Amputee Manual Module 4 Communication …...Module 4 - Communication techniques 5 2 Non Verbals and...

MODULE FOUR Communication techniques

Training Manual for NSW Health Services EnableNSW

2 Establishing an Amputee Peer Support Visiting Service - Training Manual for NSW Health Services

3 Module 4 - Communication techniques

1 Outline of Module.

Objectives By the end of the module, participants will have:

• demonstrated at least two basic communication techniques which can be used effectively during visits

• identified at least four strategies to facilitate a client-centred conversation

• described circumstances and behaviours that can create barriers to communication during a client visit and identified strategies for minimising these obstacles

• described the importance of Peer Support Visitor sensitivity to the client’s feelings and to the client’s emotional recovery.

Time 2-3 hours

Resources Data projector, PowerPoint presentation, handouts

Program • Non-verbals and body language

• Client-centred conversations

• Active listening

• Reflecting

• Summarising

• Paraphrasing

• Feedback

• Questions

• Perception

• Barriers.


PowerPoint Presentations • Communication

• What are non-verbals?

• Non-verbal communication

• What is listening?

• Active listening

• Reasons for listening

• Why listening is important

• Focus on…

• What do you see...

• Principles of perception

• What we do

• Barriers to listening

• Strategies for better listening.

Handouts • The importance of listening

• Feedback guidelines

• Barriers to listening

• Ten don’ts of listening

• Listening skills checklist.


2 Non Verbals and Body language

Communication

Explain that only 7% of communication is done verbally. 38% paralanguage (how things are said) and 55% nonverbal.

Explain what “non-verbals” are.

What are non-verbals

How something is said - rather than what is said. Tone of voice, inflections, emphasis, speed of delivery, quantity, pitch of voice.

Exercise: A simple sentence

Facial expression and body movement – Smile, frown, raising eyebrow, direction of attention, eye contact, posture.

Gestures – Nod or shake of head, hand gestures.

Touching behaviour - pat on the back, handshake – be aware of some of the cultural differences.

Personal space - conversation distance, seating arrangements (the boss at the head and the people with the next level of power sitting next to him/her).

Exercise: Standing around

Physical characteristics – dress, decorations (uniform, medals) personality and stereotypes, hair.

Environment – natural, climate, colour (hospital environment).


Exercise: Discuss own observations

Non verbal communication

Explain that non verbals are important because they:

Communicate emotions You cannot not communicate Seen to be more reliable Relates to verbal communication

Exercise: Don’t communicate

Exercise: Building rapport

3 Conducting a client-centred conversation

Explain about a client-centred conversation.

When a Peer Support Visitor visits a client, it is for the client’s benefit and therefore the visit must be centred around the needs of the client.

A client-centred conversation assumes that the client is the expert on their own lives and feelings, as such, it is not the Peer Support Visitor’s responsibility to try and “fix” the clients problems.

It promotes active listening, empathy, reflection of feelings, clarification and unconditional regard for the client. Qualities in the Peer Support Visitor that would be seen as effective are genuineness, warmth, respect, unconditional acceptance and permissiveness.

Sincerity - relates to an attitude that is free of pretensions and role-playing. It allows a level of spontaneity and promotes trust. Both participants can feel free to express thoughts and feelings and are usually more aware of their own motivations.

Unconditional acceptance – having an attitude that avoids judgements, does not disapprove and does not interpret. This frees the client up as they feel accepted, respected and supported.

Empathy – is the willingness to walk with the other person – to see through their eyes and circumstances. Empathy comes from the German word einfuhlung, which literally means “feeling into”. The visitor listens to the client’s story as they choose to tell it. It involves accurately responding to the other person’s feelings and needs without being affected by them.


The three components of empathy:

1. The empathetic person has a sensitive and accurate understanding of the other person’s feelings while maintaining a certain separateness from the person.

