620 - communication and heuristics

Heuristics

the methods people use to estimate risk

can introduce bias and inconsistency into decision making

availability heuristic

-a person draws on firsthand experience and its emotional impact to gauge a risk

-the more memorable/available an event, the higher the perceived risk

-hard to overcome even when someone is aware they are doing it

-rare events are more likely to stick and be easier to recall

representativeness heuristic

- people inappropriately generalize from a small sample they know personally to predict a larger pattern

- assessing how likely an event is based only on one similar experience

- similarity and probability are related - but representativeness pushes that relationship too far, producing predictable biases

the anchoring and adjustment heuristic

-the common tendency to rely too heavily on one initial piece of information - anchor when processing risk

- 2 part process: an initial idea forms the anchor - often a memory, experiences or environmental trigger, the person adjusts toward or away from that anchor to reach a new interpretation

- the order in which risk information is presented can itself create an anchor

When do people use heuristics

-they have limited knowledge of the topic

-they're under pressure to decide quickly

-they believe relevant information is out of reach

-they perceive low personal relevance to the topic

-there's low motivation to process the decision carefully

-there's a low likelihood of ambiguity in how the risk is interpreted

Defense motives

- processing in whatever way protects one's own desires

-often triggered when a sense of self feels threatened

Impression motives

-processing in a way that means a self-imposed responsibility to others

-shaped by how to person wants to be seen or how they want to protect someone else

framing bias

patients favor radiation over surgery when it's frames as 9-% survival rate rather than a 10% mortality rate, same numbers different reactions

framing effects

a 1 in 200 miscarriage risk from amnio reads as far more alarming than the same fact stated as 99.5% chance of no complication

Explore clients personal beliefs

- ask about the rationale behind a client's risk perception

- helps you understand - and gently address - the narrative shaping risk perception

build in reflective discussion

-explore clients beliefs about their own risks

- ask what shapes this risk for you, what factors feel like part of this risk

allow time to process

-clients who feel rushed are more likely to fall back on heuristics

-follow ups, letters or calls, support more systematic processing and reduce that reliance

don't assume sophistication means systematic processing

-assuming a client is "very bright" doesn't mean they'll avoid heuristics under pressure

-ask directly about the clients comfort and confidence with the material

types of communication

words, body language, silence, drawings & diagrams,

models of adult learning

Knowles model

mutual participation

life history/narrative

Knowles model

-The learner is self-directed

-Desire to learn stems from a "need to know"

-life experience, attitudes and needs shape the process

Mutual participation model

-counselor and client hold roughly equal power

-mutually satisfying, mutually independent

-counselor helps the client help themseleves

life history/narrative model

-counselor and client possess dual roles

- counselor actively listens to the client's story

-client is respondent and narrator

teacher centered paradigm

-knowledge is transmitted from teacher to student

-students passively receive information

-teachers role: primary information- giver and evaluator

-teaching and assessment are separate

-emphasis on arriving at the right answer

-only the student is viewed as a learner

Learner-Centered Paradigm

- students construct knowledge by gathering, synthesizing, and integrating information

-students are active participation

- teacher's role: coach and facilitator, students help evaluate learning

- teaching and assessment are intertwined

-emphasis on generating better questions and learning from errors

-teacher and student learn together

person/psychologically-oriented counseling

-introduced by Kessler in 1979

-engages with the full weight of human experience: health and illness, procreation, parenthood, life and death

-treats the genetic disorder as one part of the client's large life situation

-counselor functions as facilitator, guide and model

-decisions are understood as rooted in subjective meaning, not facts alone

content-oriented counseling

-from kessler's framework

-emphasizes facts - and the meanings and consequences those facts carry for the client

-counselor gives high priority to providing information

-counselor functions as authority, educator, and advisor

-tends to foster more emotional distance than a person-oriented approach

challenges to communication in counseling

-medical and psychological priorities often compete for time and attention

-how that balance is struck varies within clinical settings and experience

-one-time visits limit how much can be addressed in a single session

-meaningful psychological work can still happen, even briefly

traits of an effective GC session

expertise, empathy, enthusiasm, clarity

stages of a GC session

information gathering

diagnosis and risk assessment

information giving

psychosocial assessment and counseling

decision making

ongoing client support

information gathering

-learn the client's own perception of the problems or reason for referral

-contract with the client, name the mutual goals of the session

-take the family history as a two-way opportunity, teaching as you're learning

diagnosis and risk assessment

-show family tree and explain what you are seeing

-before a physical exam, walk the client through what will happen, who will do it and how

-pretest counseling

-review medical records and screening reports with the clients directly - show them the report, and take the mystery out of it

information giving

-start general, then move toward the specifics

-use clear, non technical, culturally sensitive language

-use visual aids and analogies

-some counselors draw while they talk, consider what works for you

psychosocial assessment and counseling

-assess where the client is emotionally before pressing forward

- ok to directly ask how they are doing with the information - what questions do they have

decision making

-present balanced information

-facilitate the decision making process without directing in

-establish a realistic time table

- use reflective communication

contracting

establish shared goals at the start of the session

summarizing and clarifying

periodically recap

organizes the conversation and reduces confusion

active listening

full attention- nodding, eye contact

reflective statements

helps client feel heard and understood

nonverbal communication

open passive, gentle tone, eye contact

stay alert to the client's nonverbal cues - fidgeting, silence

plain language

translate medical terms to patient-centered language

can also use the term then define it

Teach-Back Method

ask client to repeat info back in their own words

how would they explain it to their family?

risk communication

present risk clearly - percentages, ratios, visuals

check for understanding and framing effect

encouraging resilience

highlight existing coping strategies

how they handled challenges in the past

exploring values

ask what matters most when the client is weighing testing or a decision

aligns counseling with the client's own values and autonomy

cultural and family context

recognize that decisions often involve family or community

who else is important in making this decision

empathetic response

recognize and validate the client's emotion

reflects the REM's emphasis on patient emotions

managing emotional overload

pause when a client is overwhelmed

offer silence, tissues, or support before resuming

Barriers to communication in GC

overuse of medical jargon

counselor domination the conversation

ignoring emotional cues

missing visual body language

cultural mismatch

time pressure or a rush session

power imbalance