Communication skills lecture 2:

Basic techniquesBasic techniques

Trudi AspdenTrudi Aspden2012

At th d f thi l t h ld b bl t th f ll iAt the end of this lecture you should be able to answer the following:

What is empathy?

What are the basic techniques of non verbal communication?What are the basic techniques of non‐verbal communication?

What are six important aspects of verbal communication?p p

What's the difference between open and closed questions?

What are reflective techniques?

Rapport is a positive harmonious relationshipa positive harmonious relationship

To develop rapport.....................Sh  Show acceptanceOffer empathy and support Be sensitiveBe sensitive

Ability to understand the thoughts and emotions of another person.p

‘The action of understanding  being aware of  The action of understanding, being aware of, being sensitive to… the feelings thoughts and 

i   f  th     ith t th  experiences of another .. without the thoughts, feelings, or experiences being 

d b l fcommunicated in an objectively specific manner’ 

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The understanding and gsensitive appreciation of

another’s problem or feelings

The communication of that understanding back to the gclient in a supportive way

In communication, different situations call for different responses.

Not right/wrong but

RISK ofRISK ofLost rapportCausing offencegIncomplete information Incorrect informationW  di iWrong diagnosisYou or patient feeling lostDissatisfactionDissatisfaction

Verbal communication

Can be more precise,

Non-verbal communication

Approx 90% of what we p ,direct

Can be less truthful

ppcommunicate

Often harder to interpret real Can be less truthful Often harder to interpret real meaning

Need to attend to both for good clinical practice

P tPosturePosition relative to othersto others

Brief non‐verbal facial expressionsThought

Last only a few tenths of a second Micro-expression

Then modified to more socially acceptable but often less accurate  Modified acceptable but often less accurate expression  expression

Exhibit appropriate non‐verbal behaviour

eye contact, posture & position, movement, use of i  f i l  ivoice, facial expression

Recognises patient’s non verbal cues:Recognises patient s non‐verbal cues:

b d  l   h  f i l  i   ff tbody language, speech, facial expression, affect

acknowledges these as appropriateacknowledges these as appropriate

Appropriate use of questions

Silence

lMinimal encouragers

Reflecti e techniq esReflective techniques

ClarificationClarification

SummarisingSummarising

Introduce an area of enquiry without unduly focusing the q y y gcontent of the response. 

“Can you tell me about.. ?“    

“Wh t d    thi k h   d ?”“What do you think has caused…?”

“Can you start at the beginning and take me through what y g g g

has been happening …?”

“How have you been feeling...?”

Questions that limit the response to a narrow field set by the i  questioner: 

Often one word answers

“Are you in pain right now?”

“Do you often get this pain?”

“Is the pain a dull ache or a sharp pain?”

Open question A series of closed questions

What would you Would you like tea or coffee?y

like to drink?

Milo please with

tea or coffee?Um… coffee

Do you want Milo, please, with milk and no sugar

milk?Yes please

Do you wantDo you want sugar? No thanks

Here you are But I really wanted Milo!wanted Milo!

Using a series of closed questionsOpen question

Can you tell me about your headaches?

Do you always get headaches?your headaches?

W ll i fi

No..Do you get them

g

Well, it starts first thing most mornings with a drilling

most days?Yes...

Are they therewith a drilling sensation in my left temple, and by noon

Are they there all day? It depends..

p yit has become a throbbing across the

h l l ft id

So there is no real pattern, th ?

Sort of... Oh never mind you

’t d t d!whole left side ... then? won’t understand!

Open questions “open up”Open questions  open upAllow the pharmacist time to listen and think

Encourages the client to tell their story in a more complete fashion. 

Allow for possible answers you haven’t thought of

Helps the client to feel understoodHelps the client to feel understood

Sets a pattern of client participation 

Prevents a stab‐in‐the‐dark approach

Closed questions “mop up”

Allow you to elicit fine details

All      ‘  h h ’Allow you to ‘test hypotheses’

May help you to investigate areas that don’t May help you to investigate areas that don t 

emerge in the client’s account

Useful for some aspects of functional enquiry

For Information

Closed QuestionsClosed Questions

For Confirmation

General Open Question(s)

S ifi O Q ti ( )? Overview of topic

Specific Open Question(s)

? ? ?More specific detail

Closed Question(s)? ? ?

