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Counseling Skills
(Listening and Learning)
Source : Infant and Young Child Feeding : An
Integrated Counselling Course (WHO October 2005)
Listening and Learning
5/1
After completing this session
participants will be able to:
List the 6 listening and learning skills
List the 6 building confidence skills
Give an example of each skill
Demonstrate the appropriate use of the
skills
Communication Skills
Good Communication means you
respect the women’s own
thoughts, beliefs, and culture.
Communication skills
maybe used to :
 Listen and learn about the womans’
beliefs, knowledge, practices
 Build her confidence , praise practices
 Offer information, suggest changes
 Help co-workers who resist changes
 Communicate with supportive family
members
 Communicate with policy makers
Counseling
is a way of working with people in which
you try to understand how they feel and
help them to decide what they think is
best to do in their situation.
Counseling is USEFUL when you …
• talk to mothers about feeding their infants
• talk to patients or clients in other situations
• talk with your family and friends or your
colleagues at work.
A mother may not talk easily about her
feelings, especially if she is shy, and with
someone whom she does not know well.
You will need the skill to listen and to make
her feel that you are interested in her. This
will encourage her to tell you more. She
will be less likely to “turn off” and say
nothing.
Part I :
Listening and Learning Skills
Communication can be:
VERBAL or
NON VERBAL (BODY
LANGUAGE)
Communication can be:
VERBAL or
NON VERBAL (BODY
LANGUAGE)
SKILL 1
USE HELPFUL NON-
VERBAL
COMMUNICATION
Non-verbal communication
means showing your attitude through
your posture, your expression,
everything except through speaking.
Demo 1 hinder/help
Helpful Non-verbal
Communication
1. Keep your head level
2. Pay attention- eye contact
3. Remove barriers
4. Take time
5. Touch appropriately
Non-verbal communication often
demonstrates our approval or disapproval
of a situation.
We should avoid allowing our own views
on certain subjects, e.g. religion, where it
might appear as though we are judging a
mother.
Helpful Non-verbal
Communication
1. Keep your head level
2. Pay attention- eye contact
3. Remove barriers
4. Take time
5. Touch appropriately
Non-verbal communication often
demonstrates our approval or disapproval
of a situation.
We should avoid allowing our own views
on certain subjects, e.g. religion, where it
might appear as though we are judging a
mother.
Verbal communication:
Tone of our voice is important. Always
try to sound gentle and kind when talking
to mothers.
To find out how people feel about their
worries and concerns, we need to be
interested to be able to probe beneath
the surface
SKILL 2
ASK OPEN QUESTIONS
Open questions are usually the most
helpful.
To answer them a mother must give you
some information.
Open questions usually start with
How Who
What When
Why Where
Closed questions
’ -usually less helpful. They tell a
mother the answer that you expect
,and she can answer them with a
‘Yes’ or ‘No’.
-usually start with words like
“Are you?’ ‘Did he?’
‘Has he?’ ‘Does he?
SKILL 3
USE RESPONSES AND
GESTURES WHICH SHOW
INTEREST
Demo skill 3
Examples:
Response and Gestures Which Show Interest
Health Worker: “Good morning, (name). How is (child’s
name) now that he has started solids?”
Mother: “Good morning. He is fine, I think.”
Health Worker: “ Mmm.” (nods, smiles)
Mother: “Well, I was a bit worried the other day,
because he vomited.”
Health Worker: “Oh dear!” (raises eyebrows, looks
interested.)
Mother: “I wondered if it was something in the
stew that I gave him.”
Health Worker: “Aha!” (nods Sympathetically).
Usual responses are:
• Smiling
• Nodding
• “um Humm”
• “go on”
• Repeat or reflect back
SKILL 4
REFLECT BACK WHAT
MOTHER SAYS
Demo – skill 4
Health workers usually ask mothers a lot of
factual questions.
Answers to factual questions are often
not helpful. The mother may say less
and less in reply to each question.
For example, if a mother says: “My baby was crying too
much last night”, you might want to ask:
“How many times did he wake up?” But the answer is not
helpful.
Reflecting back
It is more useful to repeat back or reflect
what a mother says.
