Medidas Medical Center Session 2 of Lactation training management

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.

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

56. SKILL 3
GIVE PRACTICAL HELP

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

70. SKILL 5.
USE SIMPLE LANGUAGE

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.