Avoid the Diagnosis Trap
It is important to remember in communicating the results of the screening to the person seeking consultation, avoid labeling him/her with a diagnosis. In Motivational Interviewing, labeling is de-emphasized. Labeling people with a mental illness or substance use disorder diagnosis is likely to increase feelings of stigma-associated shame and resistance of the person to changing health behaviors that can improve health, mental health, well-being and quality of life.
MI uses open-ended questions to elicit a story from a person about his/her understanding of the problem. Screening instruments use closed questions (yes-no or short answer) to elicit information from the person. Open-ended questions (How or What questions or “tell me more about…” statements) invite the person into a relationship with you and create a space in the consultation room where quality communication can take place. Avoid barraging the person with closed ended-questions simply to get the information required on the screening questionnaire or during you assessment interview.
Even when routine questions are required, services can be designed to avoid institutionalized questioning as the dominant style in practice. When a standard questioning format is being used, one can still start in a natural manner with a series of open questions, acknowledging that some more specific questions will follow. The patient’s responses to open questions often provide the answers to specific closed questions. Then you can use closed questions to fill in other needed information that did not emerge in response to the open questions. (Rollnick, Miller, & Butler, 2008, p. 51)
Reflective listening is the most important core skill of MI. In the pressure of a brief interview and the need to get a lot of information from the person consulting you, it may feel like reflective listening takes too long or doesn’t move the consultation along. However, Rollnick, Miller and Butler (2008) state that “Even a little high-quality listening can greatly promote your relationship with a patient. It can take as little as 1–2 minutes” (p. 65).
People whose providers listen to them are more comfortable and satisfied with their care.
- When you take time to listen, people feel as though you have spent more time with them than you actually have.
- Good listening is an important, “non-specific” aspect of healing. Just listening can facilitate change.
- Listening involves an attitude of curiosity and acceptance of the person who has come for consultation.
- Follow open-ended questions with 1–2 reflective listening responses.
- Summarize at key points in the interview. Summarizing is a special form of reflective listening. (Rollnick, Miller, & Butler, 2008, pp. 65–69)
Informing is used in a wide range of situation in a primary care setting including: explaining what happened, clarifying what something means, breaking “bad” news, sharing evidence, obtaining informed consent, mastering a task such as a medical device, and giving advice (Rollnick, Miller, & Butler, 2008, pp. 86). After doing a screening, the provider. will need to inform the person of the results (which can often be “bad” news), sharing evidence then making recommendations (giving advice). Here are some MI consistent practices for informing:
- Ask permission to do the screening and give the results.
- Be a friendly consultant and provide the information in a clear and concise manner. Avoid jargon, acronyms and abbreviations.
- Do not overload people with information. Provide simple information in small chunks.
- Check with the person about his/her understanding of the information you have provided.
- Ask permission to give your recommendations (giving advice) based on the screening results. (Rollnick, Miller, & Butler, 2008, pp. 86–107)