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close this bookEducation for Health (WHO, 1988, 274 p.)
close this folderChapter 4: Health education with individuals
View the document(introduction...)
View the documentThe purpose of counselling
View the documentRules for counselling
View the documentDifferent types of counselling
View the documentFacilitating decisions and follow-through
View the documentA sample counselling session
View the documentMore practice in counselling

A sample counselling session

Here is an example of a problem that requires counselling: A teacher has asked a community health worker to talk to one of his students. The teacher tells the community health worker several things about the student. He is seventeen years old. He is intelligent, but lately has missed a lot of time from school. He always seems tired. This is the student's final year, and the teacher is worried that he may not pass his exams.

The discussion that follows shows what the community health worker might do in this situation. Pay careful attention to what he says. Note that he asks general questions to start the boy talking freely. He greets the boy and tries to build up a good relationship. He listens carefully to all that the boy says. No advice is given until the community health worker has heard the whole story behind the boy's problem.

Also the community health worker encourages the boy to think carefully about the problem so that he can understand the cause better and come up with some possible solutions for himself. Remember that people are more committed to solving their problems if they participate in developing the solutions.

If you are with other people, you can use this counselling session as a short play. Ask everyone to read the discussion once. Get two volunteers. One will read aloud the part of the community health worker, the other will read aloud what the boy says. This will be a good way to practice counselling.

Sample counselling session

Health worker:

Good morning. I hope everything is going well with you and your parents.

Boy:

Thank you. Everyone is all right except that Mother has some back trouble.

Health worker:

I believe that this is your last year at school. How are your studies coming along?

Boy:

Well, I usually do fine at school, but you know the last year is always difficult.

Health worker:

Have you been healthy so far this year?

Boy:

Actually, I've been feeling a bit weak and get these headaches. I thought it was probably malaria, but I am not sure.

Health worker:

Malaria is bad at this time of year. Did you take any medicine for it?

Boy:

I've taken the full course of chloroquine tablets about three times so far, but I never seem to get completely well.

Health worker:

The tablets are necessary, but medicine alone cannot solve all our problems. Are you eating well?

Boy:

I think so.

Health worker:

Tell me, what have you been taking for your meals the past few days?

Boy:

My mother always tells us to have a good breakfast, so I make big bowls of cereal for myself and my brothers. Then, too, I always try to buy fruit.

Health worker:

You are saying that you do some cooking and shopping?

Boy:

These jobs are necessary. A few years ago my mother hurt her back. Now it is giving her a lot of trouble. The doctor says she is getting older and there is not much more that can be done. They give her pain-relievers, but the doctor told all of us children to try to help our mother in any way possible. Since I am the oldest, most of the responsibility falls on me.

Health worker:

What other chores do you have?

Boy:

I help prepare the evening meal too. I get the smaller children to clean the house, but I have to watch them to see that they do it well.

Health worker:

With all this work, when do you find time to study?

Boy:

That is a problem. It is really hard to do any serious studying until the chores are done and the younger children have settled down for the night. Then I read for as many hours as possible, or until I just fall asleep at the table.

Health worker:

Where do you actualIy study?

Boy:

As you know, we only have two rooms to live in. One is my parents' bedroom. The other is used for sitting and eating in, and as the children's bedroom. That's why I can't concentrate on my studies until the younger ones are asleep. I even try not to turn the lamp up too bright so they won't wake and disturb me.

Health worker:

I can see that things are difficult for you just now. From what you have said, you are under a lot of stress. I realize that you have duties you must carry out for your family, but I think all this extra work and reading late at night in a poor light have contributed to your feeling of weakness and your headaches. Does this sound reasonable to you?

Boy:

I guess I never thought about it like that before, but it does make sense. I am worried, however. As you said, I do have to do my chores at home. How can I deal with this problem?

Health worker:

First, what do you really want to achieve?

Boy:

I want to pass my exams this year, so I probably need to study more.

