Lecture # 005:
Communication Skills of the
Rehabilitation Counselor

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

The sharing of information is a basic human activity. We exchange information in many different ways - verbally, through the body by the way we use it and our faces, and in writing. In speech, especially when communicating about God and His Word, we try to be very clear and choose our words carefully. As James said in James 3:1, those of the faith who teach will be judged more strictly.

Our bodies show what we are thinking or feeling. Show me surprise on your face! Sadness, happiness, tiredness. Do you remember or do you see these emotions on the faces of people you met or live with? At times, it seems that the face shows a person's innermost being. Even though he/she may not say anything, their thoughts, which have been with them in their minds are reflected on their faces. I find that in Russia, faces are often a mask, not showing any emotion, and therefore it is difficult to know what the other person is thinking. If my Russian friends are at home in their apartments, they are more animated.

Another aspect of speech is how we say what we want to say. We may ask our friend not to bother us because we are studying, in either a quiet, firm way, or we may shout angrily at him. This type of communication is especially important when talking to children since they need to know that they are loved, but they cannot do everything. Another aspect of speech is to use a tone of persuasion or excitement. This type of voice tone is used in preaching and teaching. We can also make our voices sound sad by lowering them and making the words lengthen.

Meditate Word By Word On These Verses:
Acts 4:7-14.

Speech also changes according to our emotions. If we are excited, our speech is often fast and we end the words abruptly. Think of telling a friend about a surprise you received. Sometimes when we have this emotion, we talk so fast that it is difficult for others to understand what we are saying. If a person is depressed, speech may be very slow or not used at all. The person may simply point or sit. If we are saying something that is important to us and to the person we talk with, we talk slowly and ask if the person understands us.

The way we walk or use our bodies also communicates. The tired man may walk slowly and be bent forward. The happy person may stand straight and walk briskly. If one is thoughtful or in deep conversation with another while walking, usually the walk is slow and two people lean toward one another to heard and share thoughts only for themselves. Sometimes with disabled people it is very difficult to understand their body language. For example if a child has cerebral palsy, he/she may not be able to control body movement showing what he/she is thinking. The counselor must ask for a verbal understanding of what the cerebral palsied person thinks. The blind person may take a few seconds to register his facial emotions because his reaction is different from ours. He/She must gather data not from sight, but from the words and sounds associated with a conversation. God has given us many ways to communicate how we feel and think.

Question 1: Communication with others is:
(One or more of the following answers may be correct.)
by our facial expression,
by tone of voice,
by posture of the body,
by singing a song.

Probably the most important aspect of communication is listening. Often times it is hard to listen to the handicapped or even a normal person as he/she speaks. Our attention span is not long, usually for a lecture class, the maximum length of concentration is one hour and a half for adults. For children, the length of concentration is 15 minutes. Our thought processes can change to other topics as fast as every 30 seconds. Do you understand why it is so difficult to read the Bible quietly and meditate on it? Sometimes it helps our concentration to read the Bible out loud.

Question 2: We must be careful when sharing Scripture or other knowledge because:
(One or more of the following answers may be correct.)
the person does not always understand as we understand,
his background in a certain topic may be limited,
we are more knowledgeable than most people.

In a counseling situation, listening is an active process. It involves not making judgments and focusing on the person to hear the content, feeling, and reason for the feeling in the client's experience. Listening gives the hearer or counselor what is needed to respond to what the client thinks deeply inside. It has been said that listening skills are demonstrated when the counselor can answer in detail the question, "What is going on inside this person right now and in his/her life space?" Listening involves several skills and to use them the counselor must want to understand and communicate with a client to build a relationship of trust and acceptance. This process is sometimes called "a personal story". It is an opinion that a pastor or counselor must know the "story" of every person in his congregation. Without this knowledge, I don't think people's need can be met in preaching or counseling sessions.

The following are types of communication strategies used when you are listening to a client:

1. Simple phrases such as "and then" or "tell me more" may be used. Leaning forward indicates interest and nonverbal messages such as nodding or smiling send a message of interest.
   
   
2. Use Questions to obtain more information and demonstrate empathy and respect.
   
   Types of questions:
   • Open Ended - an inquiry in which there are many possible answers the person may answer. They begin with: How, What, When, Why, Can you tell me, Can you give me an example?
     
     
   • Close Ended Questions - ask for specific answer such as "yes" or "no" or facts. They may also be used to make a definite answer, for example - you say, " I am still not understanding what you are saying. Are you saying that your family cares for you OR that they don't care for you?"
     
     
   • Focused Questions - ask specifically about data. They require more than a simple "yes" or "no" answer. For example, if insufficient detail is given, you may ask this type of question. The client may say, "I have trouble making the right choice" and the question you ask is "What happens when you try to make the right choice?"
     
