Active Listening Webinar

1. INTRODUCTION TO
COUNSELING AND ACTIVE
LISTENING SKILLS

2. LEARNING
OBJECTIV
ES
To define Counseling and its
uses
Enumerate the functions of
primary care counseling
Discuss the Rogerian Model of
Counseling
Discuss the different active
listening skills

3. There is a continuum ranging from a narrow
disease orientation to a social orientation. In the
disease orientation, the physician is concerned
almost exclusively with a patient's liver. The
more humanistically oriented physician asks
the nurse and the patient not only about the
diseased liver but about whether the patient
has expressed fears of dying or any second
thoughts about alcohol use. The meaning of
illness in the patient's culture is considered.
Doherty and Baird

4. BIOPSYCHOSOCIAL
MODEL

5. COUNSELIN
G
MAGLONZO, COUNSELING
SKILLS FOR CARING
PHYSICIANS, 2005.
It is defined as a set
of techniques, skills
and attitudes to help
people manage their
own problems using
their own resources.
Skills alone is not
enough.
It seeks to provide
self insight,
behavior change
and symptom relief.

6. PEOPLE NEED COUNSELING
WHEN…
A noticeable change
in behavior (self-
defeating behavior or
unaware of the
consequences of their
behavior
Unusually troubled,
tensed or anxious
Thinking is clouded
Not solving problems
which they have the
resources to solve
Not mobilizing their
energies
Not responding to
usual motivators

7. FUNCTIONS OF PRIMARY CARE
COUNSELING
1.Suppor
t
1.Challen
ge
1.Educati
on
1.Prevention

8. Active Listening
and the
“Rogerian Model”

9. ROGERIAN MODEL
 Carl Rogers
 "Client-centered" or "patient-
centered"
 The problem begins when there is
discrepancy or incongruence
between what is actual and what is
perceived

10. ROGERIAN MODEL
 Many of the chief complaints and
symptoms of the patient during
consultation have no biomedical
basis or the biomedical component
can be aggravated by a
psychosocial factor

11. ROGERIAN MODEL
Key attitudes:
1. Genuineness
2. Unconditional Positive Regard
3. Empathy

12. GENUINENESS
 Genuineness demands transparency
 Key ingredients:
 Self-awareness – knowledge of one’s biases
and prejudices, perceptions, values and
belief systems
 Self-acceptance - one’s ownership of the
full range of feelings and thoughts one has
and not being ashamed of any part of it
 Self-expression – the innermost thoughts
and feelings must be expressed judiciously

13. UNCONDITIONAL POSITIVE
REGARD
 Setting aside the conditions, such as
biases and prejudices inherited from
upbringing, for the period that we
are dealing with our patient.
 This creates a “healing environment”
 Insight Constructive Action

14. EMPATHY
It is the ability to put oneself in the
situation of another.

15. ACTIVE
LISTENI
NG
SKILLS
Attending
Bracketing
Leading
Reflecting
Focusing
Probing

16. ATTENDING SKILLS
 Attending skills refer to the way in which
we use our bodies to communicate the
message nonverbally that we are listening
to our patients.
 Lean forward
 Open stance
 Voice of compassion
 Eye contact
 Relaxed
 Sit at an angle

17. BRACKETING
 Setting aside your own thoughts,
feelings and judgements that detract
from emphatizing with the patient.
 “Mental skill”
 We need to see the world from the
patient's point of view

18. LEADING
Indirect Lead
 Open invitations made by
the counselor for the patient
to talk about anythings that he
wishes.
"What would you like to talk
about?" Or "What can I do for
you?"
It may also be in a form of
words of phrases: "yes", "go
on", "and then?"
Direct Lead
The doctor-counselor
make a judgement call as
to where the patient
should go and asks him
to go in that direction.
Guidelines for the
doctors to make
judgments:
1. Feeling is greatest or most
intense
2. Most important issues saved
for last

19. REFLECTING SKILLS
1. Reflecting Content
2. Reflecting Feeling
3. Reflecting Experience

20. REFLECTING CONTENT
 The doctor-counselor takes the
verbal content of what the patient
says, repackages and rephrases it so
that it becomes clearer, then gives it
back to the patient.
 Two ways of doing this:
1. Paraphrasing - "To summarize in ten
words what it took the patient hundred
words to say"
2. Perception-checking - same as
paraphrasing but it is phrased in the

