Week 5: Being a Present and Curious Listener (PDF)

WEEK 5 BEING A PRESENT AND CURIOUS LISTENER OARS REVISITING THE CONVERSATION BETWEEN DOCTOR AND PATIENT OARS Open-ended questions Affirmation and acknowledgement Reflection of content + emotion + meaning Summaries – smiles - silence OPEN-ENDED QUESTIONS Open ended questions are elaborative:...

WEEK 5 BEING A PRESENT AND CURIOUS LISTENER OARS REVISITING THE CONVERSATION BETWEEN DOCTOR AND PATIENT OARS Open-ended questions Affirmation and acknowledgement Reflection of content + emotion + meaning Summaries – smiles - silence OPEN-ENDED QUESTIONS Open ended questions are elaborative: they invite others to tell their story in their own words, without leading them in a specific direction. Open ended questions are useful when opening a conversation topic, for example: ”Can you tell me about stress in your life?” or “how do you experience that in your body?” Open ended questions should be used often in conversation When asking open questions, you must listen to what the person is saying and respond based on what you have heard à REFLECT content, feeling, or meaning + BE CURIOUS and ask follow-up questions (the content points on these slides are adapted from handouts by David Rosengren and from Miller & Rollnick, Motivational Interviewing, 2nd Edition, 2002) OEQ Open questions are the opposite of closed questions. Closed questions typically elicit a limited response such as “yes” or “no.” They are good for clarifying details, but should not be heavily relied on in conversation. They tend to shut conversation down, limit the flow of information, and can create a power differential. The following example contrasts open vs. closed questions. Notice that the topic is the same, but the way of framing the question is very different: Did you have a good relationship with your parents? What can you tell me about your relationship with your parents? When you use open questions effectively, your patient will likely be doing most of the talking. Open-ended questions help to: Establish a safe environment, and build trusting and respectful relationship Explore, clarify and better understand your patient’s world view Learn about the patient’s past experience, feelings, thoughts, beliefs, and behaviors Gather information Help the patient make an informed decision Some examples of open questions: How can I help you with ___? Help me understand ___? How would you like things to be different? What are the good things about ___ and what are the less good things about it? When would you be most likely to___? What do you think you will lose if you give up ___? What do you want to do next? What was that like for you? What is it like for you when ___? Sometimes closed questions are appropriate: Have you had a pregnancy test? Have you had sex without using birth control in the last three months? Was it your choice to have sex? When did you have the heart attack? What medications are you currently taking? When was the last time you experienced these symptoms? Note: the LODRFICARA questions are generally closed questions, which are very useful for getting specific details about a symptom or complaint AFFIRMATION AND ACKNOWLEDGEMENT The use of affirmaYons and acknowledgement convey empathy, understanding, and non- judgment. They also invite recogniYon of the paYent’ experience, including their strengths, resilience, and potenYal for present-moment choice. AffirmaYons are statements that recognize a personal strength, or an ability, or a quality of resilience. We are affirming/acknowledging something that a paYent has already done in support of their own wellbeing. AffirmaYons are a way of acknowledging behaviors that support self-compassion, self- care, and/or lead in the direcYon of posiYve change, no ma]er how large or small. To be effecYve, affirmaYons must be genuine and congruent Be mindful to offer your paYent statements of appreciaYon and understanding, and to provide posiYve feedback during your conversaYon. AFFIRMATIONS To make a genuine statement of affirmation, you must be present and be able to listen carefully to what your patient is telling you. Affirmation statements help to: Build rapport and demonstrate empathy Affirm exploration into the client’s world Affirm the client’s past decisions, abilities, and healthy behaviors. Build a client’s self efficacy – a sense that they can be responsible for their own decisions and their lives in a healthy way. Build confidence in one’s ability to change Examples of affirming responses: I appreciate that you are here today and are looking for some answers. You are clearly a very resourceful person. You’re smoking a little less and finding new ways to help let go of stress. That’s a good suggestion. If I were in your shoes, I don’t know if I could have managed nearly so well. I notice how you used your breath as a resource just now. I hear that you’re able to offer yourself kindness. Your tears are welcome here. I’ve enjoyed talking with you today. ACKNOWLEDGEMENT Acknowledgement can be part of an affirmative response, and may also be used to bring attention to something that is happening in the present moment, particularly with regards to emotion and sensation in the body. For example: I see there is emotion present as you are speaking I notice that you took a big exhale there It seems like you’re experiencing that pain right now? I see how hard this is for you I saw how you lit up when you spoke about ___ REFLECTIVE STATEMENTS Reflecting content: use key words that the patient has used to describe their experience (noticing significant language) + paraphrasing what you think you have heard them say Reflecting feeling / emotional energy: naming the emotion you think you sense, observing body language and offering it to them as a reflection