2. Empathy means understanding the situation that contributed to or “triggered” those feelings.

3. Empathy means communicating in such a way that the other person feels accepted and understood.

Bolton R. (1987). People Skills. Simon and Schuster, Sydney. P272.

As a Peer Support Visitor, you may have experienced the same feelings as the client and have a deeper understanding of the client’s grief, and the knowledge that you have experienced the same grief can result in a sensitive sharing of the issues.

4 Active Listening

People often find it difficult to communicate and this is understandable as effective communication is a learned skill. We will introduce you to some simple but effective strategies to develop the communication skills you already possess.

What is listening?

Listening is more than just hearing the words. Listening involves thinking processes, perception and commitment – it is active.

Definition of active listening

It is active because it involves taking information from speakers, processing it, giving meaning to it and, when appropriate, encouraging the continuation of communication by giving appropriate feedback.

Reasons for listening

• Acknowledges a person’s worth.

• Can be a mutually rewarding experience.

• Speakers tend to give more honest and valid responses.

• Feelings can be aired and acknowledged.

• Achieve mutually beneficial outcomes.


Why is listening important?

Handout The importance of listening

Go through the handout with the participants or hand it out after – explain:

• Listening is a way of communicating to other people that they are important and that you are accepting them as people and not judging them.

• Listening acknowledges a person’s worth and meets a basic human need for recognition and respect.

• If people are listened-to and given opportunities to solve their own problems, they tend to feel encouraged to have confidence in their own abilities and self esteem is increased.

• Listening can be a mutually rewarding experience. People who are listened-to usually appreciate the listener and cooperate with them.

• Speakers and listeners who are communicating in a climate of acceptance and trust give more honest and valid responses to each other.

• Feelings can be aired and acknowledged instead of being held-in, only to erupt later in unproductive or destructive ways.

• We can use our listening ability to work with others to achieve mutually satisfying outcomes.

• By listening to others and reflecting on our responses, what we say and how we say it, we can learn a great deal about ourselves.

Active listening includes some sub-skills of reflecting, summarising, paraphrasing and feedback.

5 Reflecting

Explain that the art of good listening involves the ability to respond reflectively.

In a reflective response, the listener restates the feeling and / or content of what the speaker has communicated and does so in a way that demonstrates understanding and acceptance.

Reflecting feelings, where appropriate, is important as it shows empathy and gives permission for the client to speak about the feelings they may be experiencing. This could be the first time they may acknowledge them. Discussion of these feelings can aid in the client understanding that what they are experiencing is normal.


6 Summarising

To summarise is to give a brief restatement of the main themes over a longer period of a conversation. The client will feel that you have been listening to them and feel that they have been ‘heard’. This summary can draw a whole picture of what is happening.

7 Paraphrasing

Explain that paraphrasing is the skill of repeating the client’s story in your own words.

Listening with the intent of paraphrasing, restating the speaker’s message in your own words, will force you to focus on the message being presented. Indeed, one of the most effective ways of checking whether you have received a message is to repeat it. Restating not only gives you a chance to check the ideas you have received, but also informs the other person that you are listening.

Given how rare good listening is, paraphrasing to demonstrate your attentiveness can be a great compliment. In addition, if you force yourself to paraphrase, you will find you must listen to the entire message without interrupting.

Skilled paraphrasers repeat only the speaker’s general idea not the entire message. Paraphrasing starters include: “It sounds as if you...” “You seem to be saying...” “It appears to me that you believe...” “What I perceive is...” “What I heard you say was...” and “So you believe that...” When paraphrasing is done well, it is the best way to demonstrate that you are focusing on the speaker and listening thoughtfully.

The skill of paraphrasing is extremely important when you are talking with people who may not speak the same native language as you do. Being able to reword their thoughts enables both people to check the accuracy of the message.