Reflecting back would:
show you are listening
it encourages the mother to continue
talking and to say what is important to her.
It is best to say it in a slightly different way, so that
it does not sound as though you are copying
her.
Reflecting back
Example:
if a mother says:
“I don’t know how to feed my child, she
refuses everything.”
You could reflect back by saying:
“Your child is refusing all the food you
offer her?”
Reflecting back
SKILL 5
EMPATHIZE- SHOW THAT YOU
UNDERSTAND HOW SHE FEELS
Demo skill 5
Empathy is a difficult skill to learn because
it talks about feelings.
(It is easier to talk about facts)
When a mother says something which shows how
she feels,
it is useful to respond in a way which
shows that you heard what she said,
and that you understand her feelings from
her point of view.
ie: mother says:
“My baby wants to feed very often and it
makes me feel so tired!”
you respond to what she feels,
“You are feeling very tired all the time then?”
EMPATHIZE
If you sympathize, you might say:
“Oh I know how you feel. My baby wanted to feed
often too, and I feel exhausted.”
This brings the attention back to you, and does not
make the mother feel that you understand her.
When you sympathize you are sorry for a
person, but you look at it from
your point of view.
When you reflect back what the mother says
about the baby…..
“He wants to feed very often?
When you reflect back what the mother said
about the baby’s behavior, and it misses
what she said about how she feels. She
feels tired.
Scenario : “My baby wants to feed very often and it makes
me feel so tired!”
Empathy is
• more than reflecting back what a
mother says to you
• to show you understand her bad
feelings
• helpful to empathize with a mother’s
good feelings too.
SKILL 6
AVOID WORDS WHICH SOUND
JUDGING.
demo
‘Judging words’ are words like: right, wrong,
well, badly, good, enough, properly.
If you use judging words
• you may make her feel that she is wrong,
• that there is something wrong with the
baby
• mother may feel there is something wrong
with her breast milk.
Mothers may use judging words about their
own situation. You may sometimes need
to use them yourself, especially the
positive ones, when you are building a
mother’s confidence.
Judging questions are often closed
questions. Using open questions often
helps to avoid using a judging word.
Summary
LISTENING AND LEARNING SKILLS
1. Use helpful non-verbal communication
2. Ask open questions
3. Use responses and gestures which show
interest
4. Reflect back what the mother says
5. Empathize- show that you understand
how she feels
6. Avoid words which sound judging.
Building Confidence and Giving
Support
Adapted from: IYCF: A Counselling Course 2005
Counselling Skills : Part II
Building confidence and giving
support
After completing this session participants
will be able to:
• list the 6 confidence and support skills
• give an example of each skill
• demonstrate the appropriate use of the skills
when counselling on infant and young child
feeding
10/1
SKILL 1.
ACCEPT WHAT A MOTHER
THINKS AND FEELS
Question:
How will a mother feel if
you disagree with her, or
criticize, or tell her that it is
nothing to be upset or to
worry about?
if you disagree with her, or criticize, or tell her
that it is nothing to be upset or to worry about
:
Mother would feel very upset about that
because:
• you know it is not a serious problem.
• that she has a mistaken idea
This will reduce her confidence and may
not want to say anything more to you.
It is also important
not to agree with a mistaken idea.
Instead, you just accept what she
thinks or feels.
Accepting means responding in a
neutral way, and not agreeing or
disagreeing.
33
Reflecting back and simple
responses are useful ways to
show acceptance.
Empathizing can show acceptance
of a mother’s feelings.
If a mother is worried or upset, you
say something like,
“ Oh, don’t be upset, it is nothing to
worry about,”
she may feel that she was wrong to
be upset.
This reduces a mother’s confidence
in her ability to make her decisions.
(so just accept what she feels)
Demo A
• Mother: I give my baby a bottle of
formula every evening because I don’t
have enough milk for her.
• Health Worker: I am sure your milk
is enough. Your baby does not need a
bottle of formula
Agree/disagree/ accept
Demo B
• Mother: I give my baby a bottle of
formula every evening because I don’t
have enough milk for her.
