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DEVELOPING GREATER SENSORY AWARENSS OF MINIMAL CUES BY WHICH PEOPLE SIGNAL THEIR THOUGHTS AND FEELINGS

DEVELOPING GREATER SENSORY AWARENSS OF MINIMAL CUES BY WHICH PEOPLE SIGNAL THEIR THOUGHTS AND FEELINGS. Adapted from www.bathgptraining.co.uk. Rapport. What is it? Why is it important? How and when do we achieve it? How do you know that you have achieved it? Why and how to break it? .

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DEVELOPING GREATER SENSORY AWARENSS OF MINIMAL CUES BY WHICH PEOPLE SIGNAL THEIR THOUGHTS AND FEELINGS

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  1. DEVELOPING GREATER SENSORY AWARENSS OF MINIMAL CUES BY WHICH PEOPLE SIGNAL THEIR THOUGHTS AND FEELINGS Adapted from www.bathgptraining.co.uk

  2. Rapport What is it? Why is it important? How and when do we achieve it? How do you know that you have achieved it? Why and how to break it?

  3. Ways of communicating • Verbal • Speech (tone, rate, pitch, volume) • Content • Non verbal • Olfactory • BODY LANGUAGE (posture, gestures, facial expression, eye movements) Patients rarely ever tell you EXACTLY how they feel and what they want you to do about it....

  4. Gambits and Curtain-Raisers • GAMBITS ‘ the rehearsed opening moves’ planned by the patient, usually refined in the waiting room • But they often change once they enter the consulting room. These CURTAIN RAISERS often betray their state of mind and feelings towards you. N.B. Curtain raisers will only happen if the doctor allows them to happen - and doesn’t smother them with... “Hello Mrs X, come in what can I do for you”

  5. Minimal Cues • Non verbal messaging outdates formal language on an evolutional scale

  6. Representational Systems • Brain encodes all experience into information • Visual • Auditory • Kinaesthetic- feelings arising from skin/ proprioception • Olfactory We all have a preference for one of these modalities Can be used to connect and empathise with a patient

  7. Types of language used Visual people – “see, show, reveal, appear, colourful” etc Auditory people – “hear, tell, listen, sounds good/awful, he/she said…., sounds good/awful” etc Kinaesthetic people – “I feel, my guts tell me, I just can’t get hold of it, I don’t know why but it feels….”etc

  8. Which type of person am I?

  9. Using this to build rapport • Adapting your language so it mimics the style of the patient may help them feel that they have a better connection to you

  10. Visual Cues • Facial expression- mood, variability, appropriate • Gaze- at you, downward, objects, flirty, cold • Eye contact- good, poor

  11. Eyes • People glance upwards when remembering/Imagining a VISUAL image • Glance to the side when remembering/ imagining an SOUNDS or WORDS • Glance downwards when experiencing/remembering a feeling

  12. Visual Constructed Visual Remembered Auditory Auditory Remembered Constructed Kinaesthetic Auditory Internal Dialogue

  13. AUDITORY CUES FROM THE PATIENT • Pace- fast or slow • Pitch- high or low • Volume- quiet loud or comfortable • Rhythm- regular and rhythmic, broken up • Modulation- how much do the other qualities vary • Matching of tone, pace and inflexion • Picking up and reflecting back the same words

  14. The importance of what is not said • Hesitations, omissions and vagueness imply that speech is being censored • Aim would be to help the patient to find a way of expressing what is not being said as • May be important clinically • Patient will find a sense of relief, and contributes to rapport building

  15. Speech censoring • Key features • Hesitating • Omitting details • Vague in descriptions • Raising sensitive issues by hinting and implication • Skipping from one idea to another without obvious link Associated with quiet voice, nervous clearing of throat, poor eye contact, restless, posture withdrawn

  16. Kinaesthetic Cues • Posture- open, slumped, lean in/out, matched • Distance- too far/close • Touch- Accepted/ welcomed • Gesture- which part of body is most expressive • Mobility- stationary or moving- high energy or low • Muscle Tone- Relaxed or tense • Breathing- rate depth

  17. Making the most of Minimal Cues • Three groups • Speech censoring • Internal Search • Acceptance Set

  18. Internal Search • Key features- • Lengthy pause • Immobility • Eye movements • Gaze far away Do not interrupt! You may destroy a productive line of thought. The end will be apparent- respecting privacy of times of internal search is a powerful aid to rapport

  19. Acceptance Set • Although a patient may sound like they are verbally in agreement with you, their non verbal cues may tell the other story! • But big variation though in physical signs • Mmm, mmm • Face looks blank • Lack of eye contact Vs • Steady eye contact • Attentive posture • Echoing words • Nodding

  20. Rapport • Match your language and non verbal cues to those of the patients

  21. Now watch the videos • Play I Spy minimal cues • Share what your saw in small groups • Re-run the video step by step and see how many more you can identify • Then use the scoring sheet looking at the first four COT competencies

  22. Where do I go from here? Read Liz Moulton’s book! The Naked Consultation

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