The purpose of this study is to describe the main ways in which nurse coun sellors' questions and advice are initiated, received, accepted or refused during health counselling. Thirty-eight health counselling situations were videotaped in a Finnish hospital and the data were examined using adapted conversation analysis. We found two types of health counselling models, which fluctuated during the encounters. Empowerment, 'reciprocal' health counselling began with the nurse counsellors' reflective questioning which took the form of check up questions about the patient's condition, followed by questions about the patient's feelings. The patients' answers guided the conversation. 'Non-recipro cal' health counselling sessions did not contain questions about the patients' feelings, nor did the patients reflect on their health habits. On the basis of our results we suggested training programmes, where the development of professionals' communication skills can occur in practical, dynamic situations, being videotaped and transcribed for later evaluation.
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