Reflecting meaning: offering your own tentative interpretation and checking to see how that lands for them à clarifying your understanding of what it mean to them REFLECTIVE LISTENING Reflective listening is a primary communication skill. It is a pathway for engaging others in relationships, building trust, and fostering motivation to change. Reflective listening appears easy, but it takes focused attention and practice to do it well. It requires that you are present and that you are attentive to the nuances of communication, including: tone of voice, emotional cues, and body language. You will reflect using your own words and perceptions, checking in to see if you are accurate or if the patient wants to clarify/elaborate. It is vital to learn to think reflectively. This is a way of thinking that accompanies good reflective listening. It includes interest in what the person has to say and respect for the person’s inner wisdom Sometimes the ways we relate to others are roadblocks to effective communication. Some examples of this are misinterpreting what is said or assuming what a person needs. Reflective listening is meant to close the loop in communication to ensure breakdowns don’t occur. Listening breakdowns occur in any of three places: Speaker does not say what is meant Listener does not hear correctly Listener gives a different interpretation to what the words mean Reflective comments invite clarification and greater exploration. Combining open ended questions and reflections can be a skilful way of navigating conversation. Notice how questions alone tend to interrupt the client’s flow. Some people find it helpful to use some standard phrases: “So you feel... “ “It sounds like you... “ “You’re wondering if... “ Some benefits of reflective listening: Demonstrates to the patient that you are listening and trying to understand their situation Can help to deepen or increase the intimacy between speaker and listener, and thereby change the affective tone of an interaction. Offers the patient an opportunity to “hear” their own words, feelings and behaviors as you speak them back Names/acknowledges the patient’s thoughts, feelings and behaviors Name/acknowledges the patient’s general experiences and the “in the moment” experience of the clinic visit. Some types of reflective listening: Simple reflection: repeat the patient’s words, noticing significant language Listener repeats or rephrases, substituting synonyms or phrases, but stays close to what the speaker has said; listener identifies significant language and preserves those words Paraphrasing with a reflection of meaning: Listener makes a restatement in which the speaker’s meaning is inferred Reflecting present-moment experience: state an observation about the patient’s behavior/body language and inquire about it with an OEQ: “I noticed you just _____.” “What are you thinking?”- or- “What are you feeling right now?” –or- “what’s happening for you right now?” Reflecting feeling: Listener emphasizes emotional aspects of communication through feeling statements. This is the deepest form of listening. When you reflect feelings, you name what you get a sense of in terms of the patient’s emotional experience: “It seems like you might be feeling some ___ right now?” or “I hear that you are feeling ___ about that.” SUMMARIES – SMILES - SILENCE Summaries are special applications of reflective listening. They can be used throughout a conversation but are particularly helpful at transition points, for example: after the person has spoken about a particular topic, has recounted a personal experience, or when the encounter is nearing an end. Summarizing helps to ensure that there is clear communication between the speaker and listener. It’s a skill that can keep you and your patient on the same page throughout the session. It can also provide a stepping stone towards change. SOME PLACES TO USE SUMMARIES Some transitions where summaries can be helpful: 1) A collective summary: “So let’s go over what we have talked about so far.” 2) A linking summary: “A minute ago you said ___......Maybe now we can talk about what that would mean in terms of ___.....” 3) A closing summary: “So you will make an appointment today before you leave, you can do that with Kelly at the main desk, and then we will see each other again soon.” – or- “so today we’ve looked at the ways that stress relates to the sleep disturbances you’ve been experiencing, and we’ve talked about 3 things that you can do to support better sleep….” Structure of a summary: 1. Begin with a statement indicating you are making a summary. For example: “Let me see if I understand so far... “ “Here is what I’ve heard. Tell me if I’ve missed anything.” 2. If the person expresses ambivalence, it is useful to name and include both sides in the summary statement. For example: “On the one hand..., on the other hand...” 3. It could be useful to include objective information in summary statements from other sources (e.g., your own clinical knowledge, research, etc). Be concise. 4. End with an invitation. For example: “Did I miss anything?” “If that’s accurate, what other points are there to consider?” “Is there anything you want to add or correct?” “Is there anything else you want to give a voice to before we close?” Depending on the response of participants to your summary statement, it may lead naturally to planning for or taking concrete steps towards the desired change. SMILES AND SILENCE These “s” words remind us to use appropriate silences, to pause and allow silence between questions, reflections, and voices. It also reminds us to be attentive to body posture and appropriate eye contact. We want to maintain a relaxed facial expression and tone of voice, providing a reassuring space of safety, inclusivity, and co-regulation.