud off in the past? Now?
- what do others say that you well?
- Culture/ gender/ family inventory: strengths?

Exceptions (ask’ when the problem didn’t happen? What happened?’...)


Feedback coupled with positive Qs (‘you have done good work...what else can be your
resources / assets in this situation?’)

OBSERVATION SKILLS (OS)

Self - aware interviewed is aware of the client and here and now in the sessions. Observe verbal
and non verbal means: how does the client interpret the world?

What do you see? Hear?

OS in 3 areas:

1. Non Verbal behaviour (eye contact, body language, vocal qualities, SOLER...)
2. Verbal behaviour (verbal tracking- topic change? Concrete? Abstract? I vs
others? More negatives....changing to more positive? Key words? Note
repetitive words, themes)
3. Discrepancies (mixed messages, incongruities, conflict?) Non V behaviours/ or 2
statements/ or both?
Examples:
- My son is perfect but he does not respect me...
- I love my brother (looks down)

- Smiles but has closed fist

- Says he loves child but guilty of child abuse..


- I deserved better marks (but has lower grades)

Discrepancy: between you and the client! (value / goal conflict..)


Concrete: specific examples, actions
Abstract: reflective, self analysis (thoughts and behaviours). Use CCT or Psychodynamic
oriented therapy

ENCOURAGING, PARAPHRASING & SUMMARISING

Clients need to know that their story has been heard. Accurate listening through EPS help client to
open up...

E: NV means like ....uh – huh/ simple repetition of key words/ restatements (exact
words)
P: Essence of what is said to clarify (use some of your own words....not parrot)
S: longer time and more information (to begin or end an interview/ transition to new
topic; give clarity to complex stories; distilled form)
P & S has four dimensions:

1. Sentence stem:.....Ravi, I hear what you are saying...


2. Keywords: exact
3. Essence of what was said
4. Check – out: ....have I heard you right?

OBSERVING & REFLECTION OF FEELINGS

Emotions, feelings are the source of our thoughts and actions.

Trust develops and explorations become more deep...

....Sad, mad, glad, sacred...


- Label the client’s emotions.

IDENTIFY FEELINGS

1. Verbal: Emotional words used by the client?


2. Physical words: ....I was tense; ...I had a headache, ...was tired
3. Vocal tone: Flat? Distant?
4. Words NOT actually spoken? (Implicit): ....I am over the moon/ I feel like
running out of the room
5. NV expressed emotions? Body slumped? Upright?
6. Mixed: V & NV emotional cues (discrepancies)

ASK ....“how do you feel about...?”

REFLECTING FEELINGS (Steps)

1. SENTENCE STEM: ....You are.../ ....You feel ...glad about ...(OR sounds like
you feel...)
2. ADD Feeling word/ REFLECT STRENGTH OF FEELINGS: .....You feel as if..OR
Sound as if....(use name) and ADD feeling words (sad..glad..)
3. ADD content (....you feel glad about your marks...)
4. NOW/ Present tense: ...You feel glad right now (not FELT or will feel)
5. CHECK –OUT: ....Is that right?

Your reflection of feelings gives insight to client.....


SHOWING ATTENTION & INTEREST

- Be available: (can be overworked/ create distances)


Send clear messages about availability and access
- Adopt relaxed posture
(open body, lean forward, appropriate gaze, face tuned,
gestures, personal space, clothes)
No slouching, tension, crossed arms/ barriers; mirror images as
assign of liking
- Use touch sparingly
- Mixed V and NV: .....Smile with foot tapping/ fidget

STARTING & STRUCTURING

Good beginnings increase the chance of good middle and good


endings...

Permission to talk...(door openers..) Opening statement

o Formal settings: ....what brings you here.../ you have


been referred by..
o Informal settings: ....is there something on your mind/
I am available if you want to talk/ you seem unhappy
today...
o Follow up lubricating comments: ...it’s hard to get
started/ ....take your time/ when you are ready...
Structuring

- Time boundaries: ....We have about 45 minutes together...


- A single problem:... you have a clear idea why you have come...understand
the situation more clearly..
- Laundry list/ more than one: summarise and ASK: ...what would like to focus
on? ...

