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1. Change nothing in your practice initially. Change offers the potential of both opportunity and loss. After you have finished a clinical conversation review it in your mind or with a colleague and consider where and when and how any of these strategies below might have been useful. As you become familiar with thinking about how they could contribute to a conversation they will find their way in.

2. In response to trauma or difficulty try:

How did you get through?
What kept you going?

We are trained to elicit trauma and difficulties as ways of understanding how this person ended up in this predicament. Questions like these have the possibility of opening up something quite different.

3. In response to hearing about something and noticing ourselves judging try (using a tone of voice and demeanour indicating interest rather than judgment):

How did you make that decision?
How well does that work for you?
What were you hoping when you …?

Answers can be surprising and we might find a sense in the choices people make which leads to discoveries for them and for us. The person may evaluate the action effectively and decisively.

4. At any time:

Are we talking about what is most important/useful/interesting to you?

This is a straight forward invitation to share responsibility for structuring the conversation. We need to have some openness for negotiation in case the person has priorities which are not the same as those we hold.

5. When offering a recommendation, or feel as if you hold some knowledge as to the most advantageous choice a person could make, pose it as a question.

What would happen if you …
Do you think it would help if you …

Asking for someone’s opinion indicates that you value it. If the idea you have is unhelpful, little is lost. If they take up the idea then they are making their own choice to do so, rather than following your instructions. Listening to hear what their ideas are rather than just waiting for their agreement and appreciation of the wisdom you are offering.

6. Summarise what the person has said.

This can be a powerful intervention done with varying levels of sophistication (see gathering threads) but even at the simplest level it slows the conversation down and gives everyone time to think. People usually find it soothing and acknowledging, hearing their thoughts spoken in the room by a person who holds power. It lets them know you have noticed and remembered what they said.

7. Ask yourself:

How well do I understand what this experience is like for this person?
What would help to increase the understanding I have?

Use the answer to guide you in developing more depth of understanding

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