Exercise: Recognising effective paraphrasing

8 Feedback

Reporting how you are reacting to the way another person is behaving is often called feedback. The purpose of feedback is to provide constructive information to help another person become aware of how his or her behaviour affects you and how you perceive his or her actions. It is important therefore, to give feedback in a way which will not be threatening to the other person and increase defensiveness. The more defensive an individual is, the less likely it is that he or she will correctly hear and understand feedback.


Feedback: Focus on….

Handout: Feedback Guidelines

Go through feedback guidelines using the handout.

9 Minimal encouragers and open questions

Explain that at times the conversation can appear to become one-sided and that you are the person that seems to be doing all the talking.

There are a couple of easy ways to overcome this problem, using minimal encouragers and open questions.

Minimal encouragers are simple responses that encourage the speaker to tell their story while keeping the listener actively involved in the conversation. Minimal encouragers show the client that you are still with them – they “encourage “ the client to continue talking.

Some examples are:

“Tell me more.” “Oh?” “I see” “Then?” “Yes” “Really?” “And?” “Go on” “Hmm, hmm”


10 Open and closed questions

There are two general categories of questions – open and closed.

Closed questions direct the client to give a specific short response: e.g. Are you in pain? Yes/No

Is your family coping Yes/No Have you thought about what you are going to do? Yes/No

Open questions provide space for the client to explore their own thoughts or feelings. e.g. How are you feeling?

How is your family coping? What are you going to do? What’s on your mind?

The open question is usually preferable as it does not suggest an agenda and the client can decide how much to open up.

Asking too many questions is a trap into which many people fall. They feel that they have to fill the ‘gaps’. Silence is a useful tool, as it gives the client time to answer the previous question or to participate in the conversation at his/her own pace. It is their prerogative. Too many questions can make it feel like an interrogation.

During the ‘silent’ periods it is important to attend to the client. That is, watch their body language, keep good eye contact, watch your posture, think about appropriate responses.

Exercise: Develop some open questions

11 Perception

Exercise: What do you see?

What do you see?

We continually interpret the world around us as we attempt to make sense of it. We process incoming sensations - we evaluate them and make decisions.


Principles of perception

No two people perceive things the same Each individual has a unique view of the world influenced by our values, experience, needs, tensions, culture.

Perception is highly selective We select what we want to perceive, which is very little of the total impressions actually picked up.

Perception is influenced by the psychological factors at the time Our moods influence how we process or interpret the world around us. When sending messages we should try to take into account the other person’s emotional state.

Information has no inherent meaning - it is open to various interpretations Different people will interpret the same situation a different way.

Simplification of complex information People tend to organise and simplify complex information. Too much information can overload the other person.

What we do…

Discuss the issues in the PowerPoint slide – What we do...

12 Barriers

The following PowerPoint slides and handouts can be discussed directly. Promote discussion for each point.

Handout: Barriers to listening Barriers to listening

Strategies for better Handout: listening Ten don’ts of listening

Handout: Listening skills checklist


13 Activities

A simple sentence Choose a simple sentence, e.g. “please come in and sit down”. State the same sentence a number of times demonstrating different feeling, such as excitement, anger, frustration, nervousness, boredom, unpreparedness etc. Have the participants (working in pairs) write their perception of the feeling you were trying to demonstrate. Discuss the reasons why they chose the feeling they did. They are usually all non verbal.

Standing around Get participants to stand up in pairs with people they don’t know. Have them stand four feet apart, then have them walk slowly closer together and then stop when they feel uncomfortable - discuss.

Don’t communicate Find a partner, face one another and without speaking, try NOT to communicate for two minutes – discuss.

Building rapport How could you use “non-verbals” to build rapport with the client?

Cultural differences Can the participants think of any others that they have experienced – maybe from their own culture. For instance, people from some cultures will stand closer together during a conversation.

Recognising effective paraphrasing Select the effective paraphrase of the sender’s message. 1. Speaker: “Sometimes I think I’d like to drop out of school, but then I start to feel like a quitter.”

a) Maybe it would be helpful to take a break and then you can always come back.

b) You’re so close to finishing. Can’t you just keep with it a little bit longer?

c) It sounds like you have doubts about finishing school but that you don’t like to think of yourself as a person who would quit something you started.

d) What do you think the consequences will be if you drop out?

