Art of questioning & mirroring

mirroring

advantages:

• allows Pt to get a grip on his internal experiences, feelings, attitudes, ways of behaviour, desires, objectives, & to manage them better.
• allows Dr to choose correct distancing or closeness to his Pt.
• most impressive way of signalling to the Pt that the Dr is listening to him actively.

procedure: not done mechanically by a facade or echo.
foremost to mirror are : all emotional statements, objectives & presumptions/biased judgements.
try to mirror:

• all imp statements as soon as possible, briefly, concretely, clearly.
• make the attempt to workout the meaning for the Pt
• use term ‘you’ not i, we or one
• interject to make sure you understood the Pt
• use synonymns/antonymns to replay/verbalise Pt’s emotions.

if the Pt doent feel undestood: either directly intervene with a verbal confirmation or indirectly imply by describing Pt’s experience.

ability for empathetic behaviour comes from

• ethical attitude & social involvement
• sensibility level & coping level
• perceiving the relation & influencing it

“If you can discover a person
who is peaceful,
without affectation
who, with presence of mind,
with true involvement,
can quietly listen to needs,
who does not interrupt, who does not pose two questions at the same time,
who waits for the answer and grasps it all,
who does not peer into the future or past,
who does not fix you with a studied look, and put you down,
who does not avoid your gaze, looking upwards or downwards,
who is as prudent as he is at ease, then -
then you will think that you have found treasure in a field,
then you will think that you have found a pearl”.

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art of questioning:

good questioning is like a zipper technique decreasing digressions from flow or contact & increases willingness & trust in communication. it shows that the Dr is interested & understands, so decreases Pt’s anxiety/anger/shame.

bad questioning is always with impricse wording & at an inappropriate timing which increases resistance of the Pt to answer.

open Q conveys interest & attention. Pt describes freely in his own words & attempts to make himself understood, this, increases confrontation with the conflicting matter leading to effective learning & better management. disadv – avoids unpleasant topics & is easier to digress.

closed Q is used only for extracting rapidly some precise info or to keep to the subject from excursions. it shouldnt be used at the onset since it decreases unravelling dimensions or building relations by preventing thinking & active listening.

inappropriate questioning arises from impatience & inexperience:

• multiple Qs overwhelms the Pt. so take time to ask one Q at a time.
• hold up Qs elicits irrelevant or aggressive Ans
• leading Qs have a backdrop of prejudice or wishful thinking of the Dr, exerting subconscious pressure on the Pt to avoid unpleasant topics
• ambush Qs suggest impoliteness or unawareness & makes the Pt defensive or aggressive. its easier to reply painful Qs if the A can be constructed on a preceeding fact.

forbidden Qs do not account for Pt’s autonomy:

• [epistaxis fingering]trap Qs trip up or over ride the A
• [potency, breastfeeding]curiosity satisfies the questioner but doesnt deepen relation & shames the Pt or evokes a climate of police interrogation
• [adi,nonlocalers]socratice Qs gives self-assurance to the questioner that others cannot answer & conveys to the Pt thatt he doesnt know what he believed he knew
• why instead of what reason]judgemental Qs puts Pt on defensive
• [esra doctors]aggressive Qs achieve the very opposite of the intended behaviour
• [status quo girls]flowery rhetorical Qs are hollow & insincere & maintain only superficial flow

questioning behavior of the Pt:

• need for info, contact, help, critism
• why is Pt asking at this time
• what is the overlying real Q
• why doe Pt repeat the same Q
• why doesnt Pt ask – out of anxiety, time pressure, speech barriers, different realities, insufficient stimulus

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