21. REFLECTING
CONTENT
Paraphrasing
Doctor-Counselor: “So
you’ve been having on
and off headache for 3
months already. You have
tried different
medications but still not
relieved and now it’s
giving you dizziness too
and you don’t know why”
Case: 33/F, single, a call center agent,
came into the clinic because of frontal
headache. "Doctor, I've had this on and
off headache for 3 months already. I had
a consult with our company physician
and she gave me Paracetamol." (Looks at
the floor). ”I’ve been religiously taking
the mediation, it recurred again and now
it it is making me dizzy, too." (patient
shifts in her seat and looks at the floor)
"I went back to our company doctor and
she gave me Mefenamic Acid. I have
been taking it for 1 week now but the
headache still recurs. I just can't

22. REFLECTING
CONTENT
Perception-Checking
Doctor-Counselor: “You
have been having on and
off headache for 3
months already. You tried
2 different medications
already but your headache
still recurs and you don’t
understand why. Is that
it?”
Case: 33/F, single, a call center agent,
came into the clinic because of frontal
headache. "Doctor, I've had this on and
off headache for 3 months already. I had
a consult with our company physician
and she gave me Paracetamol." (Looks at
the floor). ”I’ve been religiously taking
the mediation, it recurred again and now
it it is making me dizzy, too." (patient
shifts in her seat and looks at the floor)
"I went back to our company doctor and
she gave me Mefenamic Acid. I have
been taking it for 1 week now but the
headache still recurs. I just can't

23. REFLECTING FEELING
 The doctor-counselor will articulate the
feelings for the patient
 Reflecting feelings have therapeutic
purposes
1. Articulating the feelings makes the patient
aware of the emotion
2. Unarticulated feelings have somehow a way
of taking control of the behavior
3. Patient feels understood if feelings are
accurately reflected
 It is important for the doctor-counselor
to realize the the feelings are neither
right nor wrong.

24. REFLECTING
FEELING
Case: 33/F, single, a call center agent,
came into the clinic because of frontal
headache. "Doctor, I've had this on and
off headache for 3 months already. I had
a consult with our company physician
and she gave me Paracetamol." (Looks at
the floor). ”I’ve been religiously taking
the mediation, it recurred again and now
it it is making me dizzy, too." (patient
shifts in her seat and looks at the floor)
"I went back to our company doctor and
she gave me Mefenamic Acid. I have
been taking it for 1 week now but the
headache still recurs. I just can't
Doctor-Counselor:
“You seem to be
anxious about your
on and off
headache.”

25. REFLECTING EXPERIENCE
 Reflecting of non-verbals that are
often done unconsciously and that
the patients are not aware of doing
them.
 Patient becomes aware of his/her
behavior by pointing out the non-
verbals
 The patient may be able to gain
insight if he/she becomes aware of
the feeling or perception behind the

26. REFLECTING
EXPERIENCE
Case: 33/F, single, a call center agent,
came into the clinic because of frontal
headache. "Doctor, I've had this on and
off headache for 3 months already. I had
a consult with our company physician
and she gave me Paracetamol." (Looks at
the floor). ”I’ve been religiously taking
the mediation, it recurred again and now
it it is making me dizzy, too." (patient
shifts in her seat and looks at the floor)
"I went back to our company doctor and
she gave me Mefenamic Acid. I have
been taking it for 1 week now but the
headache still recurs. I just can't
Doctor-Counselor: “I
noticed that your
voice became softer
and you became
teary eyed when you
you said that the
headache still
recurred even with
the new medication.
Can you tell me what
was behind that

27. FOCUSING
 When a patient is anxious or emotionally in
pain, they have the tendency to bring up a lot of
things in their mind or they present with a
jumble of emotions
 What to do?
1. Enumerate the emotions.
2. Ask the patient to choose which one is the most
troublesome for him/her.
3. Talk about the issue or emotion that is giving
him/her most pain.

28. PROBING
 Asking questions in order to elicit more
information
 It must be open-ended
 Probing for feelings > Probing for content
 “How does that make you feel?”
 “Can you tell me more about that feeling?”
 Probe…
1. Where the emotional content is greatest
2. What the patient decides to mention last
3. When the patient repeats several times

29. SUMMARY
1. Counseling is a set of techniques, skills
and attitudes that can help address the
psychosocial issues associated with the
biomedical problem of the patient
2. The key attitudes of a doctor-
counselor are Genuineness,
Unconditional Positive Regard and
Empathy
3. The active listening skills are essential
to fully understand what a patient
would like to say. Verbal and non-
verbal cues are equally important.
Active listening skills include:
Attending, Bracketing, Leading,

30. Are you ready for the
workshop/interactive session?
Thank you for listening!