Session on Counseling Skills for MI team

Counselling is
the service offered to an individual who is undergoing a problem and needs
professional help to overcome it. The problem keeps him /her disturbed, high
strung and under tension and unless solved his/her development is hampered or
stunted. Counselling therefore is a more specialized service requiring training
in personality development and handling exceptional groups of individuals.

So on 5th
January, we held a T/C with the Bombay MI Office on the very topic and Viji took us through the importance and need for good counselling skills. I have tried
my level best to recollect the session as below:

We work not
only for the patients but for the caregivers who can be family or friends. When
someone is diagnosed with cancer, it affects everyone around the patient. Key
questions going through their minds are “Why me? Will I live?  How long will I live? What does the treatment
consist of? Will I be able to go through with it? Will I be able to attend the
wedding of my son ? Should I discuss this with my mother or son? In one stroke,
patients and their caregivers go from being confident to feeling totally
helpless.  In this session we went
through all the emotions and experiences of those caregivers and patients which
they pass through. We discussed the impact of diagnosis on their lives.

On a day to
day basis, we talk to patients visiting us and also over the phone. There are
times when we get impatient on repeated questions which are very similar
sometimes from the same patient. Here we need to understand that the person
sitting in front of us has cancer and is going through hell and may have other
personal problems also. He/she has severe stress. 

Besides the mental trauma of
the diagnosis which even if curable is a shock to anyone, the patient has to go
through so many tests and then have the agonising wait for test results which takes
them  down physically and mentally. 

Once diagnosed
a patient’s entire role changes. Before diagnosis he may be the main supporter
of the family but afterwards the situation may change and it might become the
other way round. The patient can lose their confidence and self-esteem. They
are distressed and may have reactions like anger, denial, shock, and anxiety.
With proper counselling and an empathic ear, this anger /anxiety may be
converted to an action which can be positive for the patient. It may help them
focus and help them come to terms with their diagnosis better.

The feeling of
fear is present in most patients especially when the diagnosis is given and
when a new treatment plan is discussed with them. It relates to the fear of the
unknown. Patients may think is this report really mine?  Will I have all the side-effects? A good
counselling session should allay the patients fear and anxieties and it’s
important that we hold the patients hand during treatment so they remain
compliant to treatment prescribed by their doctor and do not stop treatment
because of side effects.  Every patient
goes through these conflicting emotions knowingly or unknowingly. The many
unanswered questions can make them lonely and isolated. Patients can sometimes lose
interest in living and get depressed very easily. It is important to identify
this and refer the patient to specialist help.

The attitude
of people towards cancer patients was also discussed. People sometimes sympathize
negatively with the patients and the caregivers.  .  In
such situations the only way to help the patients and communicate with them as
a counselor is to empathise with them and guide them towards having people
around them who are supportive, positive and comfortable with the diagnosis.
Remind them that people may react differently to good/bad news and this is
usually due to lack of awareness. Counsel your patient to stay away from such
people as one can handle them later when one is feeling stronger.
Communication
plays a vital role in our work environment. We have to give patients confidence
that they can trust us. The most important thing in communication is being able
to listen with compassion. We have to get involved in the talk when they are
communicating with us but at the same time we should not intimidate them. Nor
should we criticize them.

We discussed the non-verbal communication
skills. The various forms of it were:

Touch
Through holding of hand we can give that trust to the patients that we are
there for them.
Body language-
folded hands or pushing away form the patient should not be done. Lean towards
the patient while they are talking to show that you are very much interested in
what they are saying.
Facial
expressions
– The attentiveness or the concern can best be depicted in silence
when they are talking.


Respect Privacy
– We have to respect the privacy of the patient which will make the patient
feel more comfortable discussing any things with us. See one patient at a time
and do not answer phone calls.

Eye contact
Keep eye contact with the patients while talking to them. It shows our interest
in listening to them.

Moral support
– We have to provide moral support to patients. Encourage them without being
patronising.  

Encourage the
patient to talk
– Always allow the patient to speak and be a good listener.
Understand/listen to the things which the patient has not even mentioned.

You are there
– Let the patient’s know that we are always there to listen to them, their
problems, to share their feeling.

Understand
We have to think before we react – Understand their situation/problem and then
react.

Tone/ pitch
While communicating over phone the tone matters a lot. That encourages a person
to talk and confide in the person whom he is unable to see.

Clothing – Our
appearance and grooming matters a lot. The clothes we wear to work and on
hospital visits matter a lot. We cannot wear a low neck line salwarsuits
without a dupatta (scarf) or body tight t-shirts or casual jeans. We present
our personality through our clothes and the respect to our work and our patients
and colleagues too.

Awareness – In
our communication we should educate the patients. In office we have so many
posters which tell them to have the medicine daily, return the empty strips,
let us know about change in address and phone numbers and dosage changes too.

While
communicating we should also remember not to give any false hopes or answer
questions which we do not have full knowledge of. It is better to say “I don’t
know” or I’ll get back to you about this” rather than give wrong information. Like
any health related queries should be listened to and guided to the physician. Sometimes
patient asks us many queries-for eg will he be cured, then we need to tell them
 that he should discuss this with the
doctor at the next visit but he must take the medicine regularly which will
help him live life normally and longer.

To
conclude we expect many more such sessions which will help us in  in clear thinking.

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