Listening and Learning

Building Confidence and

Support
 5/1

Listening and Learning

After completing this session
participants will be able to:

 List the 6 listening and learning skills

 List the 6 building confidence skills
 Give an example of each skill
 Demonstrate the appropriate use of the
skills
What is Counseling?
Counseling
is a way of working with people in which
you try to understand how they
feel and help them to decide what
they think is best to do in their
situation.

is a process wherein the provider assists the

client in making a free and informed decision
 Counseling mothers about feeding their
infants is not the only situation in which
counseling is useful.

 Counseling skills are useful when you talk

to patients or clients in other situations. You
may find them useful with your family and
friends or your colleagues at work.
A mother may not talk easily about her feelings,
especially if…
she is shy, and
with someone whom she does not know well.

You will need the skill to listen and to make her

feel that you are interested in her. This will
encourage her to tell you more. She will be less
likely to “turn off” and say nothing.
SKILL 1.

 USE HELPFUL NON-VERBAL

COMMUNICATION
Question:

What do you mean by non-verbal

communication?
Non-verbal communication - means showing
your attitude through your posture, your
expression, everything except through
speaking.
Skill 1
With each demonstration say exactly the
same few words, and try to say them in the
same way, for example:

“Good morning, Susan. How is feeding

going for you and you baby?”

•Posture:

Hinders: Stand with your head higher than

the other person’s
Helps: Sit so that your head is level with
hers.
Skill 1

“Good morning, Susan. How is feeding

going for you and you baby?”

•Eye contact:

Helps: Look at her and pay attention as she

speaks

Hinders: Look away at something else, or

down at your notes
Skill 1
“Good morning, Susan. How is feeding
going for you and you baby?”

•Barriers:

Hinders: Sit behind a table, or write notes

while you talk
Helps: remove the table or the notes
Skill 1
“Good morning, Susan. How is feeding
going for you and you baby?”

•Taking time:

Helps: Make her feel that you have time. Sit

down and greet her without hurrying; then; just
stay quietly smiling at her, watching her
breastfeed, and waiting for her to answer.

Hinders: Be in a hurry. Greet her quickly,

show signs of impatience, look at you watch.
Skill 1
“Good morning, Susan. How is feeding
going for you and you baby?”

•Touch:

Helps: Touch the mother appropriately.

Hinders: Touch her in an inappropriately

way.
Helpful Non-Verbal
Communication

 Keep your head level

 Pay attention
 Remove barriers
 Take time
 Touch appropriately
Non-verbal communication
often demonstrates to a mother or caregiver
our approval or disapproval of a situation. We
should be careful to avoid allowing our own
views on certain subjects, e.g. religion, to be
expressed in a counseling situation where it
might appear as though we are judging a
mother.
Verbal communication:

 Tone of our voice is important. Always try to

sound gentle and kind when talking to mothers.

 Try to find out how people feel. We need to be

interested and to probe beneath the surface if
we wish to learn their real worries and their
concerns.
SKILL 2

ASK OPEN QUESTIONS

 To start a discussion with a mother, or to take a
history from her, you need to ask some
questions.

 It is important to ask questions in a way that

encourages a mother to talk to you and to give
you information. This saves you from asking too
many questions, and enables you to learn more
in the time available.
Skill 2
2.1 Ask Open Questions:
Health Worker: “Good morning, Julia. I am
Bea, the community midwife.
How is baby Gerald today?”
Mother: “He is well, and he is very hungry.”
Health Worker: “Tell me, how are you feeding him?”
Mother: “He is breastfeeding. I just have to give
him one bottle feed in the evening.”
Health Worker: “What made you decide to do that?
Mother: “He wants to feed to much at that time, so
I thought that my milk is not enough.”
Open questions are usually the most
helpful.
To answer them a mother must give you
some
information.
Open questions usually start with
○ How
○ What
○ Why
○ Who
○ When
○ where
2.2 Ask Closed Questions:
Health Worker: “Good morning, Julia. I am Bea, the
community midwife. Is baby Gerald well?

Mother: “Yes, thank you,”

Health Worker: “Are you breastfeeding him?”
Mother: “Yes”
Health Worker: “Are you having difficulties?”
Mother: “ No.”
Health Worker: “Is he breastfeeding very often?”
Mother: “Yes”
 Closed questions are usually less helpful.
They tell a mother the answer that you
expect ,and she can answer them with a
‘Yes’ or ‘No’.