Health worker:

And to be able to study more you have to be strong and rested.

Boy:

That's true, so I also have to figure out how to get more rest.

Health worker:

Let us think about when you might find more time to study. You say you prepare the evening meal and do some shopping. What do you do between the time you leave school and the time you start preparing the meal?

Boy:

Usually after school I walk to the market to pick up the few things I may need for the evening meal. There I meet some friends and we talk and play games for a while. Then when I see the sun is going down, I go home to start the meal.

Health worker:

Play is necessary to keep your body fit, but do you think it might be possible to spare some time after school a couple of days a week to do a little reading? Reading in daylight would be better on your eyes than reading by a dim lamp at night.

Boy:

hat makes sense. I really like playing with my friends, though.

Health worker:

I am not saying that you should stop playing, because playing helps keep you fit. But you do have to think about what is most important to you. You do seem worried about your school work. You must decide for yourself what sacrifice you are ready to make for the sake of your studies. Right now you are sacrificing your health.

Boy:

I never thought of it that way, but you are right, I do value my studies and, if I am not in good health, I cannot do well in school. I am sure I could stay after school an extra hour and read at my desk there. No one would disturb me then, and even the teachers might still be around. They could help me with any questions I had. My friends would not miss me for only one hour, so I could join them later. I hope they will not make fun of me for wanting to remain at school.

Health worker:

Do your friends understand the problems you have at home?

Boy:

Of course, they always stop by the house at the weekend to say "hello" to my mother and ask how she is. I guess they would understand and not make fun of me.

Health worker:

Now about weekends. Can you arrange time to study then?

Boy:

Saturday morning is usually taken up with chores. And after that the house is never quiet. The younger children are always running in and out and then there are visitors.

Health worker:

Do you have to stay at home to study?

Boy:

Maybe I could see if some of the classrooms at the school are open, or I could even go out to my father's farm. It is always quiet there. I could take some snacks and sit under those big shady trees.

Health worker:

It's good that you are able to think of so many solutions to this problem. The teacher was right. You are a bright boy. Now I'm interested to know about your younger brothers. How old are they?

Boy:

The next younger is thirteen, and then there are the twins aged nine.

Health worker:

The one who is thirteen -is he also doing well at school?

Boy:

He tries very hard. His grades have been almost as good as mine. He could probably do better.

Health worker:

How old were you when your mother's back trouble began?

Boy:

About fourteen.

Health worker:

And you had to start doing all those chores from that age?

Boy:

Yes.

Health worker:

I was just thinking that if your brother is also a bright boy, and since he is nearly fourteen, maybe he could also start taking on more responsibility in the home. What do you think about this?

Boy:

I have always thought of him as being very young, but, if I could handle the chores at his age, I am sure he could manage too. Maybe we could take turns with the cooking and other jobs. That would be another way for me to get more rest and more time for study.

Health worker:

With all the ideas you have mentioned, I am sure you will have no more trouble with your studies, but please feel free to come to me again if you or any other member of your family has problems. Now, before you leave, please remind me of the things you are going to do to solve your problems. It will help us to make sure that we have forgotten nothing and that we are satisfied with what we have decided.

Boy:

First I need to get more rest and find better times for study. I will stay after school for about an hour so I can read in the daylight. Then at weekends I will go to the farm to read. At home I will get my younger brother to take turns with me in doing the cooking and other chores.

Health worker:

Thank you. That's very good. Now give my regards to your parents.

Boy:

I will. Thank you for your help. Good bye.

In this example the health worker never assumed that he understood the boy's problem until he had enough information. He never forced the boy to take advice. He always encouraged the boy to think about his problem and make his own decisions.

He asked questions that helped the boy to think carefully and seriously about the cause of the problem.

When the health worker discovered that the boy was reluctant to give up his play time, he asked the boy to examine his values. The health worker helped the boy realize what things were really important to him and guided the boy in making choices. A compromise was then reached so that the boy could study more, but not give up playing with his friends.