2. Speaker: “I really don’t want to go to a party where I don’t know anyone. I’ll just sit by myself all night.”

a) You’re apprehensive about going to a place where you don’t know anyone because you’ll be alone.

b) It would really be good for you to put yourself in that kind of a situation.

c) I can really relate to what you’re saying. I feel awkward too when I go to strange places.


Develop some open questions Have the participants develop some open questions that they may use to establish rapport - ask after their feelings or open discussion surrounding practical issues.

What do you see?

Ask the participants to look at the picture on the PowerPoint slide. Make sure it is only just long enough for them to get a first impression. Take it off quickly.

Then ask the participants what they saw – a vase or two faces.

Discuss the implications – bring the discussion to such aspects as perception, familiarity, personal experience, culture etc.

14 Appendix A: Handouts and Exercise Sheets

POWERPOINT PRESENTATION Communication

What are non verbals?

Non-verbal communication

Definition of active listening? Reasons for listening

Why listening is important Feedback

What do you see?

Principles of perception

What we do... Barriers to listening Strategies for better for listening

HANDOUTS What is listening? Definition of active listening What is listening?

Barriers to listening

Ten don’ts of listening

Listening skills checklist The importance of listening

Communication

7%

38% 55%

Communication Verbal Communication How things are said Communication Nonverbal

Module 4 - Communication techniques 15


What are non-verbals?

How things are said

Facial expression and body movement

Gestures

Touching behaviour

Personal space

Physical characteristics

Environment


Non-verbal communication

Communicates emotions

Seen to be more reliable

You cannot not communicate

Relates to verbal communication


What is listening?

The active process of receiving, attending to, and assigning meaning to sounds - and remembering.


Active Listening

Listening is active because it involves taking information from speakers, processing it, giving meaning to it, and when appropriate, encouraging the continuation of communication by giving appropriate feedback.


Reasons for Listening

Comprehension

Appreciation

Identification

Evaluation

Empathy

Self-understanding


Why listening is important

Acknowledges a person’s worth

Can be a mutually rewarding experience

Speakers tend to give more honest and valid responses

Feelings can be aired and acknowledged

Achieve mutually beneficial outcomes


The Importance of listening

There are other reasons why listening is important

• Listening is a way of communicating to other people that they are important and that you are accepting them as people and not judging them.

• Listening acknowledges a person’s worth and meets a basic human need for recognition and respect.

• If people are listened-to and given opportunities to solve their own problems, they tend to feel encouraged, have confidence in their own abilities and their self-esteem is increased.

• Listening can be a mutually rewarding experience. People who are listened-to usually appreciate the listener and co-operate with them.

• Speakers and listeners who are communicating in a climate of acceptance and trust give more honest and valid responses to each other.

• Feelings can be aired and acknowledged instead of being held-in, only to erupt later in unproductive or destructive ways.

• We can use our listening ability to work with others to achieve mutually satisfying outcomes.

• By listening to others and reflecting on our responses, what we say and how we say it, we can learn a great deal about ourselves.

Developing Interpersonal Communication. University of Technology. Sydney


What to focus on…

Exploration of alternatives rather than answers or solutions

On the value it may have for the receiver not the value of release that it provides the person giving it

On the amount of information the person can receive

The time and place

What is said rather than why it is said


Feedback Guidelines

These can be very helpful for checking perceptions and communicating our perceptions in a non threatening way.

