Core Skills Flashcards
What are the core skills of motivational interviewing?
Asking
Listening
Informing
How can you differentiate between policing and guiding questions?
Policing is bad
Example: Have you been wearing your hearing aids every day?
Guiding is better
Example: You’ve been trying to get in the habit of wearing your hearing aids every day. What would be most helpful for us to talk about today?
When asking questions, should we use open ended questions liberally?
Yes
What are open ended questions used for?
Allow freedom for patient to express their thoughts and be actively involved
Give impression of personal interest and caring
Do not have to take a lot of extra time
Be willing to listen to answer!
What are two ways to ask what’s next?
Probe for patient’s level of commitment to change (what do you think about?)
Hypotheticals (less threatening)
(if you made this change, what would happen?)
How should we listen to patients?
Gather important information you might otherwise miss
Improve relationship with patient (even 1-2 minutes)
Patient comfort and satisfaction with provider and with appointment increased
Listening in and of itself can foster healing and change
What are some roadblocks to listening?
Agreeing, disagreeing, instructing, questioning, warning, reasoning, sympathizing, arguing, suggesting, analyzing, persuading, approving, shaming, reassuring, and interpreting
Why should we reflect during counseling?
Reflect in our own words (conveys you are listening)
Gives them the opportunity to correct you
Reflect back change talk
Do patients always absorb the information you relay?
No
May not be ready to hear what you have to say or may not agree with importance
May not understand based on cultural, linguistic, or other background differences
What are factors that can affect understanding?
Confusion
Passivity – you’ve lost them
High emotion
Mood and distractedness
What are some things you should consider while informing?
Interpersonal skills
Patients often report they don’t feel listened to
Slow down
Tailor information delivery to patient’s or family’s needs
Consider patient’s priorities
Frame the message as positive
“if you stop smoking, you may find breathing is easier”
People vary widely in the amount of information they want
Clear information delivery
Written material
Remain attentive and respond skillfully
What are some ways to ask for permission to inform?
“Would you like to know some things that other patients have done?”
“Would it be all right if I tell you one concern I have about this plan?”
“There are several things that you can do to keep the level of sugar in your blood under control. Do you want to hear them, or are there other things that we should talk about first?”
“May I make a suggestion?”
Why should you ask for permission to inform?
Respects patient autonomy
Lowers resistance
Alerts you to what is on patient’s mind is they say no
What are some things you can do if the patient says to when you ask permission to inform?
If you feel the information is optional, then don’t share
If you feel the information is essential to be conveyed at that appointment, you have a few options
Directly state you have information that you need to convey
Give them a choice of talking about something else first
Prefacing (this may or may not concern you, but…; I don’t know if this will make sense to you or not…)
What are some ways to inform?
Offer several options simultaneously
Talk about what others do
Provide info chunks and check in for understanding (would you like to know what other patients have done)
Elicit-provide-elicit (EPE) - what would you most like to know about; what do you already know about (then elicit patient’s perception (what do you make of that; what does this mean to you)
Plant seeds of hope
