R. Pattammal,
Incharge of MLOP Manual,
Aravind Eye Care System.

People from diverse educational and economic backgrounds come to an eye hospital for treatment. Patients need to have a clear understanding of their eye ailment. Counselling is a helping process through which a counselor assists a client in solving his/her problems. The counselor should not cause unnecessary anxiety to the patient but at the same time help the patient to understand the critical condition.

The counselling relationship is one where the counselee and counselor work together at problem solving. In an eye hospital the counselor furnishes the appropriate information and guidance as well as counselling. To be an effective counselor one needs to possess certain basic skills, as illustrated further with suitable examples.

To be an effective counselor the following skills are essential:

Relationship building skills:

• Acknowledging the uniqueness of the patient
• Employing appropriate eye contact
• Listening with interest and empathy
• Communicating acceptance and support
• Responding with warmth and caring

The counselor has to establish a rapport with the patient and give him /her confidence to accept the counselor . T he patient must be treated courteously and made to feel comfortable in the presence of the counselor. According to the age, educational status, and profession of the patient, the counselor has to open the conversation instead of directly informing the patient about his illness. Without a frown or a discomfiting look proper eye contact must be established.

Reading the case sheet and writing the details in the register and talking to the patient at the same time will not give desired response from the patient. The patient may assume that either the counselor avoids him due to some reason or may not be sure about what he speaks.

Listening plays a very important role. Listening disinterestedly will upset the patient. Interest and enthusiasm should be expressed in an appropriate manner, which will build confidence in the skills of the counselor to help resolve issues. While listening to the patient many details could be gathered; this will be later very useful in convincing the patient to accept surgery or treatment.

If the counselor were to monopolize the conversation the patient may feel discouraged and avoid  sharing important details that may adversely impact the resolution of the problem It is therefore imperative that a counselor be a good listener.

It is important to e mpathize with the patient and view his problems in the right perspective. Communicating the necessary details and enabling him understand them correctly is a skill that a counselor should posses. While communicating, the doubts of the patient have to be clarified suitably. The patient should not be made to feel inferior for having asked a question. For e.g. a p rofessor may enquire about the cataract surgery procedure (“Will they remove the eye to place the lens?”) The counselor should offer the right answer in a professional manner and avoid displaying any other emotion which could upset the client. A candid tactful answer will inspire confidence in the counselor.

The patient always expects warmth and caring from the counselor. They expect the counselor to answer all their queries. The counselor has to respond without anger or irritation.

Data gathering skills:

• Understanding the patients's feelings, concern and perspectives
• Asking appropriate questions
• Assisting the patient
• Summarizing the content of what the patient says and feel

As the patient enters the hospital he will have a lot of doubts and will be in a confused state. The doctor may not have the time to explain all the details to the patient. So, the patient expects the counselor to clarify all his doubts. The counselor should understand the feelings of the patient. For e.g. A lady patient may postpone her surgery due to some function but she may have a matured cataract for which the surgery cannot be postponed. The counselor has to explain the consequences of the postponement of the surgery and try to convince the patient and get her consent for surgery. If the patient all efforts the counselor should not express dissatisfaction either through gestures or words. The patient must be advised to not avoid the surgery but, accept it as early as possible! Though the counselor is to establish a rapport with the patient, she has to ask only appropriate questions. Unnecessary questions are to be avoided.

The counselor is to assist the patients in selecting the correct procedure. Sometimes when there is more than one option, the patient may find it difficult to make a choice . The counselor can describe the benefits of different options and help the patient arrive at a decision.

Supportive tension reduction skills:

• Appropriate touch
• Moderate rate of speech
• Expressing optimism
• Reviewing progress

As mentioned earlier the patient may be tense about his/her eye disease; it is the duty of the counselor to reduce their tension through communication.  A gentle tone, use of appropriate words delivered in clear moderate speed would help them relax Optimistic words should be used; pessimistic remarks about either the disease or the treatment should be avoided. According to the age and gender of the patient the counselor can touch the patient and give him/her the confidence to accept the treatment. When patients come for a review encouraging words must be used which will motivate them to continue their treatment. For e.g. r etina patients are to be encouraged to come for review and they will do it only with effective counselling.

Perceptive skills

This skill is necessary to help the patient develop new insights, to increase their motivation and to secure their attention.

It is a skill to be possessed by a counselor to help the client recognize inappropriate reactions. For e.g. a s soon as the doctor suggests cataract surgery, the patient may become dejected and may imagine bizarre things and may convey the same to the counselor. Now, it is the counselor’s skill to make the patient realize that his reaction is inappropriate. Patients may assume that the eyeball will be removed during the surgery and after placing the lens, the eye will be placed back. The counselor must explain the procedure in a manner that does not upset the patient.

Directive skills:

• Increasing the client’s ability to resolve problems
• Providing information
• Offering suggestions

Instead of selecting an option on behalf of the patient, the counselor must provide the patient with all the options to help him make a choice . Cataract surgery could be done with ordinary lens, foldable lens and imported lenses. Patients can stay in three different types of rooms- based on their capacity to pay and inclination, the patients can choose a room. Suggestions could be given by the counselor but the final decision is to be taken by the patient.

A good counselor must possess these skills to be effective. They can be sharpened through interaction, reading appropriate literature, listening to people and attending workshops and seminars to up date their knowledge in counselling.