COUNSELING INTERVIEW AS THERAPEUTIC COMMUNICATION[Rupendra Shrestha]

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COUNSELING INTERVIEW AS THERAPEUTIC COMMUNICATION:

COUNSELING INTERVIEW AS THERAPEUTIC COMMUNICATION Mr. Rupendra Shrestha Department of Human Genetics Sri Ramachandra University Chennai, Porur- 600-116 Permanent Residence NEPAL

CERTIFICATION PROCESS 1981:

CERTIFICATION PROCESS 1981 FIRST MASTER TRAINING PROGRAM IN GENETIC COUNSELING 1971 RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

COUNSELING AND INTERVIEWING ARE INTERCHANGEABLE?:

COUNSELING AND INTERVIEWING ARE INTERCHANGEABLE? They do overlap, but there is also a difference between them. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

INTERVIEWING:

INTERVIEWING The most Basic process for: Information gathering Problem solving Information and advice giving Interviewers may be Genetic Counselor, medical personal guidance and Counseling staff, ,business people or members of a wide variety of other professions. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

COUNSELING:

COUNSELING Is usually more intensive and includes a personal process that is geared to help people deal with issues. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

Genetic Counseling…is a communication process which deals with problems associated with the occurrence or the risk of recurrence of a birth defect or a genetic disease in a family:

…is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. This process integrates: Collection and interpretation of family and medical histories to assess the chance of disease occurrence or recurrence Education about inheritance, testing, management, prevention, resources and research Counseling to promote informed choices and adaptation to the risk or condition. Genetic Counseling…is a communication process which deals with problems associated with the occurrence or the risk of recurrence of a birth defect or a genetic disease in a family Adapted from the NSGC website RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

Prevention or at least amelioration of the effects of genetic disease or birth defect is the ultimate goal of genetic counseling:

Prevention or at least amelioration of the effects of genetic disease or birth defect is the ultimate goal of genetic counseling Victor Canter for the Prevention of Jewish Genetic Diseases RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

HEALTH PROFESSIONL FUNCTION BOTH AS INTERVIEWERS AND COUNSELORS:

HEALTH PROFESSIONL FUNCTION BOTH AS INTERVIEWERS AND COUNSELORS Interviewing and Counseling should be distinguished from psychotherapy, which is a more intense process focusing on deep seated personality and behavioural difficulties. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

GOALS OF COUNSELING INTERVIEW:

GOALS OF COUNSELING INTERVIEW The genetic counseling aims to provide the family with complete and accurate information about genetic disorders. Promoting informed decisions by involved family members Clarifying the family’s options available treatment and prognosis Explaining alternatives to reduce the risk of genetic disorders Decreasing the incidence of genetic disorders Reducing the impact of the disorders RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

INTERVIEWING TECHNIQUES:

INTERVIEWING TECHNIQUES TWO way interaction between genetic counselor and the clients/patients Counselor : Host-Interviewer while Clients: Guest-Interviewee. the purpose of the interview is to obtain accurate & thorough information put your client at ease as they may feel uncomfortable about revealing sensitive information to you explaining your format helps clients accept & understand the purpose of the interview RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

INTERVIEWING TECHNIQUES:

INTERVIEWING TECHNIQUES in general, use open-ended questions however, to obtain specific information, closed-ended questions are preferable validate information clarify responses use reflective questions/comments & paraphrasing RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PREPARING FOR THE COUNSELING INTERVIEW:

PREPARING FOR THE COUNSELING INTERVIEW Analyzing Self Know yourself before trying to help others know themselves . Good problem solvers may be poor counselors . Do not stray beyond your level of expertise. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PREPARING FOR THE COUNSELING INTERVIEW:

PREPARING FOR THE COUNSELING INTERVIEW Analyzing the Interviewee Be informed but keep an open mind . Be aware of past, present, and future events . Be prepared for rejections of offers to counsel . Listen rather than talk. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PREPARING FOR THE COUNSELING INTERVIEW:

PREPARING FOR THE COUNSELING INTERVIEW Selecting an Interviewing Approach Directive Approach Nondirective Approach Combination of Approaches RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PREPARING FOR THE COUNSELING INTERVIEW:

PREPARING FOR THE COUNSELING INTERVIEW Selecting the Setting Do not underestimate the importance of location and seating . A round table is a traditional arrangement for problem solving. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PROGRESSION OF THE INTERVIEW:

PROGRESSION OF THE INTERVIEW Broad Openings such as “Tell me about yourself” are designed to allow the client to relate his or her story in a way that is comfortable RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PROGRESSION OF THE INTERVIEW:

PROGRESSION OF THE INTERVIEW Open-Ended Questions encourage the client to elaborate or give explanations (for example, “What happened yesterday?”) they provide direction & keep the conversation focused RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PROGRESSION OF THE INTERVIEW:

