The first step of counselling is to build a partnership with the patient and, if present, with his/her family. This partnership is the foundation that encourages people not just to participate in health education meetings, but also to engage in all aspects of treatment and care. Developing a trusting and caring environment is needed for this partnership, so that people are more likely to talk about their situation and concerns and receive necessary information. Forming a partnership allows for the sharing of information which is important to the process of counselling. Trust and a feeling of understanding should develop between the patient and the health-care provider.
Understanding is one of the most important elements in forming a partnership. A health-care provider should try to understand a patient’s problems and feelings in a particular situation and should be able to communicate that understanding back to the patient. In order to build understanding, the healthcare provider should: 1) listen and observe carefully, without making judgements, in order to gather information; 2) focus and understand how the patient feels; and 3) talk with the patient to make sure he/she has been understood correctly. This is particularly important because it shows the healthcare provider’s sincere desire to help, develops a full understanding and provides an opportunity for the patient to explain further. This can be achieved by statements such as “it sounds as if the pain is unbearable...” or “have I got it right that you are unable to sleep because of the cough” or “let me just check that...”.
Empathy is not the same as sympathy. Sympathy means, for instance, that a health-care provider feels sad or becomes tearful when a person starts to cry. Understanding does not mean that a health-care provider has to actually “feel” like the person. Instead, the health-care provider has to “understand” how the person might feel (43). For a complete understanding, health-care providers should understand the cultural values and health beliefs of the patients they treat. They need to constantly check that they have understood what the patient explained. This might be a reason why patients continue to seek health advice from faith healers who share a better understanding of the patients’ experiences.
Many of the skills of good communication are important when providing counselling – including active listening, the language used, gestures and body language, and showing genuine interest and care.