• Health Worker : Yes, a bottle of feed
in the evening seems to settle some
babies
Dsagree/ agree /accept
Demo C
• Mother: I give my baby a bottle of
formula every evening because I don’t
have enough milk for her.
• Health Worker : I see. You think you
may not have enough milk in the
evening ?
Disagree/ agree / accepting
SKILL 2.
RECOGNIZE AND PRAISE
WHAT A MOTHER AND BABY
ARE DOING RIGHT
Question:
How does it make a mother
feel if you tell her that she is
doing something wrong, or
that her baby is not doing
well?
It may make her feel bad, and this can
reduce her confidence.
We must first recognize what they do
right; and then we should praise or
show approval of the good
practices.
if you tell her that she is doing something wrong,
or that her baby is not doing well?
Praising good practices has
these benefits:
• it builds a mother’s confidence
• it encourages her to continue
those good practices
• it makes it easier for her to
accept suggestions later.
10/2
13
12
11
10
9
8
7
6
5
4
3
2
Kilogram
s
1 2 3 4 5 6 7 8 9 10 11 12
First year
Month
Case 1
Which of these remarks will help to
build the mother’s confidence?
• “Your baby’s growth line is going up too
slowly.”
• “I don’t think your baby is gaining
enough weight.”
• “Your baby gained weight last
month just on your breastmilk.”
10/3
SKILL 3
GIVE PRACTICAL HELP
Sometimes practical help is better than saying
anything.
Ex:
• when a mother feels tired or dirty or
uncomfortable
• when she is hungry or thirsty
• when she has had a lot of information already
• when she has a clear practical problem.
• Help to make her clean and
comfortable.
• Give her a drink, or something to eat.
• Hold the baby yourself, while she gets
comfortable, or washes, or goes to the
toilet.
What kind of practical help might you offer?
> helping a mother with
positioning and attachment,
expressing breast milk,
relieving engorgement or
preparing complementary
feeds.
practical help
10/4
No, I have not breastfed him
yet …
My breasts are empty and it
is too painful to sit up!
Which response is more
appropriate?
• “You should let your baby suckle
now to help your breast milk to
come in.”
• “Let me try to make you more
comfortable, and then I’ll bring you
a drink.”
10/5
SKILL 4.
GIVE A LITTLE
RELEVANT INFORMATION
It is also important to correct
mistaken ideas.
Listen to the mother and
choose just two or three
pieces of the most relevant
information to give at this
time.
Explaining the reason for a
difficulty is often the most
relevant information to help a
mother to understand what is
happening.
Give information in a positive way, so that it does not sound critical
Try to give information :
• that is
relevant to her situation NOW
• in a positive way
For example,
instead of saying
“Thin porridge is not good for your
baby”,
you could say:
“Thick foods help the baby to grow”.
Before you give information to
a mother, build her
confidence.
Accept what she says, and
praise what she does well.
10/6
He has started to
have loose stools.
Should I stop
breastfeeding ?
Which response gives positive
information?
• “It is good that you asked before
deciding. Diarrhoea usually stops sooner
if you continue to breastfeed.”
• “Oh no, don’t stop breastfeeding. He may
get worse if you do that.”
10/7
SKILL 5.
USE SIMPLE LANGUAGE
It is important to use simple,
familiar terms, to explain
things to mother.
SKILL 6.
MAKE ONE OR TWO
SUGGESTIONS, NOT
COMMANDS
When you counsel a mother, you
suggest what she could do. Then
she decide
This leaves her feeling in control, and
helps her to feel confident.
Donottotell/commandher todoit
10/8
I breastfeed
Amy twice in
the morning
and twice in
the evening …
13
12
11
10
9
8
7
6
5
4
3
2
Kilograms First year
1 2 3 4 5 6 7 8 9 10 11 12
Month
Which of these responses is a
command, and which is a
suggestion?
• “You must feed Amy at least
10 times a day.”
• “It might help if you feed Amy
more often.”
10/9
In Summary :
Building CONFIDENCE AND SUPPORT
SKILLS
1. Accept what a mother thinks and
feels
2. Recognize and praise what a mother
and baby are doing right
3. Give practical help
4. Give a little, relevant information
5. Use simple language
6. Make one or two suggestions, not
commands.

