Mental Health Care Active Listening
It is fundamental for mental health professionals to demonstrate foundational skills of counselling using an integrative process which is inclusive of a holistic, person-centred recovery orientated framework (Commonwealth of Australia 2013; Geldard & Geldard 2016; Muir-Cochrane et al. 2014). This can be achieved by adopting an integrated counselling approach as described by Geldard and Geldard (2016) as well as considering aspects like the physical environment and appropriate communication skills to ensure the consumer feels encouraged to explore concepts of self-discovery and learning. To facilitate this, a collaborative, person-centred recovery based framework must be implemented for a comprehensive and holistic provision of therapeutic care
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(Commonwealth of Australia 2013; Ramon 2012; Slade 2013). Therefore, to identify these concepts in practice, a recorded counselling session with my consumer will be critiqued and critically reflected upon through the analysis of engagement strategies I attempted, could improve, as well as those I could have implemented.
Summary of session
Alfie, a 22 year old male optometry student revealed to be struggling with his current university workload and procrastination, is considering dropping out, uncertain toward his future, disclosed a number of alternative pathways to take as well as few strategies to cope with these issues. Initially, to allow for such disclosure of personal feelings, thoughts and actions, a number of strategies and methods must be put into consideration. As outlined by Geldard and Geldard (2016, p. 152), this can be facilitated by the counselling process which involves preparation, joining, active listening, emphasis on emotions, emphasis on problem clarification and thought restructuring, emphasis on behaviour as well as closure techniques.
Preparation
To ensure the session with Alfie was completed in a professional manner, it was assured the conversation took place in a comfortable, clean, tidy and private setting with minimal external noise and distractions. As Slade (2013, p. 25) identifies, this is fundamental as it allows for a pleasant, respectful and welcoming environment for the client to share their issues or concerns.
Joining
To initiate a natural conversational pace in the session, it is important to establish a foundational relationship through relaxed basic introductions and small talk (Dziopa & Ahern 2009, p. 20; Geldard & Geldard 2016, p. 155). Regarding this, I did briefly mention my role as a counsellor and declared that it was a safe space to speak about his problems or any worrying concerns (00.30). However, I failed to clarify the structure of the session as well as my role adequately. In this instance, as Geldard and Geldard suggest, I could have stated:
“I don’t see myself as an expert who can solve your problems for you. I believe that you will always know and understand yourself better than I will know and understand you. However, I hope that in this session you and I, collaboratively can explore what’s troubling you so that you can make some progress towards feeling more comfortable” (2016, p. 156)
In conjunction with this, it would have better to establish my role as a counsellor from the health services department of the university, rather than one from the local hospital as it would have been more relevant to his concerns.
To continue, for Alfie to feel more at ease, it would have been useful for me to ask questions like, ‘how’d you get here?,’ ‘did you get caught in the rain?’ or perhaps even offering a glass of water, instead of beginning the discussion right away (Slade 2013, p. 25). Also, a statement specifying that the content mentioned during the session will remain confidential should have been vocalised. In spite of these faults, I was able to address him as his preferred name, gain consent to record the session in addition to ask whether he had any questions before the session began. These strategies are helpful as it allows the consumer to feel more comfortable, settled and open to engage with discussion (Dziopa & Ahern 2009, p. 17). Essentially, as previous studies (Dziopa & Ahern 2009; Geldard & Geldard 2016; Happell 2013; Kitchener, Jorm & Kelly 2016) have identified, these strategies along with the establishment of rapport and demonstration of respect, non-judgement, effective non-verbal and verbal communication, interest, acceptance, empathy, genuineness, reflective listening, honesty and unconditional positive regard, are all fundamental when developing a therapeutic relationship to facilitate change.
Active Listening
Additionally, to enable this, it is important the counsellor demonstrates relevant active listening skills by putting the person at ease and inviting them to self-disclose what is troubling them (Geldard & Geldard 2016, p.
43). At 0:50, by asking Alfie ‘what brings you here today?’ I felt I was able to demonstrate that well. In future, to extend that skill and to become more encouraging, it would have been helpful to reassure Alfie by giving him more time to respond and ensure he did not feel pressured to respond immediately (Geldard & Geldard 2016, p. 43).
