Session 4 - psychological management of medical patients 1: counselling

Question 1

What stems out of a good patient-doctor relationship?

Answer 1

Greater access to potentially relevant diagnostic information.

Increased likelihood that patients will follow medical advice.

Question 2

What does the quality of a doctor-patient relationship depend on?

Answer 2

The patient’s expectations and the practitioner’s style

Question 3

What are the expectations of the patient?

Answer 3

A competent practitioner who exhibits, friendliness, interest, empathy and concern. The practitioner also has to provide clear explanations about illnesses and treatment and should encourage the patient to ask questions.

Question 4

What are the consequences of a patient-doctor relationship mismatch?

Answer 4

more stress during unpleasant procedures
reduced likelihood of following advice
switching doctors

Question 5

What characterises a doctor-centered practitioner style?

Answer 5

closed-ended questions
focus on the first problem mentioned
use of medical jargon
patients are not involved in decision-making

Question 6

What characterises a patient-centred practitioner style?

Answer 6

open-ended questions

patients are given the opportunity to discuss other problems

avoid use of medical jargon

participation of patients in decision-making

Question 7

What are the rules effective helping?

Answer 7

1. all insights, understandings, decisions and solutions should occur within the person experiencing the problem, not the doctor.
2. differentiate between an internal frame of reference (how the patient feels about their situation) and an external frame of reference (how the doctor sees the patient’s situation)

Question 8

What are the aspects of counselling?

Answer 8

building rapport
helpful responding
helping relationship
goals
process
support systems
multi-cultural considerations

Question 9

Which nonverbal skills help build rapport?

Answer 9

relaxed posture
open posture
lean in
eye contact
squarely face your patient

Question 10

Which aspects determine how helpful you are with regards to helpful responding?

Answer 10

your intentions and attitude
the phrasing of your response

Question 11

List the different response styles.

Answer 11

Advising
Interpreting
Reassuring
Probing
Understanding

Question 12

Explain the Advising response style

Answer 12

These responses communicate an evaluative, corrective or moralizing attitude or intent. The doctor implies what the patient ought to do or might do to resolve the problem.

Question 13

Explain the Interpreting response style.

Answer 13

The doctor’s intentions are to teach, to tell the patient what their problem means or to impart some psychological knowledge to the patient.

The doctor implies what the patient might or ought to think.

It attempts to give the patient some additional insight through an explanation.

Question 14

Explain the Reassuring response style.

Answer 14

It indicates that the doctor wants to reassure, be sympathetic, or reduce the intensity of the patient’s feelings.

Question 15

Explain the Probing response style.

Answer 15

It indicates that the doctor wants to get further information, guide the discussion along certain lines, or bring the patient to a certain realization or conclusion the doctor has in mind.

The doctor implies that the patient ought to or might profitably develop or discuss a point further.

Question 16

Explain the Understanding response style

Answer 16

It indicates that the doctor’s intention is to understand the patient’s thoughts and feelings. It asks the patient whether the doctor has understood what they are saying and how they are feeling.

Question 17

What are the 3 situations in which you would use the Understanding response style?

Answer 17

1. When you are not sure you have understood the patient’s thoughts and feelings.
2. When you wish to ensure that the patient hears what they have just said.
3. When you want to reassure the patient that you are trying to understand their thoughts and feelings.

Question 18

Explain the Respect component of the Helping Relationship.

Answer 18

The patient is accepted in totality as a unique being and as someone with the right to self-determination. This also forms the basis for the ‘first do no harm’ rule and prompts the doctor to assume the patient’s goodwill and not rush to judgement.

Question 19

Explain the Empathy component of the Helping Relationship.

Answer 19

The patient’s true feelings are understood and reflected accurately. The patient is understood from their point of view and through the context of their life. The doctor understands the dissonance between the patient’s point of view and reality.

Question 20

What are the goals of counselling?

Answer 20

1. manage specific problems and develop opportunities
2. improve the patient’s ability to manage problems in everyday life
3. help the patient develop an action-orientated prevention mentality

Question 21

Name the stages of counselling.

Answer 21

Stage 1 - the current picture
Stage 2 - the preferred picture
Stage 3 - the way forward

Question 22

What are the tasks under Stage 1 of counselling?

Answer 22

Task 1 - help the patient to tell their story and identify their problems

Task 2 - help the patient develop new perspectives that help them reframe their stories more constructively.

Task 3 - help the patient to meaningfully select issues to work on.

Question 23

What are the tasks under Stage 2 of counselling?

Answer 23

Task 1 - help the patient to imagine the possibilities for a better future

Task 2 - help the patient to choose realistic and challenging goals

Task 3 - help the patient find incentives for change and to commit to goals

Question 24

What are the tasks under Stage 3 of counselling?

Answer 24

Task 1 - help the patient develop possible strategies to achieve their goals

Task 2 - help the patient to choose the strategies that best fit their resources

Task 3 - help the patient to formulate these strategies into a plan of action

Question 25

What are some multicultural considerations that the doctor should take to mind?

Answer 25

Examine own worldview, assumptions and prejudices.

Acknowledge the effect of power and privilege.

Suspend preconceived ideas

Be open to learning

Remember intra-cultural differences

Question 26

Name the psychological techniques for pain management.

Answer 26

Relaxation
The Behavioural Approach
The cognitive Approach

Question 27

What is the aim of the psychological management of pain?

Answer 27

To help the patient cope more effectively with their pain and other stressors and to reduce the reliance on medication.

Question 28

How does Relaxation assist with the psychological management of pain?

Answer 28

it decreases the frequency of episodes of pain. although it is helpful, it does not provide all the pain relief that most patients need so it is used in conjunction with other approaches.

an example of this would be progressive muscle relaxation.

Question 29

How does the Behavioural Approach assist with the psychological management of pain?

Answer 29

This method is usually used with patients with chronic pain conditions. It reduces their high risk of experiencing difficulties and impairments associated with chronic pain.

it focuses on both patient and caregiver

Caregivers are taught to pay no attention to the patient’s pain behaviours (extinction) and use positive reinforcement for compliant behaviour.

an example of this would be administering pain medication at a fixed schedule.

Question 29

How does the Behavioural Approach assist with the psychological management of pain?

Answer 29

This method is usually used with patients with chronic pain conditions. It reduces their high risk of experiencing difficulties and impairments associated with chronic pain.

it focuses on both patient and caregiver

Caregivers are taught to pay no attention to the patient’s pain behaviours (extinction) and use positive reinforcement for compliant behaviour.

an example of this would be administering pain medication at a fixed schedule.

Question 30

How does the Cognitive Approach assist with the psychological management of pain?

Answer 30

It focuses on the patient’s beliefs and uses cognitive strategies to modify their experiences, such as distraction (for acute pain), Imagery (for mild or moderate acute pain) and Redefinition (coping statements and re-interpretative statements)

Question 31

What are some of the things that people favour when consulting with a practitioner?

Answer 31

Friendliness and interest
Empathy and concern
Projecting reassurance
Presenting a calm and competent image

Question 32

How can counselling skills help you?

Answer 32

You can effectively demonstrate sensitivity, warmth and concern

They enable you to adopt a patient-centred style

Help you deal with a patient in crisis or distress

Effective listening will be of great help to the people in your practice and in your personal life.

Question 33

What is a Helping relationship based on?

Answer 33

Respect
Empathy