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Transcript

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??

The Case for Listening

Eliciting Change Talk

  • Direct & specific to MI

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

Collecting Summary

  • 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

  • No one is unmotivated
  • 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
  • Pros & Cons
  • If the past was worse, explore what has happened that caused the improvement
  • Develop discrepancy

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

Eye contact

"I'd probably be around to enjoy my grandchildren as they grow up."

Lack of distractions

Facilitative Responses

Asking Listening

  • 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

Change talk

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