Counseling and Communication
Counseling and Communication tests behavior-change theory and the micro-skills of a patient encounter. Expect items on motivational interviewing, the transtheoretical model, health literacy, and cultural responsiveness.
Core rules
- Transtheoretical stages: precontemplation, contemplation, preparation, action, maintenance; match the intervention to the stage rather than pushing action.
- Motivational interviewing spirit: partnership, acceptance, compassion, evocation. Core skills: open questions, affirmations, reflections, summaries (OARS).
- Reflect change talk and explore ambivalence; avoid the righting reflex, confrontation, and unsolicited advice.
- Use plain language, teach-back, and chunk-and-check for low health literacy; use a qualified interpreter, not a family member, when possible.
- Cultural humility means asking about food practices, beliefs, and resources rather than assuming.
Worked example
A patient says, "I know I should cut out soda, but I just can't." A poor response is "You need to stop-it's empty calories." A better response is a reflection: "You're worried it will be hard to cut back, and you're not sure you're ready." This preserves autonomy and invites change talk. If the patient then says, "Maybe I could switch to one a day," that is preparation-stage change talk, and the counselor can ask what would make that easier.
Traps
Giving a full plan to a precontemplative patient; asking "why" questions that trigger defensiveness; using closed questions for most of the session; assuming literacy from education level; and confusing education (information) with counseling (behavior change).