STARTING AND STRUCTURING SKILLS

Steps

o Make opening statement


o Give permission to talk
o Paraphrase**
o Reflect feelings
o Encouragers
o Open Qs
o Summarise

**5 STAGE INTERVIEW STRUCTURE (IVEY)

1. Initiate session (rapport....hello....client will know what to expect...)


2. Gathering data (drawing out stories, concerns, issues, drawing out strengths and
resources....what’s available for problem resolution)
3. Mutual goal setting (...what do you want to happen? new thinking, direction, action,
behaviour change)
4. Working (alternatives, restorying, confrontation ....what are we going to do about it?
New goals, new actions, challenges and new skills, creative problem solving)
5. Termination (change in thought behaviour, feelings)

CONFRONTATION SKILLS (CHALLENGING)


Supportive challenge where incongruities are fed back (paraphrase and work through
resolution)

Inconsistency in:
o V and NV messages: ....You say you feel sad, yet you are smiling

o Verbal messages and actions: ....you say you are done with your
husband yet you keep phoning him...

o Values and actions:..... you say you are honest...but you bent the truth...

o Statements and evidence: ....you said your husband never does anything
and now you say he is cleaning the kitchen last night...
o Between own and others evaluations: you seem to think you handled
your quitting smoking pretty well but the rest of the family/ group is still
unhappy with your behaviour

SKILLS:
SAY:
...On the one hand you seem/ say... but on the other hand...
...I am getting two messages..
...I am getting mixed messages...
Helpers: .. be relaxed, friendly

AVOID
o Strong challenges
o talking down
o superior
o As equals
o No muscle
o Put down helper, creates resistance, turns sour
o Avoid in early phase (before trust, rapport)

CLIENTS’ Strategies to resist challenges:


o Persuade to change your views
o Discredit you
o Seek support elsewhere
o Agreeing but doing nothing

SKILLS to HELP:
o Ultimate responsibility left to client to assess value of
their challenges and to move forward or not?
o Keep it well timed
o choose tactful words
o Do not overdo, create unsafe emotional climates,
block clients, block collaboration
o Shift your style, gentler approach
o Positive asset search/ strengths identified/ wellness
search
FOCUSSING THE INTERVIEW

Add focusing skills to attending, questioning, paraphrasing, (observe); brings


awareness to problem definition and assessment, interconnects issues, reduces
scattering of issues..
What you focus/ select on determines what the client will say next

o Focus on the client...sheila you said last time that you were concerned about
your health..
o Main theme/ problem: ..tell me more about you getting fired from your job..
o On others: ..so you did not like your boss...tell me more about him...
o On family: ..how supportive has your family been?...
o Interviewer:..My experience with such a situation is...
o On culture/ environment: ..yes there are many couples working in different
locations these day...given that how important is it to be together as a family?
SELF DISCLOSURE

Shows involvement, its intentional verbal disclosure

To be specific:

I am really pleased..
That’s good
I am sorry to hear that..

Client as a person:

I admire your persistence to...


I appreciate your commitment to...

To client’s vulnerability:

I am available f you get really anxious


I feel sad when you say..

IMPROVING SELF –TALK

Calming self – talk

o Slow down
o Take it easy
o Breathe
o I can manage
o relax

Cooling self talk statements

o Count to ten
o Be careful
o I can choose
o Problem solve
o Cool it

Affirming self- talk

o I am getting better at this..


o Well done, I did it

Coaching self- talk

o Spend time with people I like


o I can retrieve mistakes
o When I listen I can show that I understand

IMPROVING CLIENT’S RULES

o Demanding rule:
- I must be a good counsellor by today (negative feelings..?)
o Preferential rule:
- I prefer to...

RESISTANCES AND

MAKING REFERRALS

Resistances are normal in the early stages of helping

Use active listening skills

 Build trust
 Reflect feelings back
 Help them feel they have a friend
 Offer support

Give permission to discuss reluctance and fears

Invite cooperation, collaboration

Enlist self- interest: what are your goals? Would like yu to be more in control of the situation?

Reward silent clients for talking

REFER

 Avoid unnecessary referrals


 Refer to those you trust (not blind referrals)
 Calmly explain to client how this maybe a good idea/ give information
 Discuss their queries
 Build your network of supports

PROBLEM SOLVING

1. Clarify goals
2. Generate solutions/options
3. Develop a plan
4. Explore commitment/ anticipate difficulties /negotiate homework

TERMINATING HELPING

 Fixed...6 sessions, contracts


 Open terminations ....when goals are attained
 Faded...weekly, monthly ....
 Booster (teach new skills, check progress)
 Scheduling Follow up (post, phone, emails..)
 We have a few sessions left/ we have 15 minutes left...how best we can spend remaining
time together...
 Our next session if the final session
 Ethical and professional: Business like yet friendly
 Dependency

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