Specific facts?? ? ? ? ? Specific facts

Open‐ended questions ‐ Wide range of answers possible.

“How has your pain been recently?”

Closed questions ‐ Narrow range of answers defined by q g yquestioner

“Are you still getting that pain?”y g g p

Leading questions ‐ Particular answer is suggested in the Leading questions Particular answer is suggested in the question.

“You don’t feel sick anymore now, do you?”You don t feel sick anymore now, do you?

Open and Closed Questions - a continuump

What kind of pain is it? Burning, throbbing, aching, dull, sharp, really really bad!

When did the pain start?

How did you hurt your arm? I fell over the cat ..playing sport…

Tuesday night …when I was 15

Was it the left or right arm?

p y g

Left

Does it hurt right now? Yes, a bit

ClosedImplicitlyOpen

Open

Leading,Closed

The pain has stopped now, hasn’t it ?

Criterion: How free is the patient to answer what they want.Risk: Patients may agree with you out of courtesy or anxiety.

Q ti   k b t  h  th    Questions work best when they are: 

Clear and easily understoodClear and easily understood

Unambiguous

Open‐ended (if this is most appropriate)

Are not leading 

The questioning situation works best when:

You match the pace/content/language of questions to 

the clientthe client

The client understands your reason for asking the y g

question

SilenceMi i l Minimal encouragersClarificationParaphrasingReflectionReflectionSummarising

Don’t just do something  sit there!Don t just do something, sit there!

Helps both sides to collect their thoughtsHelps both sides to collect their thoughts.

Allows people time to process information and p p p

emotion. 

Body language can communicate attention 

during silence.

Brief words, sounds, gestures that encourage a , , g gperson to continue talking.

Words:Yes, OK, Oh, Right 

Sounds: Hmm, Mmm, Uh‐ha 

Gestures: Nods, appropriate smiles, frowns

Questions that help to clarify any ambiguity in what the patient has told youpatient has told you.

e g  “Are you saying that your big toe is itchy and painful e.g.  Are you saying that your big toe is itchy and painful or just painful most of the time?”

Helps confirm hypotheses

Restating the essence of the message in a patient’s earlier statement in different wordsin different words. 

Does not altermeaningDoes not altermeaningDoes not add to meaning

“Even though I was one of the top students in my class, I had to k   h d t  d   ll  t  h l  N t lik    b t f i d work very hard to do well at school. Not like my best friend 

Sally, she has always done really well at school without even trying. So she had time to do nice things like hobbies and sport, unlike me ”unlike me.”

Paraphrase:You did well in school, but you spent a lot of time studying so you missed out on doing other things  Whilst your friend you missed out on doing other things. Whilst your friend managed to do well at school and participate in extra curricular activities.

Mirroring back to the speaker in brief statements Mirroring back to the speaker in brief statements the emotionsemotions that he/she is communicating 

Can also reflect meaningmeaning by reflecting back emotionsemotions and contentcontent.

Eg. “You feel worried because you have lost your wallet ”wallet.

C t  Th  d  b f      h d   h t Customer: The day before my mum had a heart attack my husband started his own business and no  he seems to spend all his time at  ork  I now he seems to spend all his time at work. I have to manage the kids, the house and mum’s needs all by myself  It’s really hard to get needs all by myself. It s really hard to get everything done on time and keep looking cheerful for everyonecheerful for everyone.

fl i d l k f l h l d bReflection: Sounds like you feel overwhelmed by your situation.

h fl hTwo or more paraphrases or reflections that condense the person’s message.

Good for reviewing what the person has said  Good for reviewing what the person has said, allowing for clarification and mutual understandingunderstanding.

Good for controlling rambling conversations!

Initiating the sessionInitiating the sessionhttp://www.youtube.com/watch?v=CrqNa9a9PZYYGathering informationhttp://www.youtube.com/watch?v=TzzH‐XVnaY4