 Closed questions usually start with words

like “Are you?’ or ‘Did he?’ or ‘Has he?’ or
‘Does he?’
SKILL 3

USE RESPONSES AND

GESTURES WHICH SHOW INTEREST
Skill 3
Using Response and Gestures Which Show Interest
Health Worker: “Good morning, Julia. How is Gerald
now that he has started solids?”
Mother: “Good morning. He is fine, I think.”
Health Worker: “ Mmm.” (nods, smiles)
Mother: “Well, I was a bit worried the other day,
because he vomited.”
Health Worker: “Oh dear!” (raises eyebrows, looks
interested.)
Mother: “I wondered if it was something in the
stew that I gave him.”
Health Worker: “Aha!” (nods Sympathetically).
 If you want a mother to continue talking, you
must show that you are listening and that you
are interested in what she is saying.

 Important ways to show that you are listening

and interested are:

With gestures, for example, look at her, nod and

smile.
With simple responses, for example, you say
‘Aha’, ‘Mmm’, ‘Oh dear!’.
SKILL 4

REFLECT BACK
WHAT THE MOTHER SAYS
Reflecting Back
Health Worker: “Good morning, Julia. How are you
and Gerald today?”
Mother: “He wants to feed too much – he is
taking my breast all the time!”
Health Worker: “Gerald is feeding very often?”
Mother: “Yes. This week he is so hungry. I think
that my milk is drying up.”
Health Worker: “He seems hungrier this week?”
Mother: “Yes, and my sister is telling me that I
should give him some bottle feeds as
well”
Health Worker: “Your sister says that he needs
something more?”
Mother: “Yes. Which formula is best?”
 Health workers usually ask mothers a lot of
factual questions. However, the answer to factual
questions are often not helpful. The mother may
say less and less in reply to each question.
 It is more useful to repeat back or reflect what a
mother says. This is another way to show you
are listening and encourages the mother or
caregiver to continue talking and to say what is
important to her. It is best to say it in a slightly
different way, so that it does not sound as
though you are copying her.
SKILL 5

EMPATHIZE- SHOW THAT YOU

UNDERSTAND HOW SHE FEELS
 Empathy is a difficult skill to learn. It is
difficult for people to talk about feelings. It is
easier to talk about facts.

 When a mother says something which shows

how she feels, it is useful to respond in a way
which shows that you heard what she said, and
that you understand her feelings from her point
of view.
Sympathy:

Health Worker: “Good morning, Julia. How are you and

Gerald today?”
Mother: “Gerald is not feeding well. I am worried
he is ill.”
Health Worker: “I understand how you feel. When my
child was ill, I was so worried. I know exactly
how you feel.”
Mother: “What was wrong with your child?”
Empathy:
Health Worker: “Good morning, Julia. How are
you and Gerald today?”
Mother: “He is not feeding well, I am
worried he is ill.”
Health Worker: “You are worried about him?”
Mother: “Yes, some of the other children in the
village are ill and I am frightened he may
have the same illness.”
Health Worker: “It must be very frightening for
you.”
 For example, if a mother says: “My baby
wants to feed very often and it makes
me feel so tired!” you respond to what
she feels, perhaps like this: “You are
feeling very tired all the time then?”

 Empathy is different from sympathy.

When you sympathize you are sorry for
a person, but you look at it from your
point of view.
 If you sympathize, you might say: “Oh I
know how you feel. My baby wanted to
feed often too, and I feel exhausted.”

 This brings the attention back to you,

and does not make the mother feel that
you understand her.
 So empathy is more than reflecting back
what a mother says to you.

 It is also helpful to empathize with a

mother’s good feelings. Empathy is not
only to show you understand her bad
feelings.
SKILL 6

AVOID WORDS WHICH SOUND JUDGING

Using Judging Words:
Health Worker: “Good morning, Julia. Is Gerald
breastfeeding normally?”
Mother: “Well – I think so.”
Health Worker: “Do you think that you have enough
breast milk for him?”
Mother: “I don’t know.. I hope so, but maybe not..”
(she looks worried)
Health Worker: “Has he gained weight well this
month?”
Mother: “I don’t know..”
Health Worker: “May I see his growth chart?”
Avoiding Judging Words:

Health Worker: “Good morning, Julia. How is

breastfeeding going for you and Gerald?”
Mother: “It’s going very well. I haven’t needed to give
him anything else.”
Health Worker: “How is his weight? Can I see his growth
chart?”
Mother: “Nurse said that he gained more than half a kilo
this month. I was pleased.”
 ‘Judging words’ are words like: right, wrong,
well, badly, good, enough, properly.

 If you use judging words when you talk to a

mother about feeding, especially when you ask
questions, you may make her feel that she is
wrong, or that there is something wrong with the
baby. A breastfeeding mother may feel there is
something wrong with her breast milk.
Summary
LISTENING AND LEARNING
SKILLS
 Use helpful non-verbal communication
 Ask open questions
 Use responses and gestures which
show interest
 Reflect back what the mother says
 Empathize- show that you understand
how she feels
 Avoid words which sound judging.
Build Confidence and give
support
YOUR communication skills can help
a mother feel good about herself
and confident that she will be a
good mother.