Further, to develop these ongoing skills of joining and listening, it is fundamental for health care professionals to listen with interest which involves the use of minimal responses, brief invitations to continue, non-verbal behaviour (matching, appropriate physical closeness, use of movement, facial expression and eye contact), clarity, volume, matching tone and speed of voice as well as use of silence (Geldard & Geldard 2016, p. 44-9). Throughout the session, I felt that I was able to exhibit these skills of active listening adequately as I remained calm, relaxed, friendly, matched Alfie’s non-verbal behaviour and posture, maintained appropriate eye contact as well as showed expressions of interest and concern through appropriate nodding and minimal responses like ‘mm’ (Elder, Evans & Nizette 2013, p. 454). However, in saying that, I could have executed this better by refraining from using ‘um,’ as this …show more content…
may imply uncertainty and denies clear communication (Dziopa & Ahern 2009, p. 17).
Emphasis on emotions & clarifying and restructuring thoughts and behaviour
To continue, as identified by Geldard and Geldard (2016, p. 156) and Kuntze et al. (2009, p. 175), it is important that while actively listening, the health care professional adapts use of paraphrasing, reflection of feeling, and summarising to reassure the client they have been heard and understood. For example, by identifying feelings and thoughts of being overwhelmed, lost, and stressed, allowed for Alfie to acknowledge and clarify these and their association with his concerns. Furthermore, some examples of some paraphrases include: 1:26, “you think that because you’re running out of time, you’re not able to complete the tasks,” 5:26, “you’re feeling quite confused at the moment and which route to take,” 7:25, “you’ve had other issues which have then effected your studies,” and at 18.16, “you feel like because you’ve invested so much time in the course, you feel the need to continue even though you don’t seem to enjoy it.” Again, by paraphrasing and reflecting back on the content discussed, this assisted Alfie to reveal and clarify his feelings and thoughts of being time restrained, uncertain toward his future, how his past concussions contribute to his capacity to study and why he continues to remain in the course.
However, there are certain areas which I could have improved, such as, at 8.20 I stated, “so again, you’re feeling overwhelmed by what you have to learn and the timing of it all.” In hindsight, it would have been preferable to say something along the lines of “it seems that you’re feeling overwhelmed by your workload and you’re starting to feel pressured and unable to cope” to adequately clarify and restructure what was said (Geldard and Geldard 2016, p.
76). In addition to that, another statement which could have been restated was at 10:37 when I asked, “do you feel like a nuisance in some way?” in the context of not wanting to bother his friends and asking for help (10:27). Alternatively, I could have reframed that by stating “it seems that you think that you’d be bothering your friends, what makes you think that?” as this would assist him self-discover his own thoughts without my intrusion. Essentially, to ensure effective communication as a number of studies (Dziopa & Ahern 2009, p. 18; Kitchener, Jorm & Kelly 2016, p. 31; Geldard & Geldard 2016, p. 156) have identified, the use of closed and open-ended questions when appropriate, clarification of what has been said, paraphrasing and summarising facts and feelings and use of minimal prompts, are all fundamental skills required to maintain a natural conversational flow to facilitate the client’s process of self-disclosure and
self-discovery. To continue, the emphasis on restructuring thoughts and behaviour is key in the client’s ability to think differently about the problem, which in turn, will guide resolution to their dilemmas and explore further options and behaviour (Ivey et al. 2015; Geldard & Geldard 2016, p. 152). I felt that this was done adequately in the session as I was able to reframe, normalise and focus on certain thoughts and strengths of Alfie’s. For example, in response to Alfie revealing he was overwhelmed by his workload, at 8.31 I said, “it’s quite normal to feel overwhelmed considering there was so much going on.” Here, I felt that I illustrated the skill of normalising to reassure and potentially reduce anxiety by letting him know that this response was a normal one (Geldard & Geldard 2016, p. 166). To follow on with this, it was important that while discussing his concerns of procrastination, asking “do you think there are other ways you can approach that problem?” (10:13), was useful as it enabled me to ask a focused question for him to explore his beliefs and possible options for change (Ivey et al. 2014; Kuntze et al. 2009). Additionally, making enquiries like, “so in previous years how would you have reacted differently?” (21:08) and “did you do certain things to motivate yourself?” (21:47), are beneficial as they promote self-discovery of skills which have been used in the past and could be used again to focus on solutions to achieve future goals (Geldard & Geldard 2016, p. 166). To add, as a health care professional, being familiar with resources and websites relevant to the content of what the client discusses is crucial as it shows your degree of knowledge and ability to support and provide the client with relevant services and resources to their situation (Hungerford et al. 2015, p. 191).
