Reflective Listening
September 18, 2012
Melissa Columbus & Becca Smith
HC 65-85
MI 74-84
Ask Open Questions
?
Listen Reflectively
5 Methods for the 1st Session
1. Ask Open Questions
2. Listen Reflectively
3. Affirm
4. Summarize
5. Eliciting Change Talk
When??
Eliciting Change Talk
Affirm
- 4 categories:
- disadvantages of the status quo
- advantages for change
- optimism for change
- intention to change
Methods for Evoking Change Talk
Summarize
- 1st part of the consultation
- Brief episodes throughout the session
- After you ask an open question
- Gather info you might otherwise miss
- Strengthen relationship
- More comfortable & open
- Seems like you've spent a longer amount of time with patient
- Great impact on patient
- Used to link together & reinforce material that has been discussed.
- 3 kinds:
- Collecting
- Linking
- Transitional
"On one hand, you think you need involve more physical activity into your daily routine. On the other hand, you feel like you're too busy to exercise."
"I think I could probably do that if I decided to."
- Asking Evocative Questions
- Importance Ruler
- Exploring the Decisional Balance
- Elaborating
- Querying Extremes
- Looking Back
- Looking Forward
- Exploring Goals & Values
- Summary of any change-talk that has been stated
- Continue their thought process. Don't interrupt their momentum
- Doing this too often can be annoying
"If I continue not brushing my teeth, then in 20 years I could have gum disease and lose all my teeth."
Linking Summary
- Ties together material that has already been mentioned
"I never really thought that much before about how that affects my family."
- Encourages the patient to reflect on the relationship between the points that he/she has already made
Looking Back
Elaborating
Exploring the Decisional Balance
Querying Extremes
Looking Forward
Importance Ruler
Exploring Goals & Values
Asking Evocative Questions
- Imagine the worst possible outcome that could occur if they do not change
- Compare their current situation to a time before the problem began
- Have the client dig deeper into a topic before moving on
- Have the client discuss the positive & negatives of the status quo
- Rating of client's perceived importance of change
- Ask open-ended questions to explore their concerns
- Find out their goals & what is important to them
- Help the client envision a changed future OR a future where they have made no changes to their current behavior.
- Imagine the best possible outcome for the future if they do change
- This can lead to further change talk
- If the past was worse, explore what has happened that caused the improvement
Transitional Summary
Deciding Whether to Improve Diet
- A wrap-up summary of what has been said during the session
Opening the Door to Listening
PRO
CON
- Emphasize the points that you feel are important
More energy
Expensive
Health benefits
Time-consuming
"This isn't what I want for my family. What can I do?"
Begin by asking an open question
Self-confidence
Limited Choices
"I'd probably be around to enjoy my grandchildren as they grow up."
Facilitative Responses
- Patients begin to feel uneasy if you say absolutely nothing
- Use facilitative responses to assure them you're listening
- Questions are roadblocks to listening
- Puts you in charge of conversation
- For listening, the only question you need is an open invitation
"Say some more about that"
Silence
Listening by Reflecting
Try not to even think the roadblocks
Agree, disagree, instruct, warn...
- A short summary of what they have been saying
- Proves you have been listening
The Skill of Summary
- Shows you've been listening & remembering
- Helps draw together info
- Reemphasize important aspects
- Oppurtunity to change the direction
Asking & Listening
Client-centered counseling
3 Recommendations:
- Open questions
- Don't ask 2 questions in a row
- Offer 2 reflections for every questions you ask
Concerns about Listening
If I listen too well, then my patients will talk for hours
Reflect Resistance
Concerns about Listening
Patients who feel ambivalent have both sides of the argument
If I listen to my patient in this way, will they fall apart right there in my office? After all, I'm not a psychologist.
They will often back away from resistance when you reflect
Reflect Change Talk
Listening in MI
The patient presents the case for change
- Choosing what to reflect
- Reflect Resistance
- Reflect Change Talk
- Working through ambivalence
Choosing WHAT to Reflect
Working through Ambivalence
Choose what you think is most important