PROGRESSION OF THE INTERVIEW Closed-Ended Questions can be answered with 1-2 words and can be useful in obtaining specific types of information, such as “What is today’s date?” RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

EFFECTIVE INTERVIEWING:

EFFECTIVE INTERVIEWING as a professional counselors, you will spend about half of your time obtaining information from clients & colleagues excellent communication as well as interviewing skills are fundamental, yet require years of practice RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

WHY, WHAT, HOW?????:

WHY, WHAT, HOW????? why do you need the information? how will the information I am seeking direct me in helping my client? how will you phrase your questions? RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

Who to Ask?:

Who to Ask? if the client is able to speak, ask him/her family perspectives may also be important written consent may be required to question concurrent/previous healthcare providers be courteous and respectful never forget client confidentiality RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

“Why” Questions:

“Why” Questions offensive misuse of ‘why’ appears threatening and confrontational and puts clients on the defensive they can interfere with developing a therapeutic relationship & are seldom considered therapeutic RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

CONVEYING UPSETTING INFORMATION:

CONVEYING UPSETTING INFORMATION The SPIKES Model developed by Radziewicz & Baile (2001) Setting Perception Invitation Knowledge emotions Summary RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

SETTING:

SETTING private & comfortable invite others, such as family members RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

PERCEPTION:

PERCEPTION refers to what client and others already know useful in uncovering misinformation RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

INVITATION:

INVITATION For example, the statement, “Would you like me to explain more about what happened?’ RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

KNOWLEDGE:

KNOWLEDGE gradually dispense information assessing client’s ability to cope with it The family may insist that the client not be told difficult news RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

EMOTIONS:

EMOTIONS let client vent while you remain calm keep in mind Stages of Grief & Loss may need to set limits on inappropriate /harmful behavior RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

SUMMARY:

SUMMARY review all important information with the client and family may need to repeat information more than once RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

AVOID:

AVOID poor listening closed questions intimidating how/why questions obvious probing questions advice leading questions (that suggest the response that you want) judgmental comments diverting false assurance RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

THERAPEUTIC COMMUNICATION:

THERAPEUTIC COMMUNICATION

HELPING VS SOCIAL RELATIONSHIP:

HELPING VS SOCIAL RELATIONSHIP HELPING Care Trust Growth Purposeful/intentional Unequal sharing Focus on Client’s needs Time limited SOCIAL Care Trust Growth Spontaneous Usually equal or near equal sharing Focus on needs of both individuals Ongoing RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

LOCOUS OF CONTROL:

LOCOUS OF CONTROL GIVING HELP Feeling important Feeling useful Feeling powerful Feeling gratified Feeling happy NEEDING HELP Feeling unimportant or inadequate Feeling useless or depressed Feeling powerless Feeling frightened or embarrassed Feeling sad or angry RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

COMMON ERRORS:

COMMON ERRORS RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

BLOCKS OF COMMUNICATION:

BLOCKS OF COMMUNICATION Failure to respect client Failure to listen Minimizing feelings Inappropriate comments & questions Excessive questions Clichés Yes/no questions Probing Changing the subject Leading questions Advice Judgments False reassurance Giving approval/disapproval RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

SELF-DISCLOSURE:

SELF-DISCLOSURE Use self disclosure to help clients open up to you – not to meet your own needs Keep disclosures brief Don’t imply that your experience is exactly the same as the client’s Only self-disclose about situations that you have mastered RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

SELF-DISCLOSURE:

SELF-DISCLOSURE Monitor your own comfort with self-disclosure Respect your client’s needs for privacy Remember that there are cultural variations in the amount of self-disclosure considered appropriate Identify risks and benefits of self disclosure RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

THERAPEUTIC VS. NON -THERAPEUTIC COMMUNICATION:

THERAPEUTIC VS. NON -THERAPEUTIC COMMUNICATION THERAPEUTIC Facilitates transformation of working nurse-patient relationship Relationship allows for adequate & accurate data collection & assessment Performed with & not for patient RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

THERAPEUTIC VS. NON -THERAPEUTIC COMMUNICATION:

THERAPEUTIC VS. NON -THERAPEUTIC COMMUNICATION NONTHERAPEUTIC Hinders relationship formation Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013

Acknowledgement:

Acknowledgement Diane L.Baker; A guide of Genetic Counseling Ahmad Teebi, M.D. Professor of Pediatrics and Genetic Medicine; Weill Cornell Medical College in Qatar. Sindhu Sebastian; Lecturer, FMCON. Sally McDonald and Tim Corbett. RUPENDRA SHRESTHA/HUMAN GENETICS/SRU/2013