Extending Work-based Learning (A psychodynamic approach to counselling skills)

1. Extending Work-based Learning(A psychodynamic approach to counselling skills) • 10 credit module for mental health pre-registration nursing students (Advanced Diploma) • 10 x 2 hour sessions, 7 sessions of skills practice linking theory and practice - 3 sessions of theory, at beginning, middle and end of module, plus 3 days per week in practice over 11 weeks • beginning of 3rd year (1 year CFP, 2 years branch specific programme) • written summative assignment

2. ‘The safety of clients and practitioners will benefit from training programmes which explore the following issues’ (NMC 2002) • the nature of the practitioner-client relationship • doing favours or treating a client with inappropriate favouritism • in-depth understanding of relationship issues and the processes whereby a client transfers experiences and expectations from the past onto the practitioner • practitioners’ experience of manipulation by clients who are difficult to manage • helping practitioners to highlight aspects of their own behaviour which may not be therapeutic to clients .

3. Learning Outcomes • demonstrate the use of fundamental counselling skills • discern how clients' early experience may affect their current communications and functioning • identify possible transference and counter-transference reactions within helping relationships and consider how best to respond to these in the service of the client • recognise possible mental defence mechanisms and the function they may have for clients • understand the therapeutic use of professional boundaries from a psychodynamic perspective

4. Format for sessions • use of professional actor in the role of the same client over 7 sessions • actor briefed by teachers, based on real client • serial counselling, 10 minutes per student with other students in group and teacher/s observing • followed by immediate feedback after each 10 minutes, from actor, in role, from peers and from teachers, plus links made with theory • video recordings made for students’ private viewing and reflection

5. Rationale • gives a strong message re the value base of mental health nursing • SPs are flexible and realistic – give the “as if” factor • students get instant feedback • links theory to practice effectively – able to observe and make sense of the skills and approach and apply in their own practice • raises students’ confidence, improves their awareness and develops therapeutic approaches

6. Issues re SPs • background of SP unknown (actor, health professional, service user or carer) • briefing of SP • congruence of SP to role • feedback (in-role, level of criticality) • support for SP (effects of the role, can trigger their own issues) • SPs’ level of understanding of mental health problem – should we use ‘expert patients’?

7. Issues re Students • use of video (performance anxiety, reliability of equipment) • students switch from ‘nursing’ to ‘counselling’ • students’ perception of ‘upsetting’ the client • level of engagement of students – requirement of module/course • group size and timings • briefing of student • quality of peer feedback and personal review of video

8. “I could have been counselling a ‘real’ patient.” “allowed to test my developing skills in a safe environment” “has made me aware that communication is not all about talking, - learning the skill of therapeutic silence has been extremely useful.” “has helped me link theory to practice regarding clients’ past experiences and their behaviour/problem now.” “allowed me to experiment with ideas and approaches before using in practice.” “I found the process anxiety ridden at times but feel I have learned loads through sessions and it has been useful receiving feedback in sessions.”

9. Skills Cycle (This model useful to compare and contrast differing goals, strategies in using nursing skills and using counselling skills. Students have to make a significant paradigm shift) • decide goal • plan strategy • make the attempt • observe the outcome and compare it with what was intended, perceive how successful it was. • repeat with strategy adjusted as a result of feedback (Tomlinson, P 1995 Understanding Mentoring OUP)