Talking about how you are reacting to the way another person is behaving is often called feedback. The purpose of feedback is to provide constructive information to help another person become aware of how his or her behaviour affects you and how you perceive his or her actions. It is important therefore, to give feedback in a way which will not be threatening to the other person and increase defensiveness. The more defensive an individual is, the less likely it is that he or she will correctly hear and understand feedback. Some characteristics of helpful, non-threatening feedback are as follows:

Focus feedback on behaviour rather than the person. It is important that you refer to what a person does rather than comment on what you imagine he or she is. To focus on behaviour implies that you use adverbs (which relate to actions) rather than adjectives (which relate to qualities) when referring to a person. Thus you might say a person ‘talked considerably in this meeting’, rather than that this person ‘is a loudmouth’.

Focus feedback on observations rather than inferences. Observations refer to what you can see or hear in the behaviour of another person, while inferences refer to interpretations and conclusions made from what you see or hear. In a sense, inferences or conclusions about a person contaminate your observations, thus clouding the feedback from another person. When inferences or conclusions are shared, and it may be valuable to do this, it is important that they are identified.

Focus feedback on description rather than judgment. The effort to describe represents a process for reporting what occurred, while judgment refers to an evaluation in terms of good or bad, right or wrong, nice or not nice. Judgments arise out of a personal frame of reference or value system, whereas description represents neutral (as far as possible) reporting.

Focus feedback on descriptions of behaviour which are in terms of ‘more or less’ rather than in terms of ‘either or’. When you use ‘more or less’ terminology, it implies that the behaviour falls in a continuum. This means you are stressing quantity, which is objective and measurable, rather than quality, which is subjective and judgmental. Thus participation by a person may fall on a continuum from low participation to high participation, rather than ‘good’ or bad’ participation. If you don’t think in terms of more or less and the use of a continuous scale of measurement, you will be trapped into thinking in categories, which may then not reflect reality.

Focus feedback on behaviour related to a specific situation, preferably to the ‘here and now’ rather than on behaviour in the abstract, placing it in the ‘there and then’. What you and I do is always related in some way to time and place. We increase our understanding of behaviour by keeping it tied to time and place. When observations or reactions occur, feedback will be most meaningful if you give it as soon as it is appropriate to do so.


Focus feedback on the sharing of ideas and information rather than on giving advice. By sharing ideas and information you leave the other person free to decide for himself or herself, in the light of his or her own goals in a particular situation at a particular time, how to use the ideas and the information. When you give advice, you tell the other person what to do with the information. Insofar as you tell him or her what to do, you take away the other person’s freedom to determine for himself or herself what is the most appropriate course of action for him or her.

Focus feedback on exploration of alternatives rather than answers or solutions. The more we can focus on a variety of procedures and means for accomplishing a particular goal, the less likely we are to accept premature answers or solutions which may or may not fit a particular problem. Many of us have a collection of answers and solutions for which there are no problems.

Focus feedback on the value it may have to the receiver, not on the value of ‘release’ that it provides the person giving the feedback. The feedback provided should serve the needs of the person getting the feedback rather than the needs of the giver. Help and feedback need to be given and heard as an offer, not as something you force upon another person.

Focus feedback on the amount of information that the person receiving it can use, rather than on the amount that you have which you might like to give. If you overload a person with feedback, it reduces the possibility that he or she may use what he or she receives effectively. When you give more than the other person can use, you are satisfying some need for yourself rather than helping the other person.

Focus feedback on time and place so that personal data can be shared at appropriate times. Because receiving and using personal feedback involves many possible emotional reactions, it is important for you to be sensitive to when it is appropriate to give feedback. Excellent feedback presented at an inappropriate time may do more harm than good. In short, the giving (and receiving) of feedback requires courage, skill, understanding and respect for yourself and others.

Focus feedback on what is said rather than why it is said. When you relate feedback to the what, how, when, where, of what is said [or done], you relate it to observable characteristics. If you relate feedback to why things are said [or done], you go from the observable to the preferred, bringing up questions of ‘motive’ or ‘content’.

D. W. Johnson (1973). Reaching out: interpersonal effectiveness and self actualisation. Englewood Cliffs, New Jersey: Prentice Hall, pp. 15 18.


What do you see?


