Pauline Mawson, Clinical Psychologist

Tel: 011 894 8216/011 898 6540
Fax: 086 573 3370
Pr: 0341304

Medicross Clinic
Cnr Trichardt & Northrand Road


Basic counselling Skills

Summary of presentation


The aim of these training sessions is to provide you with the necessary basic skills to enable you to interact effectively with the Adolescent State Patients.

As the programme in the ward is aimed at treatment and rehabilitation and no longer observing the patients, learning and enhancing some of the skills that will be taught today and over the course of the next few weeks is crucial to the way in which we as staff members interact with the patients.

Some of the skills that you will be taught include ethics, empathy, being able to actively listen to your patient/client with a non-judgmental approach. These skills require knowledge around open and closed questions, observation, paraphrasing and summarizing of both the content of what your patient/client has said and his/her feelings.


Each profession has their own set of Professional Ethical Codes. When it comes to Basic counselling, there are a few ethical guidelines that are generic:

  • Competency
  • Informed Consent
  • Confidentiality
  • Limits on Confidentiality
  • Research and audio-taping/videotaping
  • Harm or exploitation of patients/clients (Diversity and multiculturalism)

Attending Behaviour

It is essential to "hear" what your patient/client is telling you. Attending behaviour encourages your patient/client to talk, communicates to them that you are listening and assists in establishing a sense of rapport with the patient/client.

Attending behaviour can be achieved through various skills:

The "Three V's" and "B" (Ivey & Ivey, 2003):

  • Visual/eye contact
  • Vocal Qualities
  • Verbal Tracking
  • Body Language

Empathy & Non-Judgmental Behaviour


  • Empathy vs Sympathy
  • Basic Empathy (Ivey & Ivey, 2003)
  • Additive Empathy (Ivey & Ivey, 2003)
  • Respect, warmth and positive regard
  • Authenticity

Non-Judgmental Behaviour

  • Own values, belief system, opinions
  • Understanding of patient/client

Questions: Open vs Closed

The types of questions that you ask a patient/client will determine the type of response that you get. Different situations negate different types of questioning, but the focus here will be on the types of questioning during counselling.

Open Questions:These allow the patient/client to talk more freely and usually encourage them to provide more information. Sentences starting with what, how, why or could questions will facilitate deeper exploration of the difficulty that the patient/client may be experiencing (Ivey & Ivey, 2003).

Closed Questions: These have the advantage of focusing an interview, but in counselling often cause the patient/client to close up and may render the rest of the session not particularly beneficial. Sentences that start with is, are or do are considered closed questions and can be used to obtain important specifics.

pauline mawson

Observation Skills

These skills are vitally important in working with your patient/client in the "here and now" and allow you to respond appropriately (Ivey & Ivey, 2003). Observation skills allow you to take note of both the verbal, and what is sometimes more important in counselling, is the non-verbal information that your patient/client portrays to you.

Nonverbal Behaviour (Ivey & Ivey, 2003)

  • Body language
  • Facial Expressions
  • Appearances and grooming

Verbal Behaviour

  • Refer to previous section on Attending Behaviour –vocal qualities

Paraphrasing and Summarizing

One of the essential components of effective counselling is being able to access your patients/clients world and truly understand how they experience their difficulty. It is also essential that they feel that you truly understand how they experience things. This can be achieved through the use of paraphrasing and summarizing what your patient/client has just told you and feeding it back to them, not necessarily in the way in which they told you.

Paraphrasing:this process feeds back to the patient/client the essence of what has been said (Ivey & Ivey, 2003), through shortening and clarifying what has been said. Not parroting. (Practical example).

Summarizing: Similar to paraphrases, but used to clarify what the client/patient has said over a longer period of time, especially at the end of a long paragraph or as a transition to a new topic (Ivey & Ivey, 2003). Assists in organizing complex issues or when a client/patient has a lot to say. (Practical example).

Feelings: Observing and Reflecting

This can be the more difficult task of counselling. Sometimes a patient/client presents to us with a difficulty that even they themselves are trying to make sense of. Feelings are sometimes hidden within the content of what the patient/client talks about and it is our job to make these feelings explicit and clear to the patient/client.

In order to achieve this you need to observe the patients/clients tone of voice, body language etc. In order to pick up what type of feeling they are communicating to you.

Once you have identified the type of feeling being communicated you can reflect on it.

Some useful techniques in reflecting feelings (Ivey & Ivey, 2003):

  • Sentence stem e.g. begins with the reflection of a feeling "It looks like you feel…"
  • Feeling words: assist patients/clients in identifying their own emotions e.g. "It seems like you’re feeling angry" or "Perhaps that made you feel both sad and irritated".
  • The tense is important e.g. "You seem to be angry right now" vs. "When that happened you were angry".
  • Check with the patient/client e.g. "You seem sad today –am I hearing you correctly?"

Conclusion and References

In conclusion, it is important to note that none of these skills are used in isolation but are integrated and used together. The skills have been outlined individually in this presentation as it is important to practice and understand each skill before integrating them.


Ivey, A.E. & Ivey, M.B. (2003). Intentional interviewing and counselling:Facilitating client development in a multicultural society(5thed.). Brooks/Cole: California.