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  • 1. Counseling Skills (Listening and Learning) Source : Infant and Young Child Feeding : An Integrated Counselling Course (WHO October 2005)
  • 2. Listening and Learning 5/1 After completing this session participants will be able to: List the 6 listening and learning skills List the 6 building confidence skills Give an example of each skill Demonstrate the appropriate use of the skills
  • 3. Communication Skills Good Communication means you respect the women’s own thoughts, beliefs, and culture.
  • 4. Communication skills maybe used to :  Listen and learn about the womans’ beliefs, knowledge, practices  Build her confidence , praise practices  Offer information, suggest changes  Help co-workers who resist changes  Communicate with supportive family members  Communicate with policy makers
  • 5. Counseling is a way of working with people in which you try to understand how they feel and help them to decide what they think is best to do in their situation.
  • 6. Counseling is USEFUL when you … • talk to mothers about feeding their infants • talk to patients or clients in other situations • talk with your family and friends or your colleagues at work.
  • 7. A mother may not talk easily about her feelings, especially if she is shy, and with someone whom she does not know well. You will need the skill to listen and to make her feel that you are interested in her. This will encourage her to tell you more. She will be less likely to “turn off” and say nothing.
  • 8. Part I : Listening and Learning Skills
  • 9. Communication can be: VERBAL or NON VERBAL (BODY LANGUAGE)
  • 10. Communication can be: VERBAL or NON VERBAL (BODY LANGUAGE)
  • 11. SKILL 1 USE HELPFUL NON- VERBAL COMMUNICATION
  • 12. Non-verbal communication means showing your attitude through your posture, your expression, everything except through speaking. Demo 1 hinder/help
  • 13. Helpful Non-verbal Communication 1. Keep your head level 2. Pay attention- eye contact 3. Remove barriers 4. Take time 5. Touch appropriately
  • 14. Non-verbal communication often demonstrates our approval or disapproval of a situation. We should avoid allowing our own views on certain subjects, e.g. religion, where it might appear as though we are judging a mother.
  • 15. Helpful Non-verbal Communication 1. Keep your head level 2. Pay attention- eye contact 3. Remove barriers 4. Take time 5. Touch appropriately
  • 16. Non-verbal communication often demonstrates our approval or disapproval of a situation. We should avoid allowing our own views on certain subjects, e.g. religion, where it might appear as though we are judging a mother.
  • 17. Verbal communication: Tone of our voice is important. Always try to sound gentle and kind when talking to mothers. To find out how people feel about their worries and concerns, we need to be interested to be able to probe beneath the surface
  • 18. SKILL 2 ASK OPEN QUESTIONS
  • 19. Open questions are usually the most helpful. To answer them a mother must give you some information. Open questions usually start with How Who What When Why Where
  • 20. Closed questions ’ -usually less helpful. They tell a mother the answer that you expect ,and she can answer them with a ‘Yes’ or ‘No’. -usually start with words like “Are you?’ ‘Did he?’ ‘Has he?’ ‘Does he?
  • 21. SKILL 3 USE RESPONSES AND GESTURES WHICH SHOW INTEREST Demo skill 3
  • 22. Examples: Response and Gestures Which Show Interest Health Worker: “Good morning, (name). How is (child’s name) now that he has started solids?” Mother: “Good morning. He is fine, I think.” Health Worker: “ Mmm.” (nods, smiles) Mother: “Well, I was a bit worried the other day, because he vomited.” Health Worker: “Oh dear!” (raises eyebrows, looks interested.) Mother: “I wondered if it was something in the stew that I gave him.” Health Worker: “Aha!” (nods Sympathetically).