Principles of Perception

No two people perceive things the same

Perception is highly selective

Perception is influenced by the psychological factors at the time

Information has no inherent meaning, it is open to various interpretations

Simplification of complex information


What we do...

Make assumptions and fill in the gaps

Develop and maintain images of others

Develop and apply stereotypes

Attribute behaviour to personality

Don’t challenge our own misconceptions


Barriers to listening

Overloading

Arguing with the speaker’s logic

Responding to emotionally loaded words

Failing to receive the whole message

External distractions

Internal distractions


Strategies for Better Listening

Reflecting The listener restates the feeling and / or content of what the speaker has communicated and does so in a way that demonstrates understanding and acceptance

Summarising To give a brief restatement of the main themes

Paraphrasing Restating the speaker’s message in your own words, will force you to focus on the message being presented

Feedback To provide constructive information to help another person become aware of how his or her behaviour affects you and how you perceive his or her actions

Minimal encouragers Simple responses that encourage the speaker to tell their story while keeping the listener actively involved in the conversation

Open questions Provide space for the client to explore their own thoughts or feelings


Barriers to Listening

Language - if we talk in jargon - use words or concepts that people are unfamiliar with, use sexist or racist terms, or speak at a level that is either too far above or below those we’re talking to they will ‘switch off’.

Meaning - words and gestures have different meanings to different people.

Perception - we see things through our own filter of race, class, sex, age and personal experiences.

Confused messages

Bias or Prejudice - this prevents people listening to others on the basis of personal, religious, political, sexual or socio-economic grounds.

Pain or illness - when people aren’t well their attention turns inward.

Stress

Fear of change - which can lead to aggression, passivity or defensiveness.

Personality clashes

Noise and distractions

Too much information

Interruptions

Contrasts - between words and behaviour and words and body language. Lack of common interest - if there isn’t any ‘shared ground’ communication can be difficult.

Dislike of the communication channel - if people feel uncomfortable talking on the phone or writing letters they won’t be as free and open as would otherwise be the case: they may sound distant and aloof when they’re really uncomfortable.

Level of self-esteem and self-image

Not listening

Timing and appropriateness - talking about a particular subject at an inconvenient time or an inconvenient place usually leads to hostility, resentment and misunderstanding.

Atwater E. (1981). I hear you: Listening Skills to make you a better manager. Englewood Cliffs, New Jersey. Prentice Hall


Ten Don’ts of Listening

Ten don’ts of listening, which summarise key issues relating to purposes for listening, attitudes to listening and the ability to be empathic listeners:

1. Don’t mistake not talking for listening

2. Don’t pretend to listen

3. Don’t interrupt needlessly

4. Don’t pass judgment too quickly

5. Don’t make arguing an “ego trip”

6. Don’t ask too many questions

7. Don’t ever tell a speaker “I know exactly how you feel”

8. Don’t overreact to emotional words

9. Don’t give advice unless it is requested

10. Don’t use listening as a way of hiding yourself



Listening Skills Checklist

1. Maintain appropriate eye contact with the speaker

2. Orient your body towards the speaker

3. Lean forward to show interest in the speaker

4. Use relaxed gestures to encourage the speaker to talk

5. Do not interrupt the speaker. Do not talk over the speaker

6. Show that you are following the speaker (mm hmm, I see, OK)

7. Pay attention and concentrate on what the speaker is saying

8. Resist distractions in the environment

9. Allow the speaker to talk at his or her own pace

10. Encourage the speaker to talk by nodding your head

11. Appear relaxed and receptive

12. Paraphrase what you understand the speaker’s main points to be and

how the speaker is feeling

13. Ask questions to clarify your understanding of the speaker

14. Adjust a paraphrase if it was not correct

15. Listen for the meaning behind the words

16. Listen for what is not said

17. Do not pass judgment on the speaker’s appearance, accent and so on

18. Do not pass judgment on what the speaker says

19. Manage your own emotions while you are listening: remain calm and attentive


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