Communication Skills

1. HPR 450 Chapter 6 Communication Skills

2. Without these effective interpersonal communication skills the TR Process is doomed to failure Listening Counseling Leader communication Interviewing Clients with special needs Interpersonal Communication

3. Communication skills are used in all parts of our lives • Communication process includes 5 elements • Communicator - Who • Message – Says What • Medium – In What Way • Receiver - To Whom • Feedback – With What Effect

4. Four Factors • Presentation of the material in terms of Vocabulary and Clarity • Speaker’s attitude – Concern and caring • Voice tone and volume - Tone of voice (inflection) • Speaker’s and Receiver’s ability to listen Verbal communication

5. Attending – (eye contact, posture, gestures, verbal behavior) Paraphrasing – restated in similar but fewer words Clarifying – I’m confused…would you go over that again? Perception Checking – “You seem to be happy. Is that right?” Effective listening skills

6. S − Sit squarely facing the clients. O − Observe an open posture. (arms and legs uncrossed) L − Lean forward toward the client. E − Establish eye contact. R − Relax. Table 6-1Attentive Listening Using Acronym “SOLER” Source: Adapted from Egan, G. (2002). The skilled helper: A problem management approach to helping (7th edition). Pacific Grove, CA: Brooks/ Cole Publishing Company & Townsend, M. C. (2000). Psychiatric mental health nursing: Concepts of care (3rd edition). Philadelphia: F. A. Davis Company.

7. Verbal Techniques for helping professionals to employ – Table 6-2 • Minimal verbal responses • Paraphrasing • Checking out • Clarifying • Probing • Reflecting • Interpreting • Confronting • Informing • Summarizing • Self-disclosing • Focusing • Making observations • Suggesting • Closed questions • Facilitative questions and statements

8. Effective communication in success-failure situations demands appropriate approaches from the leader Understanding nonverbal communication is a critical skill for Helping professionals because approx 2/3 of communication is nonverbal Following guidelines may prove to be helpful when communicating with persons with special needs (e.g., visually and/or hearing impaired) Interviewing skills are basic for the CTRS

9. Table 6-3General Guidelines for Using Major Verbal Techniques • Phrase your response in the same vocabulary that the client uses. • Speak slowly enough that the client will understand each word. • Use concise rather than rambling statements. • Relate the topic introduced by the client to the identified cognitive theme that is of most importance. • Talk directly to the client, not about him or her. • Send “I” statements to “own” your feelings, and allow the client to reject, accept, or modify your messages. • Encourage the client to talk about his or her feelings. • Time your responses to facilitate, not block, communication. Adapted from: Okun, B.F. (2002/Effective helping: Interviewing and counseling techniques (6th ed.). Pacific Grove, CA: Brooks/Cole.

10. Table 6-4Facilitative Questions and Statements Type Observe—to notice what went on or what goes on. Example “Tell me about yourself.” “Tell me every detail from the beginning.” “To what degree do you feel that way?” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

11. Table 6-4Facilitative Questions and Statements (Cont.) Type Describe—to stimulate recall and details of a specific event or experience. Example “What did you feel at the time?” “What happened just before?” “How did he respond to your comment?” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

12. Table 6-4Facilitative Questions and Statements (Cont.) Example “What is the importance of event?” “What do you see as the reason?” “What was your part in it?” Type Analyze—to review that information for greater understanding. Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

13. Table 6-4Facilitative Questions and Statements (Cont.) Type Formulate—to restate in a clear, direct way the relationship between thoughts, feelings, and experiences. Example “Tell me again.” “What would you say was the problem?” “Can you tell me the essence of it?” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

14. Table 6-4Facilitative Questions and Statements (Cont.) Type Test—to try out new thoughts, feelings, or behaviors. Example “What would you do if a situation like that came up again?” “In what way will this understanding help you in the future?” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

15. Table 6-5Barriers to Therapeutic Communication Non-Therapeutic Examples “If I were you…” “Don’t worry—everything will be OK.” “Let’s wait on that and talk about…” “Hold it, hold it!” Barriers Giving advice Giving false reassurance Topic jumping (changing the subject) Interrupting Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

16. Table 6-5Barriers to Therapeutic Communication (Cont.) Non-Therapeutic Examples “You’re wrong.” “It is all your fault.” “Just do what I say.” “What is the real reason?” “You can’t really hear the devil speaking.” Barriers Being judgmental Blaming Giving directions Excessive questioning Challenging Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

17. Table 6-5Barriers to Therapeutic Communication (Cont.) Barriers Expressing disapproval Hurried approaches Closed-mindedness, Stereotyped responses Non-Therapeutic Examples “I don’t approve of that.” (or frowning) “Will you please hurry up.” “That’s the only way to see it.” “Keep your chin up; it won’t be much longer.” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

18. Table 6-5Barriers to Therapeutic Communication (Cont.) Barriers Double messages Defending or defensive responses Self-preoccupation or daydreaming Patronizing Non-Therapeutic Examples “Tell me more.” (While non-verbals show lack of interest.) “Don’t blame me; you’re the one with problems.” “Oh, excuse me; could you repeat that? I didn’t hear what you said.” “Now, Honey, it will work out.” Adapted from: Haber, J. (1997). Therapeutic communication. In J. Haber, B. Krainovich-Miller, A.L. McMahon & P. Price-Hoskins (Eds.), Comprehensive Psychiatric Nursing (5th ed.). St. Louis: Mosby (pp. 121-142).

19. Clients Who Are Visually Impaired • Clients Who Are Hearing Impaired • Clients Who Use Wheelchairs • Clients Who Speak a Foreign Language Table 6-6Communication with Clients with Special Needs

20. Establish rapport • Control the external environment • Wear clothing that conveys the image of a professional and is appropriate for the situation. • Begin by stating and validating with the client the purpose of the interview. • Use a vocabulary on the level of awareness or understanding of the person. Table 6-7Techniques for the Productive Interview Source: Murray, R.B., & Huelskoetter, M.M.W. (1991). Psychiatric/mental health nursing (3rd ed.). Norwalk, CT: Appleton & Lange: pp.139.

21. Avoid preconceived ideas, prejudices, or biases. • Be precise in what you say, so the meaning is understood. • Avoid asking questions in ways that get only socially acceptable answers. • Be gentle and tactful when asking questions about home like or personal matters. • Be an attentive listener. Table 6-7Techniques for the Productive Interview (Cont.) Source: Murray, R.B., & Huelskoetter, M.M.W. (1991). Psychiatric/mental health nursing (3rd ed.). Norwalk, CT: Appleton & Lange: pp.139.

22. Carefully observe nonverbal messages for signs of anxiety, frustration, anger, loneliness, or guilt. • Encourage spontaneity. • Ask questions beginning with “What…?” “Where…?” “Who…?” and “When…?” • Keep data obtained in the interview confidential and share this information only with the appropriate and necessary health team members. • Evaluate the interview. Table 6-7Techniques for the Productive Interview (Cont.) Source: Murray, R.B., & Huelskoetter, M.M.W. (1991). Psychiatric/mental health nursing (3rd ed.). Norwalk, CT: Appleton & Lange: pp.139.