Topic 5 Other special communication techniques in a health behavior change and counselling session

Non-verbal communication

A substantial portion of our communication is nonverbal. Experts have found that every day we respond to thousands of nonverbal cues and behaviors including postures, facial expressions, and tone of voice. Nonverbal communication types include facial expressions, gestures, paralinguistics such as loudness or tone of voice, body language, proxemics or personal space, eye gaze, haptics (touch), appearance, and artifacts.

  • The acronym S.O.L.E.R. or its evolution, the S.U.R.E.Y., can be applied as a guidance for health professionals in non-verbal communication during the session.


  • Sit squarely
  • Open posture
  • Leaning towards the other
  • Eye contact
  • Relax


  • Sit at an angle
  • Uncross legs and arms
  • Relax
  • Eye contact
  • Touch
  • Your intuition

Verbal communication

Verbal communication includes the words chosen by the counsellor and the way they are organized into complete phrases. Individuals are more likely to cooperate with the health professional when he responds in a supportive manner. On the contrary, when the way of response enhances the inadequacy of the individual, then the cooperation becomes more difficult.

Some types of verbal communication pose a greater risk of destroying the relation between counselor and patient. Such is the criticism, the controversy, the disagreement, the threat. Instead, others are more likely to promote communication and collaboration. Such are the formulation of questions, the reflective listening, the affirmation, the encouragement. The following table summarizes the types of verbal responses depending on the risk involved.

Low risk

  • Encouragement
  • Confirmation / understanding
  • Introductory sentences.

Moderate risk

  • Questions
  • Provision of information
  • Non-specific praise

High risk

  • Giving advice
  • Suggesting solutions
  • Reassurance

Very high risk

  • Controversy
  • Bulling
  • Criticism
  • Disagreement
  • Expression of anger
  • To disagree: the individual questions the accuracy, expertise or integrity of the health professional.
  • To interrupt: the individual interrupts the health professional defensively.
  • To refuse: the individual refuses to recognize a problem, to take responsibility, to cooperate, to receive advice.
  • To ignore: the individual does not answer or remains silent.

How to deal with resistance?

The techniques presented in motivational interviewing are rather useful to manage resistance. In particular, health professional has to:

  • emphasize individual’s personal choice and control over his health.
  • evaluate individual’s readiness for change and self-efficacy.
  • walk “in parallel” with the individual. This does not mean that he listens passively to what the individual says. Using reflective listening he understands his problem or how he feels about it.
  • change the purpose of the intervention or the topic of discussion that creates this resistance.

The American Academy of Pediatrics has created the Change Talk: Childhood Obesity™ (Change Talk) app. This is an online and mobile app designed to help health professionals learn to manage challenging family and patient conversations regarding childhood obesity and its attendant risk factors. The app can be downloaded from here without ant cost.

More details of this app can be found in the following video.

Here is a video with a session between a pediatrician, a father and his 4-year old daughter.