Communication skills and motivational interviewing

1. Communication skills and motivational interviewing Dr. Omar Alkaradsheh

2. Outline • Introduction • Communication goals • ADEA competency • Communication pathways • Verbal • Non-verbal • Paraverbal • Listening & listening skills • How to develop good communication skills • Effective communications • Patient Education • Motivational interviewing: • Introduction • Spirit • Principles • Strategies

3. Introduction • Communication skills is the ability to use language and express information. • Communication requires a sender, a message, a medium and a recipient.

4. Don’t we just knowhow to communicate? Public and practicing dentists considered communication as 1 of the top 3 most important factors in delivery of dental care. Nearly 50 percent of dentists felt that they had received only fair or poor training in communication. Dimatteo, McBride, Shugars & O'Neil,1995

5. Why communicate? 68% to 70% of medical litigation cited communicationissues as the primarycause. Islam and Zyphur, 2007

6. Competency 3. Communication and Interpersonal Skills. Graduates must be competent to: 3.1 Apply appropriate interpersonal and communication skills. 3.2 Apply psychosocial and behavioral principles in patient-centered health care. 3.3 Communicate effectively with individuals from diverse populations.

7. Communication Goals

8. Communication Pathways • Verbal communication- the words we choose • Paraverbal Messages - how we say the words • Nonverbal Messages - our body language

9. Verbal Communication Effective Verbal Messages • Are brief, succinct, and organized • Are free of jargon • Do not create resistance, frighten, intimidate or upset the listener.

10. Functions of Verbal communications • Task ordering • “What are we trying to accomplish?” • Procedural • Process orientation • Howwe say something. • Relational/influential • Narrative • Helps to describethe situation. • Use of analogies, metaphors.

11. Structures of Meaning in Verbal Communication • Denotative Meaning • Literal / dictionary meaning. • Connotative Meaning • Meaning depends on subjective reality and context. Harris, 2008

13. Nonverbal Messages Nonverbal messages are the primary way that we communicate emotions Facial Expression Postures and Gestures

14. Nonverbal Communication Between 65% and 93% of a message’s meaning is nonverbal. • Facial Display • Body language • Paralanguage • Proxemics • Chronemics

15. Facial Display • Facial expressions-Dentist • Facial expressions- Patient

16. Eye Contact

17. Eye contact • Helps regulate the flow of communications and reflects interest in others. • Direct eye contact conveys warmth, credibility and concern. • Shifty eye contact suggests dishonesty. • Downward gaze maybe a sign of submissiveness or inferiority

18. Facial Expressions

19. ParaverbalMessages • Is the meaning received along the actual words through the vocal delivery of the message • Paraverbalcommunication refers to the messages that we transmit through the voice tone, pitch, voices. Dialects, accent, pitch, tone, rate, pauses…etc.

20. Body Language • Physical Appearance • Movement • Gestures

21. Proxemics • Patients have their own Personal space • invisible boundary that they create around themselves • Differ from patient to patient • Dentist needs to invade this space to provide treatment • Verbal and nonverbal communications should mitigate the tension created by this encroachment of their personal space.

22. Chronemics • The use of time • Wait time for patients communicate their value • Waiting room • scheduling

23. Nonverbal Communications

24. Understanding Message Reception A person’s message is perceived in 3 ways: 55% Visually (facial expressions) 33% Vocally (pitch, tone,volume) 7% Verbally (words)

25. RECEIVING MESSAGES Listening • Requires concentration and energy • Involves a psychological connection with the speaker • Includes a desire and willingness to try and see things from another's perspective • Requires that we suspend judgment and evaluation

26. Listening Skills • Do not let the mind wander. • Put aside personal concerns while the patient is talking. • Do not concentrate on formulating a reply. • Concentrate on what the patient is actually saying. • Look as well as listen. • Pick up both the verbal and nonverbal information the patient is transmitting.

27. How We Learn • 80% occurs through sight alone • 10% through hearing • 5% through touch • 5% through smell and taste.Sredl & Rothwell, 1987

28. What makes a good communicator?

29. Effective Communication . . . It is two way. It involves active listening. It reflects the accountability of speaker and listener. It utilizes feedback. It is free of stress. It is clear.

30. Barriers to Effective Communication • Socio-economic level • Education • Cultural Diversity JAMA, 2009: Kundhal & Kundhal, 2009

31. Cultural Diversity • Differences in race, gender, cultural heritage, age, physical abilities, and spiritual beliefs are variations that must be appreciated and understood when working with patients and other staff members.