Confidence can help a mother to

carry out her decisions and to resist
pressures from other people.

To build confidence and support we

need additional skills…
1. Accept what a mother thinks and
feels

Accept mother’s ideas and feelings

Without agreeing
Without disagreeing

ACCEPTING is NOT AGREEING that she

is right
ACCEPTING - helps her to trust you
Skill 1: Accepting what mother’s thinks

A.
Mother: “My milk is thin and weak, and so I have
to give bottle feeds.”

Health Worker: “Oh no! Milk is never thin and

weak. It’s just looks that
way.(nods, smiles)
Skill 1

B.
Mother: “My milk is thin and weak, and so I have
to give bottle feeds.”

Health Worker: “Yes – thin Milk can be a problem”

Skill 1

C.
Mother: “My milk is thin and weak, and so I have
to give bottle feeds.”

Health Worker: “I see. You are worried about your

milk”
Skill 1: Accepting what mother feels

D.
Mother(crying): “It is terrible, baby Gerald has a
cold and his nose is completely
blocked and he can’t
breastfeed. He just cries and I
don’t know what to do.”

Health Worker: “Don’t cry – it’s not serious. Baby

Gerald will soon be better”
Skill 1

E.
Mother(crying): “It is terrible, baby Gerald has a
cold and his nose is completely
blocked and he can’t
breastfeed. He just cries and I
don’t know what to do.”

Health Worker: “You are upset about baby Gerald

aren’t you.”
2. Recognize and acknowledge what is
right
Case study
A baby being weighed, and his mother.
The baby is exclusively breastfed. Beside the
mother and baby is the baby’s growth chart.
His growth chart shows that he has gained a
little weight over the last month. However, his
growth line is not following the reference
curves. It is rising too slowly. This shows that
the baby’s growth is slow.
 Which of these remarks will help to
build the mother’s confidence?

•“your baby’s growth line is going up too

slowly.”

•“I
don’t think your baby is gaining enough
weight.”

•“yourbaby gained weight last month just on

your breast milk.”
3. Give Practical help
Case study
“This mother is lying in bed
soon after delivery. She looks
miserable and depressed. She is
saying to the health worker: “no, I
haven’t breastfed him yet. My
breasts are empty and it is too
painful to sit up.”
Which response is more appropriate

•“you should let your baby suckle

now to help your breast milk to come
in.”

•Let me try to make you more

comfortable, and then I’ll bring you a
drink.
4. Provide relevant
information using suitable
language
 Find out what she needs to know at
this time.

 Use suitable words that the mother

understands

 Do not overwhelm her with

information
Case study
This baby is three months old. His
mother has recently started giving
some formula feeds in the bottle in
addition to breastfeeding. The
baby has developed diarrhea. The
mother is saying to the health
worker: “He has started to have
loose stools. Should I stop
breastfeeding?”
Which response gives positive
information

 “it is good that you asked before

deciding. Diarrhea usually stops
sooner if you continue to
breastfeed.”

 “oh no, don’t stop breastfeeding.

He may get worse if you do that.”
5. Make suggestions rather than
commands
Provide choices and let her decide
what will work for her.
 Do not tell her what she should do
or must not do.
 Limit your suggestions to one or
two suggestions that are relevant
to her situation.
Case study
Health worker: “good morning Julia.
What can I do for you today?
Mother: “can you tell me what you
asked me what foods to give my
baby, now that she is six months
old.”
Health worker:
I am glad that you asked. Well now, the situation
is this. Most children need more nutrients than
breast milk alone when they are six months old
because breast milk has less than 1 milligram of
absorbable iron and breast milk has about 450
calories, so less than the 700 calories that are
needed. The vitamin, a needs are higher than are
provided by breast milk and also the zinc and
other micronutrients.”

“However, if you add food that aren’t prepared in

a clean way it can increase the risk of diarrhea
and if you give too many poor quality foods the
child won’t get enough calories to grow well.
6. Arrange follow up and on-
going support
 Learn what help may be available
 Offer a time to see her / talk with her
 Encourage her to see you if she has doubts or
questions.
 Refer her to a community support group
 Refer her for more specialized counseling.
 Many women are not able to do what they want
to do or what you may suggest they do.
Case study
Amy breast feeds only four times a day,
and she is gaining weight too slowly.
Her mother thinks that she does not
have enough breast milk.

Responses:
• “You must feed Amy at least 10 times a
day.”
• “It might help if you feed Amy more
often.”
Summary
• Accept what a mother thinks and feels
• Recognize and praise what a mother and
baby are doing right
• Give practical help
• Give a little, relevant information
• Use simple language
• Make one or two suggestion, not
commands