TEST PAPER REVIEW SHEET PRACTICE
QUESTIONS AND SOLUTIONS TOP RESULT A+
◉ guidelines for patient contact Answer: - never give home or cell
phone number
- if giving a contract number specify times they may call you
- instruct what to do in emergency when you can't be contacted
- leave a voicemail system for them to call and let them know if it's
emergent you'll call back within 24 hrs
- sign pts out to another clinician when you're on vacation and
inform him of more severe pts or chronically suicidal pts. change
voicemail to have instruction to contact this clinician.
- use email but this too needs ground rules (limit to scheduling
needs and refills, anything more has to be added to their EMR).
- for HIPPA add note saying: "please be aware that email
communication can be intercepted in transmission or misdirected.
your use of email to communicate protected health information to us
indicate that you acknowledge and accept the possible risks
associated with such communication. please consider
communicating any sensitive information by telephone, fax, or mail.
if you do not wish to have your information sent by email, please
contact the street immediately."
- get pts number and email. ask if it's okay to identify yourself when
you call because some people don't want family or employers
,knowing they're in tx. hey contact info for energy contact people,
need consent before doing this.
◉ rapport building techniques Answer: - empathic or sympathetic
statements: "you must have felt Truckee when she left you".
communicate your average and understanding of painful emotions.
but don't over use them.
- direct feeling questions: "how did you feel when she left you?"
- reflective statements: "you sound dad when you talk about her".
don't overuse because it sounds like you're stating the obvious.
- if you notice countertransference happening, see them as
psychopathology and develop compassion for them on that basis
first
◉ techniques to make the patient comfortable Answer: - greet
naturally: introduce yourself and make small talk for a minute
(unless in emotional distress)
- ask what they wanna be called and use their name a few times
during the interview
- learn something about them so they're more comfortable sharing
about themselves: "before we get into what brought you here, if like
to know a little about you as a person, where you live, what you do,
that sort of thing."
- explain what will happen in the interview: many think they're just
here for psychotherapy. start by asking if they know why they're
,here and then give your explanation (length of interview, what info
you'll be asking about, and follow up going forward).
- then give them 5 minutes of free speech to explain what is going on.
Ask them to explain the most troubling symptoms first and go from
there. if they're giving you articulate info let them keep going but if
they aren't you have to cut them off and direct the interview more
but give them the inital 5 minutes.
- after this make a goal with your patient by asking them: what
would make this visit the most helpful for you today, what would you
like to get it of it?
-- if they're reluctant ask the miracle scenario: "imagine that tonight
you go to bed, like you normally do. Then, imagine that while you're
asleep, a miracle happens and your depression (or whatever
problem) goes away. what will your day be like tomorrow?"
◉ techniques to help the pt elicit sensitive material Answer: Most
common - normalization: normalize it by introducing your question
with a normalizing statement, 2 ways to do this:
- start question by implying the behavior is normal or
understandable response to mood or situation: "With all the stress
you've been under, I wonder if you've been drinking more lately?" or
"Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?"
- describe another pt who has had this behavior to show your pt
they're not alone: "I've seen a number of pts who've told me that
their anxiety causes them to avoid doing things, like driving on the
highway or going to the grocery store. Has that been true for you?"
, Note: do not normalize severely abnormal behaviors such as
extreme violence or sexual abuse.
Others:
- symptom expectation: aka gentle assumption. you infer that a
behavior is expected by stating your question implying you assume
the pt is having some behavior and you won't be offended with a
positive response. Especially good if suspect self destructive activity
like drug use or suicide. Ex: "what sorts of drugs do you usually use
when you're drinking?" or "what kinds of ways to hurt yourself have
you thought about?"
Note: only use this when you suspect behavior, don't be asking every
70 y/o women what drugs they're using.
- symptom exaggeration: often used with sx expectation helps clarify
severity of sxs. You suggest a frequency of a behavior that is higher
than you expectation, then their lower frequency will seem not as
bad. Ex: "How often do you binge and purge each day? 5 times, 10
times?"
Note: again only do this when appropriate for the pt and only if you
suspect they're already doing the behavior.