32. How do you develop your communication skills? Explore the related skills

33. Tips to good communication skills • Maintain eye contact with the audience • Body awareness • Gestures and expressions • Convey one's thoughts • Practice effective communicationskills

34. Patient Education & Motivational Interviewing

35. Patient Education • Clinician-Centred • Educational messages and direct advice provided using a unidirectional form of communication that attempts to persuade patients to comply with professional recommendations. • This puts the patient in the position of either passively accepting or, alternatively resisting the often unsolicited advice. 

36. Traditional Patient Education

37. Motivational Interviewing (MI) “a collaborative, person-centred, goal-directed method of communication for eliciting and strengthening intrinsic motivation for positive change.” Miller, Moyers, Rollnick; 2009

38. Motivational Interviewing (MI) • MI is a well-accepted strategy for behaviour change consistent with contemporary theories of behaviour change. • MI positively affect health behaviour change related to drug addiction, smoking, weight reduction, diabetes management, medication adherence, condom use, and oral health.

39. Motivational Interviewing (MI) • Through experience, Miller found the likelihood for positive change occurred more readily when the clinician connected the change with what was valued by the patient.  • He also found confrontational styles or direct persuasion are likely to increase resistance and should be avoided. • A theory that motivation is necessary for change to occur - resides within the individual and is achievable by eliciting personal values/desires and ability to change. •   It is based on allowing the patient to interpret and integrate health and behaviour change information if perceived as relevant to his/her own situation.  • It acknowledges the patient is the expert in their own life. 

40. MI Pyramid

41. The “Spirit” ofMotivationalInterviewing • The foundation for MI rests not in the specific strategies or use of a set of technical interventions but on a sincere “spirit” of mutual respect and collaboration.  • Literature has emphasized that in order to be an effective MI practitioner it is more important to embody the underlying philosophy or spirit than to be able to apply the collection of techniques. • The clinician must abandon the impulse to solve the patient’s problems (often referred to as the “righting reflex”) and allow the patient to articulate his or her own solutions.

42. The Spirit of MI is based on three key elements: • Collaboration (Vs. Confrontation)between the therapist and the client; • Evokingordrawingoutthe client‘s ideas about change; (Rather than imposing ideas) • Autonomyof the client.(vs. Authority)

43. Even such basic matters as how the patient and practitioner are seated can contribute to the patient feeling like they are truly being invited to engage in a dialogue as a partner, rather than feeling they are simply to be the recipient of expert advice. Appropriate position for a conversation: clinician is facing the patient on the same seating level. Inappropriate position for a conversation:the clinician is wearing a face mask and is at a higher level than the supine patient.

45. Principles of MI

46. Motivational InterviewingSkillsandStrategies

47. OARS • OARS: Open Ended Questions, Affirmations, Reflections, and Summaries • Brief method to begin MI. • These are Core counsellor behaviours employed to move the process toward elicitingclient“change talk” andcommitmentforchange. • Change talkinvolvesstatementsornon‐verbal communicationsindicatingtheclientmaybeconsideringthepossibilityofchange.

48. OARS • Ask open-ended questions: Approaching the patient with multiple closed-ended questions (question that will be answered with “yes” or “no”) sets the patient’s role to be a rather passive one. In contrast, open-ended questions invite thought, collaboration, and effort on the part of the patient. • Example: “How do you feel about your smoking?”

49. OARS • Affirmation: • It is human nature to presume a negative attitude, particularly when one’s own behaviour is coming under scrutiny. • Acknowledging the patient’s strengths and appreciation of his or her honesty will decrease defensiveness, increase openness, and the likelihood of change. • It assists in building rapport and in helping the client see themselves In a different, more positive light. • Facilitating the MI principle of Supporting Self-efficacy. • Example: “You’re telling me clearly why you’re not very concerned about your toothbrushing and I appreciate that honesty.”

50. OARS • Reflections" or reflective listening is perhaps the most crucial skill • It has two primary purposes. • By careful listening and reflective responses, the client comes to feel that the counsellor understands the issues from their perspective.(Express Empathy). • the therapist guides the client towards resolving ambivalence by a focus on the negative aspects of the status quo and the positives of making change. • Appropriate reflection: • (1) captures the underlying meaning of the patient’s words, • (2) is concise, • (3) is spoken as an observation or a comment, and • (4) conveys understanding rather than judgment. • Example: “You really seem to have lost hope that you can ever really quit smoking.”