Opening and Closing Skills
Opening and Closing Skills
Opening and Closing Skills
LISTENING
SKILLS
• Empathy
• Unconditional Positive Regard
• Genuineness
EMPATHY
• Direct lead
– judgement call to where the patient
should go and ask him to go in that
direction
Indirect lead
• What would you like us to talk
about?
• “Ano ang gusto mong pag-usapan
natin?”
• What can I do for you?
• “Ano ang pwedeng kong gawin
para sayo?”
• yes? ; Go on; uh-hmm; and then?
What is your problem?
“Anong problema nyo?”
• Beware
• threatening to the patient
• two minds - hesitant
• testing - trusted with problem
RUTH SILAN 35 YRS OLD WITH BREAST
CANCER STAGE IV - FUNGATING BREAST
MASS, S/P RADIOTX, REFERRED BY MED
ONCO TO HOSPICE
HUSBAND - DINDO
perception check
• if one is not sure if he understood
the patient well/correctly
• confirm
Perception check
– Same words used, followed by
question
– Is that it?
– Tama ba?
– Orients counselor towards right
direction
– allows patient to restate in
clearer terms what’s troubling
him
Reflecting feeling
– Patient feels a lot of emotions
and not able to clearly
articulate
– articulate the feeling for the
patient
– give a name to the feelings
– cognitive awareness of the
feeling
– patient examines - perception
behind feeling - uncovered
Reflecting feeling
– feelings not articulated and
acknowledge - take control of
behavior
– articulate - allows patient to
take responsibility for the
feeling and for the actions that
he will make as a result of the
feelings
– feelings clearly reflected back =
patient feels understood
Reflecting experience
– Packaging
– Wrapping up all
– Given back to patient
– Making aware of perceptions
and behaviors
– Total picture
Examples
• Nasabi mo kanina na mabigat ang loob mo sa
tuwing nakikita mo ang kabit ng asawa mo. Tama
ba?
• Mukhang napakabigat ang dinadala mo at nakikita
ko sa iyong mga mata ang pagkalungkot sa
nangyari.
• Nung nabanggit ko kapatid mo, biglang may
umagos na luha sa iyong mata. Ano kaya ang ibig
sabihin nito?
Examples
• Sabi mo naiinis ka ngayon dahil dumating
yung byenan mo, nahospital ang pangalawa
mong anak, nahulog ka sa hagdan at
kamuntik na mapilayan, mabarkada anak
mo at gabi na naman umuwi at suspetsa mo
nagda-drugs kasama barkada. Alin dito ang
pinakamabigat dalhin?
Examples
• Nung naramdaman mo yung pagkainis, ano
ang mga naisip mo?
• Ano ang ginawa mo?
• Ano ang iniinum mo tuwing ikaw ay
nahihil?
• Sino ang doktor na nagbigay sayo nito?
CLOSING SKILLS
Interpretative Statement:
You feel badly that you lost control of
yourself last night.
Alternative Interpretation:
You drank until you lost control of your
feelings. As you look back on the evening now
you want to punish yourself for acting in that
childish way.
INTERPRETATIVE
QUESTIONS
• Interpreting done in a form of
questions
• tentative than declarative
• less risky
• Example:
Metaphor
“Most of the time I perceive you as a great
big soft teddy bear who stays in any
position he is placed.”
GUIDELINES: INTERPRETATION
• career
• choosing the person to marry
• choosing friends
• personal choice - limitation (patient may
not follow advice)
• patient may follow advice and fail
• end up putting blame on the doctor
• making patient depend on the doctor, thus
putting the responsibility on the MD
Goal setting
2. INFORMING
- giving of valid information based on
expertise
- correcting misinformation
- ex. Chemotherapy in Lung Cancer
patients
Surgery (amputation) of diabetic foot
Goal setting
• Guidelines
– 1. It should be clear and relevant to the
problem
– 2. Do not overwhelm clients with
information
– 3. Do not use information giving as a
subtle way of pushing your own values
– 4. Be informed, know the sources of
your area of expertise
– 5. Phrase your advice in the form of
tentative suggestions.
Goal setting
B. HELPER SELF-SHARING
• Guidelines
– 1. Sharing should be selective and
focused
– should be towards the target goals and
should not distract patient from looking
into his own problem
– 2. Sharing should not be a burden to the
patient
– 3. Sharing should be done sparingly