M2: Counseling Skills for doctors Flashcards
8 Basic counseling skills
- Listening
- Attending
- Bracketing
- Leading
- Reflecting content
- Reflecting feelings
- Reflecting experiences
- Probes
a way of looking and dealing with a patient in which the doctor counselor, without condition (chooses to believe that there’s a good person inside the patient)- regardless of the external qualities of the patient
Unconditional Positive Regard
the ability to put oneself in the shoes of another person such that one can see the world from
the eyes of the other and as a result, one can feel what the other person is feeling
Empathy
(Consistency) in the doctor-counselor’s feeling actions and words
Congruence
a certain (approachability and willingness) to be open to the client
Warmth and genuineness
(clear and explicit) in his dealings with the client
Concreteness
it is helping the client (Identify present) thought and feelings
Immediacy
DON’TS IN THE COUNSELING RELATIONSHIP (G2K)
- Don’t ask “why” questions
- Don’t use “should” and “ought’s”
- Don’t blame
- Don’t invalidate the client’s feeling
- Don’t automatically compare
metaphorically, this is a matter of (making space) in
one’s mind and one’s heart in order to be able to truly empathize and see the world from the point of
view of the patient
Bracketing
Involves (suspending one’s own judgments and feelings and then putting them aside) for a while in order to be able to listen more fully to the patient
Bracketing
refers to the non-verbal of the doctor-counselor. All non-verbal must convey a (message of openness and willingness) to listen and understand what the patient is saying
Attending
Types of leading
- Indirect lead
2. Direct Lead
invitation by the doctor-counselor to the patient to (talk about whatever concerns him)
Indirect lead
the doctor/counselor chooses direction
in which to go
Direct lead
(paraphrasing) in a form of a question
Perception checking
oftentimes the patient says a lot of things and behaves in a way that (reflects what he feels), but he never overly states the feelings
Reflecting feelings
oftentimes the patient does a lot of non-verbal communication which (reflects some emotional state), but the feeling is not articulated. The doctor counselor can mirror talk the non-verbal behavior back to the patient and ask for clarification as to what the behavior means
Reflecting experience
opens new areas, focuses on selected areas
and delves more deeply into a patient’s total
experience.
Exploration
An inquiry which aims to know the patient’s private, subjective experience of health and illness
Open-ended, spontaneous inquiry
TWO PROCESS OF EXPLORATION
- Focused exploration (interrogative questioning)
2. Patient Cue Exploration (following through in exploring a patient cue)
Direct and lead the search for information regarding pertinent aspects of a patient’s health story and current needs for care
PLANNED EXPLORATION
Pick up and follow through in (exploring a patient cue) indirect disguised ways
SPONTANEOUS EXPLORATION
Repetition of key words or phrases
One-word phrase
(Explicit requests) for information or elaboration, although a specific topic is often introduced
Gentle commands
Provide a broad introduction to topics for discussion. Sometimes referred to as “indirect questions”
Open-ended statements
Pitfalls in the Use of Probing Skills (G2K)
- Confuse the patient
- Shifts the focus of interaction
- Shows an overbearing position of authority
- Continuous questions in succession would not give time for the patient to reply
- “Why” question
6 MOST COMMON BARRIER
- Distraction
- Preoccupation
- Too focused on Details
- The topic
- Rebuttal tendency
- The speaker
3 TIPS TO IMPROVE LISTENING SKILLS
- Show people they matter.
- Listen to understand not to respond.
- Show the speaker you are following along.
equal worth, absence of blame, non-defensiveness and closeness, it is a frame of mind rather than a skill, developed through being honest with oneself and being prepared to be open with others.
Warmth
involves helping the client put into works those things that are just being hinted
Concreteness
Current issues are addressed and problem solving can relate directly to (present day issues)
Immediacy
How do you reflect content?
By paraphrasing or paraphrasing in a form of a question (Like is this what you mean)
Asking “You love your wife and her attentiveness to your needs, but the
attentiveness also irritates you, doesn’t it?” is an example of
Reflecting feelings
Asking “While you were talking about your wife, I noticed that you were clenching and unclenching your fist. What do you think that could mean?” is an example of
Reflecting experience
“Tell me how are you feeling” is an example of..
prompt
Statements like “ so your worried about…’ or .. “and when you are in pain
you usually…”. Is an example of
Finish the sentence
Convey messages that I’m with you, I’m following
what you’re saying, I want to hear more
Minimal encouragement
Expressions like “uh huh”, “mm-hum”, and “yes”
Minimal encouragement
Patient: My son won’t be visiting me while I’m here in the hospital
Doctor: Won’t be visiting?
Patient: Yes, he says he can’t stand the sight and smells of the hospital
Is an example of?
One-word phrase
“Have you been in the hospital before?”
