B760 Mental Health Nursing
Question:
Summarise the main Learning
This week we will focus on the use of questioning and the different uses of questions when engaging with a person.
Appropriate questioning represents a skill that:
- encourages clients to further explore their specific issues and
- results in an effective assessment of the person’s issue.
Questions can be either closed or open and are used at different times and for different reasons during communication. Closed questions are used to gain information and are usually responded to in short succinct responses. Open questions, when used effectively, usually result in a freer and more open exchange between client and counselor. However, both types of questioning are contained within the counselor’s frame of reference and represent the beginning of counselor intervention. Questions therefore are useful to gain information.
However, how questions are asked is crucial for the development of client/counselor trust and respect. Questions that are asked in an interrogating fashion often result in fear, confusion and a non-sharing of information. Similarly, the counselor needs to understand the client’s cultural background as questioning is not always appropriate for certain cultural or ethnic groups.
At the completion of this week, you will be able to:
- explain the importance of questioning in a therapeutic relationship
- identify and differentiate between different types of questions
- describe the value of goal setting
- examine the implications for practice when utilising questioning skills
- explain the key issues of a first interview.
Reflect on the following questions:
- When have you used closed questions and how were they appropriate to the situation?
- When are open-ended questions appropriate? Reflect on a situation or context where you have used open questions resulting in the person sharing significant information with you? What happened as a result?
- Do you have a broad repertoire of open-ended questions?
Research the following:
- The potential problem of using ‘why’ questions when working with people in mental health.
- The use of circular questioning. What is circular questioning? What types of questions would be used and what is their purpose?
- The use of the ‘miracle question’
- The strengths and limitations of using the ‘what else?’ question, often used in solution focused therapy.
- Any other type of questions (other than the ones in the reading or mentioned above) that can be used in a therapeutic relationship.
- What type of questions will be useful in a relationship orientated first interview?
- How would this be different to an information orientated first interview?
- What is the purpose of defining goals in counseling? What do you think are the pitfalls in goal setting?
Identify the type of question from the list below and discuss the reasons it may not be helpful.
- Attacking
- Suggestive
- Judgmental
- Leading
- Assumptive
As mental health services evolve, it is important both the person experiencing a mental illness (consumer) and carers have a voice in the recovery.
Listening and engaging with an individual compared to engaging with a family requires different skills.
- List the possible challenges of working with an individual and a family.
- List the possible strengths of working with an individual and a family.
- Discuss the types of questions/ questioning style that can be used in both situations.
- What do you think the phrase ‘being respectfully curious’ implies when working within a therapeutic relationship?
Answer:
The art of questioning has been regarded as a critical factor in the assessment of issues faced by the patients susceptible to mental health deformity. While following the counselling procedure, it is vital to incorporate an approach that would help the patients in being able to identify and clearly chalk out the critical issues affecting them and at the same time also develop a clear assessment of the issue faced by the patient. The assumptive, judgemental, suggestive, leading or attacking pattern of questions are reported to be unhealthy and inefficient for the patients as it leads to the creation of an obstruction in the maintenance of smooth flow of communication between the care provider and the patient and without effective communication it is impossible to dispense a healthy counselling session as counselling is entirely dependent on the free flow of information without any obstruction pertaining to emotional stress, anger or fear.
Family has been known to play a pivotal role in the life of an individual and it is important to evaluate the mental health compatibility of the individual as well as the family members in order to design appropriate interventions that would promote speedy recovery of the client. However, challenges in the form of mental compatibility disparity between the family members and the individual might result in clash of opinion which would not generate adequate realistic information (Boszormenyi-Nagy 2013). Additionally, studies reveal that in the presence of family individuals do not express their in-depth emotions because of privacy issues. Hence, it can be said that these factors impede with the counselling procedure.
On the contrary, strong evidences of eliciting a positive hope in the clients have also been reported on collaborating with the patient’s family members while designing intervention. Association of family members help in providing an insight about the intervention and also helps in the close monitoring of the assisted therapy and medications being administered to the patient. While dealing with the elderly or the children, collaborating with the family members evoke a feeling of self-confidence in the patients that generate positive effects.
The questioning style used to interview mentally challenged people should be open-ended and qualitative in structure and should flow in a casual conversational manner (Casement 2013). The questions need to open-ended in order to allow interaction so that the client is able to provide detailed information with respect to the mental health issues that he is positioned in. It is critical to note here that the questions should be based on a recovery approach and the documentation should also be done with respect to the recovery theme. Use of strong words like what, when, who that requires specific answers should be avoided as it increases anxiety and nervousness in patients. Questions should be descriptive, for instance, instead of ‘What made you sad last month?’ the question should be structured as ‘Can you share with me your feelings on finding out something was hurting you from inside?’ (Drake and Whitley 2014)
When working in a therapeutic relationship, it is important to be respectfully curious which means that the therapist should be able to extract information from the client without showing disrespect or aggravating feelings of humiliation (Nelson et al. 2013). The therapeutic relationship should be built on mutual respect and care.
References:
Boszormenyi-Nagy, I., 2013. Intensive family therapy as process. In Intensive family therapy (pp. 107-162). Routledge.
Casement, P., 2013. Further learning from the patient: The analytic space and process. Routledge. Pp 117-127
Drake, R. E., and Whitley, R. 2014. Recovery and severe mental illness: description and analysis. The Canadian Journal of Psychiatry, 59(5), 236-242.
Nelson, J.A., Onwuegbuzie, A.J., Wines, L.A. and Frels, R.K., 2013. The therapeutic interview process in qualitative research studies. The qualitative report, 18(40), pp.1-17.
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