Table 2. An overview of clinician actions that detract from and enhance relationship building.

Detract

Enhance

Provide content Give advice, solve problems Pass judgement Blame patient Invalidate the individual's concerns Share opinions Ask close-ended questions Talk a great deal Fill silences Use jargon Focus on numbers, tests, levels Face away from patient Talk fast to save time Direct collection of detailed information Direct decision-making: tell individual what is ‘best’ to do and how to do it Complete the entire task during this encounter only Permit interruptions by others Warn and threaten Try to convince

Ask open-ended questions Reflect person's worries, concerns Label affect Explore person's beliefs and expectations Use double reflections Have individual tell their story Observe mood, tone, posture, speech Be empathic and sympathetic Summarize content and process Be at ease with sensitive topics De-emphasize numbers Active listening Genuineness: we are in this together Change the pace of usual clinical conversations Provide affirming, understanding statements Express curiosity and interest about their experience Be patient: tolerate silences Be willing not to decide today Be alert to person's values, cultural and life context and their effect on their decisions Shift from focusing on the condition to focusing on the person Turn questions back to individual Use the person's language in reflections and feedback Roll with resistance – do not confront or push back