Información y comunicación al paciente

(Thomas Gordon, Ph.D.)

1. Ordering, directing, or commanding

2. Warning or threatening

3. Giving advice, making suggestions, or providing solutions

4. Persuading with logic, arguing, or lecturing

5. Moralizing, preaching, or telling clients what they "should" do

6. Disagreeing, judging, criticizing, or blaming

7. Agreeing, approving, or praising

8. Shaming, ridiculing, or labeling

9. Interpreting or analyzing

10. Reassuring, sympathizing, or consoling

11. Questioning or probing

12. Withdrawing, distracting, humoring, or changing the subject

Negative Practice Example 2: Persuasion Exercise

This is an exercise for dyads, in which one person is the speaker and the other the counselor. The speaker talks about a topic of ambivalence - something he or she is thinking about changing, or “should” change, or might want to do. The counselor uses a variety of methods to try to directly persuade the speaker to make the change. It is important to instruct the audience that this is not motivational interviewing, and that the counselors are not to be empathic listeners in this exercise. Speaker role: Identify a change that you are considering, something you are thinking about changing in your life, but have not definitely decided. It will be something you feel two ways about. It might be a change that would be “good for you,” that you “should” make for some reason, but have been putting off. Tell the counselor about this change you are considering. [Trainer: “Speakers, this time I would like you to talk about something you have been thinking about changing in your own life. It could be a habit, attitude or behavior, but it should be

something you haven’t changed yet. Maybe it’s something that would be good for you, or that you think you should change. It should be something you feel comfortable sharing -- not your deepest, darkest secret, okay? Any questions about that?”]

Counselor role: Your task is to try as hard as you can to convince and persuade the Speaker to make the change that he or she is considering. (This is not a motivational interviewing exercise.) Specifically, once you find out what the change is that the person is considering, do these five

3. Tell the person how they could make the change.

4. Emphasize how important it is for them to make the change. This might include the negative consequences of not doing it.

5. Tell/persuade the person to do it.

And if you encounter resistance, repeat the above, perhaps more emphatically.

The exercise can also be done as a role-play in which each participant is assigned a situational identity.

Notes:

This exercise is usually a lot of fun, and the room can fill up with hilarity as trainees become more outrageous in their negative practice. Monitor the level of energy in the room, and end the exercise while it is still high. It’s important not to let this one run on too long. The point of the exercise is realized quickly.

Trainees who are very committed to the method that is being used in a negative practice exercise may argue that the approach was very effective for them, that their practice session went well and would have elicited change, etc. Substantial time can be used and ill will generated if the trainer takes an oppositional approach here (which also fails to model the clinical style of motivational interviewing). One good approach is to briefly acknowledge that sometimes people do find this kind of advice helpful, and then move on. The cast majority of Speakers will experience this conversation as aversive.

A pretraining Skill Assessment can be useful before the roadblock exercise. To do this, distribute a questionnaire before you begin to discuss reflective listening or roadblocks. The questionnaire contains 6-10 statements that might be made by a client or friend who is talking about personal material. Trainees are asked to write the next thing they would say in response to these different statements, restricting themselves to one or two sentences. If this has been done earlier, trainees can examine their own questionnaires at this point to determine which of the roadblocks they are most likely to use.

Be careful not to communicate that this is how your participants are currently practicing, and that you are going to show them the “right” way to do it! That’s a quick recipe for evoking defensiveness and resistance to learning.

Debriefing

Focus primarily on the experience of the Speakers in these conversations. What were they feeling and thinking? Write bullet-point reactions on the board or paper. Some common human responses to such advice are: angry, agitated, oppositional, discounting, defensive, justifying, not understood, not heard, passive, overwhelmed, ashamed, trapped, disengaged, uncomfortable, resistant.

NURSE'S ROLE

The Situation. You are a busy occupational health nurse. Your company has encouraged you to conduct health screening among the employees. Having done this, you are feeding back the results of a health screen to an employee. You only have about 10 minutes for your first discussion with this person.

The Client. This person is clearly overweight, also smokes, and drinks about 6 beers a night. Both blood pressure and cholesterol are elevated, and you are very concerned about this person's diet and weight. The employee is married, has 3 children, and has been working with the firm for 15 years.

Your Task. Try as hard as you can to persuade this person to do something about his or her diet, smoking, or drinking. This is a serious matter, and you do not have a lot of time. It's not your job to be a "therapist"; rather, you are paid to be a competent, concerned, and forthright health practitioner.

1. Explain why the person should make this change.

2. Give at least three specific benefits that would result from making the change. 3. Tell the person how they could make the change.

4. Emphasize how important it is for them to make the change. This might include the negative consequences of not doing it.

5. Tell/persuade the person to do it.

And if you encounter resistance, repeat the above, perhaps more emphatically.

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EMPLOYEE'S ROLE

The Situation. You filled out a health questionnaire at work, and had a blood pressure reading and blood test as part of a company-wide effort to improve employee health. Now you have been called in to see the company nurse. You have been a hard-working and loyal employee for 15 years. You're not looking forward to this session, because you know you are overweight, besides which you will probably be told to quit smoking, but you don't think there is anything you can or want to do about it.

Your Home Situation. You lead a busy life, and have a spouse (who also works) and 3 children. You don't have much in the way of recreation, besides going out for a meal and some drinks with your spouse and friends on Saturday nights. You drink a 6-pack of beer most nights, but don't see this as a problem. You like your food, and though you are a bit overweight you're not really concerned about it.