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Common Counseling Mistakes
- What Not to Say -
A Guide for Long-Term Care Professionals

The following article was provided with permission of the Social Work Consulting Group

Often, in our desire to be positive and helpful, we inadvertently say or do the wrong thing. This is not unique to long-term care professionals. It happens to the very best, highly educated psychotherapists. So, how can we become better counselors? The answer to this question is surprisingly simple. Here are four counseling fundamentals for long-term care professionals:

  • First, contain your desire to share advice. If you find yourself saying, "Well, what I would do is ..." chances are you have stopped listening and empathizing. The resident may perceive this response as insensitive. Instead, listen patiently and reflect on the resident's feelings. "How did you feel when you learned about ..."
  • Second, avoid pat phrases such as, "Oh, I know how you feel." The truth is everyone is unique and everyone experiences traumatic events differently. It is virtually impossible to know how another human being is feeling.
  • Third, be sensitive to the difference in age between the counselor and the resident. In most situations, the counselor is much younger. So, the resident may have some pre-conceived (biased) notions about you such as, who is this young person sitting in my room? She (the counselor) hasn't experienced the pain and misfortune that I have. How will she be able to help me? She has many people like me to see. I wonder if she really cares about me or is just doing what they tell her to do? A young person entering an elder's room "chock full of false enthusiasm and advice" may not only make a bad impression, but be thought of as arrogant and insensitive.
  • Don't feel disappointed if the resident does not make dramatic changes as a result of your support and care. Your primary aim is to be supportive in a way that is tangible and sustaining to the resident, within the constraints of the long-term care setting and your own availability. This is healing by itself, but any change takes time. Most psychotherapists, who have advanced training and experience, think in terms of years for successful therapy, not months, weeks or days.
  • Our best advice is to take the time to learn about the resident. Read the chart, know something about the resident's family or another important bit of information. Focus on sensitivity, empathy and respect. Be mindful of what questions you are asking in an interview and how you are asking those questions. If the person is not able to answer mental status questions discontinue this part of the interview. Not knowing the answer to common knowledge questions can be very humiliating for the person. Quick Reference Counseling Do's and Don'ts:
  • Do listen without your own personal opinions or beliefs.
  • Do encourage the person to freely and openly discuss his or her feelings.
  • Do allow silence. Do not feel obligated to fill uncomfortable silent moments with words. Sometimes these "filler" words sound and feel empty.
  • Do remain nonjudgmental throughout the session. Make sure your values do not enter into the session. Communicate unconditional concern and respect.
  • Do consider answering a question with a question. For example, if the resident says, "All these bad things are happening. What should I do?" It is permissible to reflect the question back to the person, "What do you think you should do?" Yes, the person asking this question needs support and attention from the helper. No, they do not benefit from our advice.
  • Do NOT try to correct or change the person's statement, feelings or opinion.
  • Do NOT respond with empty, vague cliches such as:
     · "Things will get better."
     · "Things are not quite as bad as they seem."
     · "I'm sure it will all work out in the long run."
     · "Give it time."
     · "You must be strong for your family now."
     · "It's in God's hands now. It's God's will."
     · "The bad things in your life are over Now is the time for you to enjoy."
     · "God wouldn't give you anything you couldn't handle."
     · "Life is funny sometimes."
     · "You've had a good life." (How do we really know what type of life the person has had?)
  • Empty cliches often serve to make the situation even worse by creating feelings of guilt and self-doubt within the resident. Imagine how you would feel if a helping professional used these phrases in attempting to help you through a rough time. You would probably feel that your life and losses have been minimized, disrespected and even ignored. In conclusion, it is imperative that the helper demonstrate candor, concern and sincerity. Steps must be taken to avoid being misinterpreted as empty, shallow and hollow during the counseling relationship. Remember, the person's feelings are not right or wrong but they are precious to the individual. Allow people their feelings. Listen and acknowledge their fears, pains and achievements.

    Contributed by: S.C. Greenwald, Victoria Dzierzbicki, Director of Social Services at Meadowbrook Manor of Bolingbrook (Illinois) and the Social Services staff at Meadowbrook manor

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