(Commonwealth of Australia 2013; Ramon 2012; Slade 2013). Therefore, to identify these concepts in practice, a recorded counselling session with my consumer will be critiqued and critically reflected upon through the analysis of engagement strategies I attempted, could improve, as well as those I could have implemented.
Summary of session
Alfie, a 22 year old male optometry student revealed to be struggling with his current university workload and procrastination, is considering dropping out, uncertain toward his future, disclosed a number of alternative pathways to take as well as few strategies to cope with these issues. Initially, to allow for such disclosure of personal feelings, thoughts and actions, a number of strategies and methods must be put into consideration. As outlined by Geldard and Geldard (2016, p. 152), this can be facilitated by the counselling process which involves preparation, joining, active listening, emphasis on emotions, emphasis on problem clarification and thought restructuring, emphasis on behaviour as well as closure techniques.
Preparation
To ensure the session with Alfie was completed in a professional manner, it was assured the conversation took place in a comfortable, clean, tidy and private setting with minimal external noise and distractions. As Slade (2013, p. 25) identifies, this is fundamental as it allows for a pleasant, respectful and welcoming environment for the client to share their issues or concerns.
Joining
To initiate a natural conversational pace in the session, it is important to establish a foundational relationship through relaxed basic introductions and small talk (Dziopa & Ahern 2009, p. 20; Geldard & Geldard 2016, p. 155). Regarding this, I did briefly mention my role as a counsellor and declared that it was a safe space to speak about his problems or any worrying concerns (00.30). However, I failed to clarify the structure of the session as well as my role adequately. In this instance, as Geldard and Geldard suggest, I could have stated:
“I don’t see myself as an expert who can solve your problems for you. I believe that you will always know and understand yourself better than I will know and understand you. However, I hope that in this session you and I, collaboratively can explore what’s troubling you so that you can make some progress towards feeling more comfortable” (2016, p. 156)
In conjunction with this, it would have better to establish my role as a counsellor from the health services department of the university, rather than one from the local hospital as it would have been more relevant to his concerns.
To continue, for Alfie to feel more at ease, it would have been useful for me to ask questions like, ‘how’d you get here?,’ ‘did you get caught in the rain?’ or perhaps even offering a glass of water, instead of beginning the discussion right away (Slade 2013, p. 25). Also, a statement specifying that the content mentioned during the session will remain confidential should have been vocalised. In spite of these faults, I was able to address him as his preferred name, gain consent to record the session in addition to ask whether he had any questions before the session began. These strategies are helpful as it allows the consumer to feel more comfortable, settled and open to engage with discussion (Dziopa & Ahern 2009, p. 17). Essentially, as previous studies (Dziopa & Ahern 2009; Geldard & Geldard 2016; Happell 2013; Kitchener, Jorm & Kelly 2016) have identified, these strategies along with the establishment of rapport and demonstration of respect, non-judgement, effective non-verbal and verbal communication, interest, acceptance, empathy, genuineness, reflective listening, honesty and unconditional positive regard, are all fundamental when developing a therapeutic relationship to facilitate change.
Active Listening
Additionally, to enable this, it is important the counsellor demonstrates relevant active listening skills by putting the person at ease and inviting them to self-disclose what is troubling them (Geldard & Geldard 2016, p.
43). At 0:50, by asking Alfie ‘what brings you here today?’ I felt I was able to demonstrate that well. In future, to extend that skill and to become more encouraging, it would have been helpful to reassure Alfie by giving him more time to respond and ensure he did not feel pressured to respond immediately (Geldard & Geldard 2016, p. 43).
