Barriers to Effective Counseling
To a great extent, the counseling process is concerned with effective communication.  Therefore, many of the barriers to effective counseling are those related to communication.
Often barriers interfere with the counseling process because they prevent the patient/client from being able to make free and informed decisions about the course of treatment, how to act on them and to continue using them.  When there are barriers the patient/client will not disclose her/his feelings and concerns fully enough for you to be able to give the necessary assistance and guidance.

Activity 12: Barriers
Before you continue reading this section do Activity 11 as a group exercise, it should take you 5 minutes to complete.

Imagine you receive a patient/client in your Health Unit, what would you consider as barriers to effective counseling of this patient/client.
Activity Feedback: (Click here to reveal)



Let us now discuss each of these barriers one by one.

Physical Barriers
Physical barriers refer to environmental factors that prevent or reduce opportunities for the communication process to occur.  They include:

  • A counseling room which does not offer privacy;
  • Poor lighting;
  • Dirty and untidy room;
  • Distracting noise;
  • Extreme temperatures;
  • Uncomfortable seating arrangement;
  • Distractions in the room such as equipment and visual aids;
  • Objects and chemicals which are dangerous to the patient/client.

If the room where you serve patients/clients at your health unit has any of these barriers you should do something to improve it.

Differences in Social and Cultural background
When a patient/client is from a different nationality, race or ethnic group, it may be difficult for you to know the patient/client’s beliefs, taboos and cultural practices. The patient/client may not be able to take action because perhaps the information you give him/her does not tally with his/her beliefs, taboos etc. As a good counselor you should endeavour to know a patient’s/clients’ cultural background before you start a counseling session.

Non-Verbal Communication
Non-verbal communication involves all the little things you do while you talk to a patient/client. It includes:

  • Gesturing
  • Frowning
  • Showing signs of boredom or humour
  • Showing signs of disgust
  • Displaying signs of despise towards a client
  • Nodding the head
  • Shaking the head

Some non-verbal communications are negative while others are positive.  Nodding the head is a positive non-verbal communication.  Gesturing can be both positive and negative non-verbal communication. Therefore, try to make good gestures which will demonstrate your interest, concern and understanding of the patient’s/client’s expressions. These may be a smile or occasional nodding in appreciation of what a patient/client tells you.

Barriers caused by patient/client
Let us now look at some of the barriers that may be caused by a patient/client.  These are:

  • Lack of interest in being counselled
  • Patient’s/client’s appearance to you (impression)
  • Patient/client’s emotions

It is important that you motivate your patients/clients and arouse their interest as soon as you start the counseling session.  Use of visual aids helps arouse patients’/clients’ interest. It also stimulates active thinking and learning while providing a shared experience.  Lack of interest makes a patient/client inattentive and biased in thinking. If there is something disturbing a patient/client, such as a family or social problem, you should be able to identify it.  If you think the patient/client is so disturbed that they cannot benefit from the session, you should postpone it to another day.  If you fail to handle your patient/clients problem they may never come to back to see you again. We hope you are now well prepared to counsel malaria patients/clients.  Next, let us consider the IEC messages you should give on malaria prevention and control.

We have come to the end of this unit on Counseling.  In this unit we defined counseling as a face-to-face communication between a counselor and a patient/client which aims at helping the patient/client understand their problems and make informed decisions for change. We said that counseling is psychological therapy and should be given to all patients suffering from malaria.  We also discussed the qualities of a good counselor and the skills in counseling. Finally, we explained the barriers to effective counseling, which included physical barriers, differences in social and cultural background, non-verbal communication, and barriers caused by patients/clients.You should now review the learning objectives at the beginning of this unit to check whether you are up-to-date with basic knowledge about counseling and health promotion in Malaria.  If you are not sure about any of the objectives go back to the relevant section and read it again.  If you feel confident that you have achieved all the objectives, complete the attached Tutor Marked Assignment attached before you proceed to the next unit.  Remember to also do the practical assignment given below.