L4: Dr/Pt Relationship IV

Question 1

What are the key elements of a pt interview focusing on behavioral change?

Answer 1

• Facilitate engagement with pt - Demonstrate empathy when building rapport - Explore context for encounter - Explore presenting problem / concern - Seek permission to talk more in depth about this concern - Explore history of the problem - Ask about precipitating event(s) - Explore ambivalence, attitudes, beliefs and resistances to change - Explore pt’s strengths, resources and affirm self-efficacy - Develop discrepancy - Assess intrinsic motivation and readiness to change using TTM - Evaluate safety and welfare of pt and others - Summarize - Negotiate a plan for change and/or follow-up - Offer recommendations and/or referrals as deemed appropriate - End the interview (16)

Question 2

What are examples of questions that could be asked during a pt interview focusing on behavioral change?

Answer 2

• Greeting, building rapport - How did you decide to make an appt to see me today? (if new pt) - What brought you in to see me today? - This is obviously an area of importance to you. Could we talk about this in more detail? - How long have you been concerned about this? When did it start? - What happened that alerted you to the need to do something about this now? - What are some attitudes and beliefs you have about this that affect the way you think about it? - How have you dealt with serious concerns before in your life? - How might this situation put you at risk in some way? - Are you concerned about your own safety? - As we have talked today, you identified some factors that have contributed to the concern you have. Any change is definitely difficult. Would you like to meet again to further discuss this? Would you like the name of people / places that could be helpful with this situation? - End interview appropriately, attuned to nature and setting of encounter. Pay attention to pts affective state.

Question 3

What are some areas to typical areas of difficulty during a motivational interview?

Answer 3

• Appropriate engagement - Not asking about precipitating event - Not asking permission to go deeper - Working with both sides of ambivalence - Rolling with resistance - Recognizing examples of self-efficacy - Developing discrepancy - Evaluating risk - Summarizing - Appropriately ending the interview