Further, to develop these ongoing skills of joining and listening, it is fundamental for health care professionals to listen with interest which involves the use of minimal responses, brief invitations to continue, non-verbal behaviour (matching, appropriate physical closeness, use of movement, facial expression and eye contact), clarity, volume, matching tone and speed of voice as well as use of silence (Geldard & Geldard 2016, p. 44-9). Throughout the session, I felt that I was able to exhibit these skills of active listening adequately as I remained calm, relaxed, friendly, matched Alfie’s non-verbal behaviour and posture, maintained appropriate eye contact as well as showed expressions of interest and concern through appropriate nodding and minimal responses like ‘mm’ (Elder, Evans & Nizette 2013, p. 454). However, in saying that, I could have executed this better by refraining from using ‘um,’ as this …show more content…
may imply uncertainty and denies clear communication (Dziopa & Ahern 2009, p. 17).
Emphasis on emotions & clarifying and restructuring thoughts and behaviour
To continue, as identified by Geldard and Geldard (2016, p. 156) and Kuntze et al. (2009, p. 175), it is important that while actively listening, the health care professional adapts use of paraphrasing, reflection of feeling, and summarising to reassure the client they have been heard and understood. For example, by identifying feelings and thoughts of being overwhelmed, lost, and stressed, allowed for Alfie to acknowledge and clarify these and their association with his concerns. Furthermore, some examples of some paraphrases include: 1:26, “you think that because you’re running out of time, you’re not able to complete the tasks,” 5:26, “you’re feeling quite confused at the moment and which route to take,” 7:25, “you’ve had other issues which have then effected your studies,” and at 18.16, “you feel like because you’ve invested so much time in the course, you feel the need to continue even though you don’t seem to enjoy it.” Again, by paraphrasing and reflecting back on the content discussed, this assisted Alfie to reveal and clarify his feelings and thoughts of being time restrained, uncertain toward his future, how his past concussions contribute to his capacity to study and why he continues to remain in the course.
However, there are certain areas which I could have improved, such as, at 8.20 I stated, “so again, you’re feeling overwhelmed by what you have to learn and the timing of it all.” In hindsight, it would have been preferable to say something along the lines of “it seems that you’re feeling overwhelmed by your workload and you’re starting to feel pressured and unable to cope” to adequately clarify and restructure what was said (Geldard and Geldard 2016, p.
76). In addition to that, another statement which could have been restated was at 10:37 when I asked, “do you feel like a nuisance in some way?” in the context of not wanting to bother his friends and asking for help (10:27). Alternatively, I could have reframed that by stating “it seems that you think that you’d be bothering your friends, what makes you think that?” as this would assist him self-discover his own thoughts without my intrusion. Essentially, to ensure effective communication as a number of studies (Dziopa & Ahern 2009, p. 18; Kitchener, Jorm & Kelly 2016, p. 31; Geldard & Geldard 2016, p. 156) have identified, the use of closed and open-ended questions when appropriate, clarification of what has been said, paraphrasing and summarising facts and feelings and use of minimal prompts, are all fundamental skills required to maintain a natural conversational flow to facilitate the client’s process of self-disclosure and
self-discovery. To continue, the emphasis on restructuring thoughts and behaviour is key in the client’s ability to think differently about the problem, which in turn, will guide resolution to their dilemmas and explore further options and behaviour (Ivey et al. 2015; Geldard & Geldard 2016, p. 152). I felt that this was done adequately in the session as I was able to reframe, normalise and focus on certain thoughts and strengths of Alfie’s. For example, in response to Alfie revealing he was overwhelmed by his workload, at 8.31 I said, “it’s quite normal to feel overwhelmed considering there was so much going on.” Here, I felt that I illustrated the skill of normalising to reassure and potentially reduce anxiety by letting him know that this response was a normal one (Geldard & Geldard 2016, p. 166). To follow on with this, it was important that while discussing his concerns of procrastination, asking “do you think there are other ways you can approach that problem?” (10:13), was useful as it enabled me to ask a focused question for him to explore his beliefs and possible options for change (Ivey et al. 2014; Kuntze et al. 2009). Additionally, making enquiries like, “so in previous years how would you have reacted differently?” (21:08) and “did you do certain things to motivate yourself?” (21:47), are beneficial as they promote self-discovery of skills which have been used in the past and could be used again to focus on solutions to achieve future goals (Geldard & Geldard 2016, p. 166). To add, as a health care professional, being familiar with resources and websites relevant to the content of what the client discusses is crucial as it shows your degree of knowledge and ability to support and provide the client with relevant services and resources to their situation (Hungerford et al. 2015, p. 191).