     
3. Restating: All or part of the person's message is said exactly as stated. It is used for emphasis or clarity. The client says, "I am no good." And the response is, "You say you are no good" with the hope that the client will go on to explain his opinion of himself. This must not be used frequently and often it is used when the client makes a surprising statement.
   
   
4. Paraphrasing: The client's words are rephrased into a similar statement of meaning. The purpose is to give other words to what was said and this demonstrates interest and attention. Usually the paraphrased statement is shorter than the original.
   
   
5. Clarifying: The client is asked to expand on a previous thought he stated. It is useful if the client is not talking logically. You might say, "You talked about having a difficult time in school, can you give me an example of what you mean?"
   
   
6. Reflecting: A strategy to help the other person focus on feelings about a situation he is in. When using this strategy, it is helpful to note the nonverbal behavior and facial expressions. An example is that a client states, "My mother died in May and my child was diagnosed with cancer in July." The reflecting response is, "You have had a difficult life recently". It is never proper to add an interpretive statement that goes beyond the facts such as: "You are not coping with the life problems you have had recently."
   
   
7. Silence: A brief pause in which the person and counselor do not speak, but feelings remain present. Silence allows the speaker to think about what has been said without your verbal comment. It is helpful to use when a person is talking about emotions or when he/she is crying.
   
   
8. Summarizing: Makes a statement about the content of what has been said. It takes the various themes of the conversation including emotions and makes a whole statement about them. The following is an example: "It sounds as if you may have difficulty helping your mother because you live far from her, you have small children and you work, but you feel an obligation to her because she is now sick."

Question 3: Which of the above strategies for listening would you use with a person who has just learned that he will die in a few weeks?

Question 4: Which ones would you use in talking to a depressed person?

There are also other verbal interventions that are used as you talk with a person. They are as follows:

1. Reinforcing the strengths of the other person - It is important for the client to recognize and use his strengths. You may say, "You have a good sense of humor (or judgment, what is the right thing to do, understanding). Strengths can include personal characteristics, social support of others, knowledge of community resources.
   
   
2. Confronting - Sometimes the client's behavior such as hostility, verbal abuse to you, or seductive actions. You might say, "I would like to help you, but your language is offensive to me and I cannot work with you when you use it. You know language that does not contain swearing, don't you?"
   
   
3. Setting Limits - This involves two processes. The first is when the client excessively blames himself or others or has aggressive feeling toward himself or others. You may say, "I know that you think your parents are the reason for all your problems, but let's talk about what you do that causes them to be angry with you." This intervention also refers to the amount of time you may have to counsel. For example, you may say, "I have an hour to talk with you today and so what is the most troubling problem for you?"
   
   
4. Giving Constructive Feedback - This intervention helps a client change distorted patterns of thinking, feeling, and behaving. For example a client may say, " I know that my mother hates me and I hate her too." The counselor may ask, "How do you know that your mother hates you, did she say that or how does she show you that she hates you?" This helps the client to clarify what he said or expand on why he thinks what he does.
   
   
5. Redirecting - This directs the person back to the main thought of the conversation. For example, the person may begin talking about his father and then talk in great detail about his father's job when the subject of the conversation is his relationship with his father. In this case, you may say, "Your father's job is interesting, but I think we were talking about how you and your father talk to one another. Can we talk about that now?"
   
   
6. Modeling - Puts into words or behavior to help the client see what a dialogue or behavior looks like before it happens again. Another name for this is role-playing. For example, a teen-ager may act out what he/she is going to say when another student accuses him/her of lying. This can also be used in finding a job - that is, how to answer questions that the employer may ask.
   
   
7. Use of metaphors - These are figures of speech that carry meaning and emotional feelings from one situation to another. In the Bible a "metaphor" is called a "parable." They may offer insight and voice that which has been silenced in a person's life.
   
   
8. Humor - In an intense moment you can use it to give new insights.
   
   
9. Coaching - Gives the client suggestions, monitors, and evaluates behavior changes. It reinforces a decision that has been made. For example, if a student must talk with a teacher about a grade that he received on an examination, the student needs to evaluate the teacher's response to such questions, choose the words carefully, and practice using his approach on the counselor. If the client needs a new behavior, this is excellent practice.

Question 5: A person is going to interview for a job: which of the above interventions would you use?

Question 6: You visit an older woman in your church to find out how you may help her, but she talks only of how her children do not visit her. Which of the above interactions would you use in talking with her?

I want to say that most often what I have seen in the university setting in Russia is an authoritarian type of communication. The person in authority commands the rest of the staff or students to do something and often offers a punishment if it is not done. This may be the Russian way of doing things, but it does not lead to logical thinking or effective decision making of the staff or the student. What we want as Christians are people who are responsible to God for their actions and behavior toward others and themselves.

Question 7: Look at the metaphor about children and sheep in Mat. 18:1-14, and the metaphor about the body in 1 Cor. 12:12-27. How would you use these with a person who has had an amputation?