  • 23. Usual responses are: • Smiling • Nodding • “um Humm” • “go on” • Repeat or reflect back
  • 24. SKILL 4 REFLECT BACK WHAT MOTHER SAYS Demo – skill 4
  • 25. Health workers usually ask mothers a lot of factual questions. Answers to factual questions are often not helpful. The mother may say less and less in reply to each question. For example, if a mother says: “My baby was crying too much last night”, you might want to ask: “How many times did he wake up?” But the answer is not helpful. Reflecting back
  • 26. It is more useful to repeat back or reflect what a mother says. Reflecting back would: show you are listening it encourages the mother to continue talking and to say what is important to her. It is best to say it in a slightly different way, so that it does not sound as though you are copying her. Reflecting back
  • 27. Example: if a mother says: “I don’t know how to feed my child, she refuses everything.” You could reflect back by saying: “Your child is refusing all the food you offer her?” Reflecting back
  • 28. SKILL 5 EMPATHIZE- SHOW THAT YOU UNDERSTAND HOW SHE FEELS Demo skill 5
  • 29. Empathy is a difficult skill to learn because it talks about feelings. (It is easier to talk about facts) When a mother says something which shows how she feels, it is useful to respond in a way which shows that you heard what she said, and that you understand her feelings from her point of view.
  • 30. ie: mother says: “My baby wants to feed very often and it makes me feel so tired!” you respond to what she feels, “You are feeling very tired all the time then?” EMPATHIZE
  • 31. If you sympathize, you might say: “Oh I know how you feel. My baby wanted to feed often too, and I feel exhausted.” This brings the attention back to you, and does not make the mother feel that you understand her. When you sympathize you are sorry for a person, but you look at it from your point of view.
  • 32. When you reflect back what the mother says about the baby….. “He wants to feed very often? When you reflect back what the mother said about the baby’s behavior, and it misses what she said about how she feels. She feels tired. Scenario : “My baby wants to feed very often and it makes me feel so tired!”
  • 33. Empathy is • more than reflecting back what a mother says to you • to show you understand her bad feelings • helpful to empathize with a mother’s good feelings too.
  • 34. SKILL 6 AVOID WORDS WHICH SOUND JUDGING. demo
  • 35. ‘Judging words’ are words like: right, wrong, well, badly, good, enough, properly. If you use judging words • you may make her feel that she is wrong, • that there is something wrong with the baby • mother may feel there is something wrong with her breast milk.
  • 36. Mothers may use judging words about their own situation. You may sometimes need to use them yourself, especially the positive ones, when you are building a mother’s confidence. Judging questions are often closed questions. Using open questions often helps to avoid using a judging word.
  • 37. Summary LISTENING AND LEARNING SKILLS 1. Use helpful non-verbal communication 2. Ask open questions 3. Use responses and gestures which show interest 4. Reflect back what the mother says 5. Empathize- show that you understand how she feels 6. Avoid words which sound judging.
  • 38.
  • 39. Building Confidence and Giving Support Adapted from: IYCF: A Counselling Course 2005 Counselling Skills : Part II
  • 40. Building confidence and giving support After completing this session participants will be able to: • list the 6 confidence and support skills • give an example of each skill • demonstrate the appropriate use of the skills when counselling on infant and young child feeding 10/1
  • 41. SKILL 1. ACCEPT WHAT A MOTHER THINKS AND FEELS
  • 42. Question: How will a mother feel if you disagree with her, or criticize, or tell her that it is nothing to be upset or to worry about?
  • 43. if you disagree with her, or criticize, or tell her that it is nothing to be upset or to worry about : Mother would feel very upset about that because: • you know it is not a serious problem. • that she has a mistaken idea This will reduce her confidence and may not want to say anything more to you.
  • 44. It is also important not to agree with a mistaken idea. Instead, you just accept what she thinks or feels. Accepting means responding in a neutral way, and not agreeing or disagreeing. 33
  • 45. Reflecting back and simple responses are useful ways to show acceptance. Empathizing can show acceptance of a mother’s feelings.
  • 46. If a mother is worried or upset, you say something like, “ Oh, don’t be upset, it is nothing to worry about,” she may feel that she was wrong to be upset. This reduces a mother’s confidence in her ability to make her decisions. (so just accept what she feels)
  • 47. Demo A • Mother: I give my baby a bottle of formula every evening because I don’t have enough milk for her. • Health Worker: I am sure your milk is enough. Your baby does not need a bottle of formula Agree/disagree/ accept
  • 48. Demo B • Mother: I give my baby a bottle of formula every evening because I don’t have enough milk for her. • Health Worker : Yes, a bottle of feed in the evening seems to settle some babies Dsagree/ agree /accept
  • 49. Demo C • Mother: I give my baby a bottle of formula every evening because I don’t have enough milk for her. • Health Worker : I see. You think you may not have enough milk in the evening ? Disagree/ agree / accepting
  • 50. SKILL 2. RECOGNIZE AND PRAISE WHAT A MOTHER AND BABY ARE DOING RIGHT
  • 51. Question: How does it make a mother feel if you tell her that she is doing something wrong, or that her baby is not doing well?