Closed Questions
“Do you wear glasses?”
Closed Questions
“Is your wife coming to visit you tonight?”
Closed Questions
“Do you have any children?”
Closed Questions
“Are you feeling nauseous?” (to a patient
recovering from anesthesia)
Focused, Closed Questions
“Do you ever get dizzy when you get out of bed too
fast?” (to a patient whose blood pressure is low).
Focused, Closed Questions
“Which of these is correct”?
Multiple Choice Questions
“How do you describe the pain? Stabbing? Pricking?
Spastic? Sharp or dull?”
Multiple Choice Questions
“Tell me about your family”
Gentle commands
“Can you describe that in more detail?”
Gentle commands
“Tell me more”
Gentle commands
“Let’s talk about that further”
Gentle commands
“Tell me what its like for you to be in the hospital”
Gentle commands
Go on, say what’s on your mind”
Gentle commands
“So, this is the first time you are having surgery.”
Open-ended statements
“I wonder how it is being sick when you’ve been so
healthy all your life.”
Open-ended statements
“I notice from reading your chart that you had a rough night .”
Open-ended statements
“You’ve been giving yourself insulin for years now.”
Open-ended statements
→ “So you’re most worried about..”
→ “And when you are in pain you usually…”
→ “Today has been..”
→ “What you really would like to know is..”
These questions are examples of
Finishing the sentence statements
“If I were in your place, I’d be angry.”
Self-disclosure
“I don’t handle pain all that well.”
Self-disclosure
“I guess I’d be wondering, what is wrong with me.”
Self-disclosure
Sometimes the most effective way to encourage
patients to explore their experiences with doctors, is for
us to share our own thoughts with the patient
Self-disclosure
Instead of completing a sentence the doctor begins it,
then trails off with an expectation that the patient will
finish the sentence
Finishing the sentence statements
“How did you sleep last night?”
Open-ended questions
“What worries you about the surgery?”
Open-ended questions
“What was your life like before you became ill?”
Open-ended questions
“How was your visit to the outpatient
department?”
Open-ended questions
5 Pitfalls in the Use of Probing Skills
- Overuse can confuse
- Shifts the focus
- Shows too much authority
- Continuous question ≠ patient to speak
- “Why” question
Means by which one person helps another to clarify his or her life situation
Counseling
2 Aim of counselling
- Free the person
2. Empower the person
6 use of counselling in medicine
- Help describe symptoms
- Help in emotion
- Help is crises
- Help in empowering
- Help is advise (HIV)
- Help manage health service
10 Deficiencies in professional communication (G2K)
- Fail to greet patient
- Fail to give easily available information
- Fail to seek clarification
- Fail to check understanding
- Fail to encourage questions
- Fail to spot verbal clues
- Fail to tackle personal situation of patients
- Fail to get info about patient’s feelings
- Failure to make a comfortable environment
- Fail to use hypothesis testing
sounding board for their ideas plans or suggestions, requires listening and empathic understanding
Supportive counseling
information about the nature of their health or the lack of it which accurate and understandable
Informative counselling
this happens in a trainer-trainee relationship or a teacher-student relationship, wherein the teacher is not just concerned about the objective part of the relationship but some personal matters as well.
Educational counseling
the manager who has also a counselor role has to learn to step back a little and allow the other person to find solutions to his or her own problems.
Management counselling
undertaken to help someone after a major trauma
Post traumatic counseling
4 main task of post traumatic counseling
- Help in accepting reality
- Help know that their reaction is normal
- Help them adjust and adopt
- Help them redirect their emotions
spiritual distress as the result of a total inability to invest life with meaning. It can be demotivating, painful, and can cause anguish to the sufferer.
Counselling in spiritual distress
this occurs of sensitive discussions with the client- the very nature of the material under discussion is painful and brings to surface a great deal of bottled up feelings
Counselling in Emotional Distress
suggest or recommend a particular line of action
Prescriptive Intervention
practical suggestions how to increase mobility with the use of the wheelchair is an example of which intervention?
Prescriptive Intervention
counselor (informs or instructs the client), information is best limited to concrete situations, practical issues
Informative intervention
“you will probably find that you will have some discomfort in your leg for 3 weeks” is an example of which intervention?
Informative intervention
challenge the client in some way or draw their attention to a particular type of repetitive behavior
Confronting Intervention
“I notice that you frequently complain about the way your wife talks to you.” is an example of which intervention?
Confronting Intervention
enable the client to release tension through the expression of pent up emotion. It should be the client who decides when if such release of emotion occurs.
Cathartic Intervention
draw the client and encourage him or her to discuss issues further, thus any sort of questions is a ______. Most useful to the health professional.
Catalytic Intervention
support, validate or encourage the client in some way e.g. I appreciate what you are doing
Supportive intervention
