A conversation that may include questions about hearing voices, thoughts of killing yourself, childhood abuse and sexual dysfunction can get uncomfortable. And at the end of the uncomfortable conversation, there needs to be enough rapport to engage someone into a treatment plan. This can be a delicate juggle.
I find it helpful to...
- Normalise - "Some people with the symptoms you describe, also get ... . Has that happened to you?"
- Ask open, general questions first - "Have you had any strange or confusing experiences?" can yield all sorts of answers.
- Acknowledge the intrusive nature of questions - "I know this can be embarrassing/difficult to talk about, but the answers can give us information that really helps."
- Ask an important question in a couple of different ways.
- Listen carefully, and use it to direct further questions - "You mentioned ... earlier, I'm wondering how often that's been happening recently?"
- Say clearly what you mean. Try not to use euphemisms. - "How often do you drink alcohol?", is preferable to "Are you a drinker?". Even better is "People who are having trouble sleeping sometimes find alcohol can help get them to sleep. Is that something you have done?"
Having said all this, sometimes words just come out clumsily. I have asked a 15 year old boy if he was "still having thoughts of killing people?" Unfortunately, he'd never had such thoughts and from that point he wanted to escape from the room as quickly as possible. I never saw him again.
Trouble with rapport due to uncomfortable questions can be repaired with patience and listening well. Just be willing to laugh and acknowledge your mix-up or faux pas. Most people cannot resist humility and someone who can laugh at themselves.
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