  • 52. It may make her feel bad, and this can reduce her confidence. We must first recognize what they do right; and then we should praise or show approval of the good practices. if you tell her that she is doing something wrong, or that her baby is not doing well?
  • 53. Praising good practices has these benefits: • it builds a mother’s confidence • it encourages her to continue those good practices • it makes it easier for her to accept suggestions later.
  • 54. 10/2 13 12 11 10 9 8 7 6 5 4 3 2 Kilogram s 1 2 3 4 5 6 7 8 9 10 11 12 First year Month Case 1
  • 55. Which of these remarks will help to build the mother’s confidence? • “Your baby’s growth line is going up too slowly.” • “I don’t think your baby is gaining enough weight.” • “Your baby gained weight last month just on your breastmilk.” 10/3
  • 57. Sometimes practical help is better than saying anything. Ex: • when a mother feels tired or dirty or uncomfortable • when she is hungry or thirsty • when she has had a lot of information already • when she has a clear practical problem.
  • 58. • Help to make her clean and comfortable. • Give her a drink, or something to eat. • Hold the baby yourself, while she gets comfortable, or washes, or goes to the toilet. What kind of practical help might you offer?
  • 59. > helping a mother with positioning and attachment, expressing breast milk, relieving engorgement or preparing complementary feeds. practical help
  • 60. 10/4 No, I have not breastfed him yet … My breasts are empty and it is too painful to sit up!
  • 61. Which response is more appropriate? • “You should let your baby suckle now to help your breast milk to come in.” • “Let me try to make you more comfortable, and then I’ll bring you a drink.” 10/5
  • 62. SKILL 4. GIVE A LITTLE RELEVANT INFORMATION
  • 63. It is also important to correct mistaken ideas. Listen to the mother and choose just two or three pieces of the most relevant information to give at this time.
  • 64. Explaining the reason for a difficulty is often the most relevant information to help a mother to understand what is happening. Give information in a positive way, so that it does not sound critical
  • 65. Try to give information : • that is relevant to her situation NOW • in a positive way
  • 66. For example, instead of saying “Thin porridge is not good for your baby”, you could say: “Thick foods help the baby to grow”.
  • 67. Before you give information to a mother, build her confidence. Accept what she says, and praise what she does well.
  • 68. 10/6 He has started to have loose stools. Should I stop breastfeeding ?
  • 69. Which response gives positive information? • “It is good that you asked before deciding. Diarrhoea usually stops sooner if you continue to breastfeed.” • “Oh no, don’t stop breastfeeding. He may get worse if you do that.” 10/7
  • 71. It is important to use simple, familiar terms, to explain things to mother.
  • 72. SKILL 6. MAKE ONE OR TWO SUGGESTIONS, NOT COMMANDS
  • 73. When you counsel a mother, you suggest what she could do. Then she decide This leaves her feeling in control, and helps her to feel confident. Donottotell/commandher todoit
  • 74. 10/8 I breastfeed Amy twice in the morning and twice in the evening … 13 12 11 10 9 8 7 6 5 4 3 2 Kilograms First year 1 2 3 4 5 6 7 8 9 10 11 12 Month
  • 75. Which of these responses is a command, and which is a suggestion? • “You must feed Amy at least 10 times a day.” • “It might help if you feed Amy more often.” 10/9
  • 76. In Summary : Building CONFIDENCE AND SUPPORT SKILLS 1. Accept what a mother thinks and feels 2. Recognize and praise what a mother and baby are doing right 3. Give practical help 4. Give a little, relevant information 5. Use simple language 6. Make one or two suggestions, not commands.