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Emotions in communication skills training − experiences from general practice to Porsche maintenance

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Abstract

The emphasis on skills in communication training of physicians has gained momentum over the last 30 years. Furthermore, a specific focus on skills to address emotions has been suggested and more recently supported by empirical studies. In this paper we use the Expanded Four Habits Model to illustrate how a structured consultation model supplemented with specific skills to address emotions is considered useful in medical and non-medical settings. The primacy of emotions in different types of professional encounters is discussed in relation to education and practice.

Introduction

In the 1980s and the early 1990s the so-called Maguire approach dominated the communication training field, emphasizing exploration of the physicians’ subjective experiences with and handling of difficult situations and challenging patients [1]. This model was also introduced in Norway with Professor Arnstein Finset as an eager promotor. Finset, originally trained as a neuropsychologist, had at that time newly started as a professor at the Department of Behavioral Sciences, at the Medical Faculty, University of Oslo. Finset attended courses with Peter Maguire and entered the field of clinical communication training and research by promoting this approach.

However, as the 1990s developed, the interest in The Maguire approach declined within the communication training field in favor of a stronger focus on communication skills per se. The skills approach seemed more effective and didactic, a notion supported by several studies [2], [3]. In line with the emphasis on skills, several consultation and communication skills models were developed, among them the Four Habits Model by Frankel and Stein in 1999 [4]. The Four Habits Model is specifically oriented towards behavior and structure, and focuses on four key habits: 1) Invest in the beginning, 2) Elicit the patient’s perspective, 3) Demonstrate empathy and 4) Invest in the end. The model aims to increase effectiveness in the encounter and improve patient outcomes. The model first gained support due to its face validity. Now, almost 20 years after its introduction, the Four Habits Model has been empirically tested in several studies. Improved patient satisfaction and enhanced physician long-term self-efficacy has been demonstrated [5], [6]. Furthermore, in Norway, the model has been tested in hospital settings and has been shown to improve physicians’ communication behavior after a two-days course [7].

Although the model originally was designed for general practice consultations, it has over the years been implemented in various clinical settings. It has e.g. proven its usefulness for nurses facing challenging conversations in pediatric practice and for student pharmacists learning how to communicate and develop relationships with patients [8], [9]. Even though the model is generic, it is not necessarily the optimal practice for all patient groups, such as for patients with emotional concerns. With his extensive experience on emotional aspects of clinical communication, especially by being a core developer of the Verona Coding System [10], Finset acknowledged this feature of the Four Habits Model. He therefore designed a study to test a new communication skills training model based on the Four Habits model, but specifically adapted for patients in emotional distress. This model was later called the Expanded Four Habits Model (X4H) [11].

Section snippets

The Expanded Four Habits Model

The Expanded Four Habits Model (X4H) combines the generic features of the Four Habits Model emphasizing the structure in the consultation, by investing in both the beginning and the end of the consultation, supplemented by a specified sequence containing six specific communication skills. The six skills are specifically designed to improve consultations with patients experiencing emotional distress or other psychosocial problems [12]. There is one skill for exploration and one for elaboration

X4H structuring various interpersonal meetings − from general practice to Porsche

The X4H model was originally developed in order to provide GPs with a toolbox for encounters with patients in distress. The generalizability of the model has however become apparent. The elements of the X4H emphasizing a good start, exploration and elaboration within the three domains of emotions, cognitions and coping behavior, and investment in the end seems to be a suitable structure for various interpersonal and professional encounters.

At the Oslo and Akershus University College of applied

Discussion

What makes the elements of X4H applicable for social workers, physicians, psychologists and Porsche service advisors? In our opinion, the strength of the model does not lie in the model itself, as much as in the focus on the person in front of you; a person with his or her own experiences, emotional and cognitive reactions and perceptions of a situation, and an individual way of coping.

The maintenance of distress, pain or emotional disorders can be conceptualized as dysfunctional emotional and

Final comments

Finsets contribution to the field of emotional communication has been and certainly will continue to be significant. Many of us could learn a great deal from his emphasis on “the other” in own relations as well as in research and teaching. In line with his work, we argue that effective and efficient communication relies on structuring the encounter and being sensitive to the others’ emotions and perspective. These skills are, however, not innate, but needs to be taught and practiced, just like

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