Building Trust to Explore Home Situations
Use open-ended questions combined with empathic responses to create a safe space where patients feel heard and understood, starting with "Tell me what's going on at home" or "What's been the hardest part for you at home?" rather than yes/no questions. 1
Create the Right Environment First
Physical setup matters significantly for disclosure:
- Sit down at the patient's level to convey you have time and are not rushed 1
- Ensure privacy with an unobstructed path out of the room so the patient doesn't feel trapped 1
- Maintain two arms' length distance to respect personal space 1
- Make eye contact and keep hands visible and unclenched to avoid appearing threatening 1
Opening the Conversation
Begin by exploring the patient's understanding and agenda before diving into your concerns:
- Ask "What are the things you want to make sure we discuss today?" to give the patient control over the conversation 1
- Use "Tell me what you understand about why you're here" to assess their perspective 1
- Get to know the patient as a person first—ask about their life before the current problem and how things have changed 1
Inquire directly about coping: "How are you and your family coping?" or "What's been happening at home?" 1
Active Listening Techniques
When the patient begins to share, demonstrate you're truly hearing them:
- Use reflective listening: "Tell me if I have this right..." or "What I heard is that..." 1
- Acknowledge emotions explicitly: "You seem sad today" or "Help me understand how you're feeling" 1
- Hold silence until the patient is ready to continue speaking 1
- Notice emotional subtexts in seemingly cognitive questions (e.g., "Isn't there anything more you can do?" may signal fear) 1
Avoid assuming quiet patients don't want to participate—ask directly: "I'm wondering what you're thinking or if I'm missing something?" 1
Responding to Disclosure
When patients reveal difficult home situations, respond with empathy:
- Name the emotion: "This has been a very tough time for you" 1
- Use partnership statements: "I want to do what I can to help you" 1
- Validate their experience: "What you're going through is difficult" or "That would upset other people too" 1
- Explore what's behind strong emotions: "What has been the hardest part of all this for you?" 1
Be cautious about providing solutions when patients are highly emotional—they often cannot process information well in that state. 1
Common Pitfalls to Avoid
Do not deceive or minimize to make the conversation easier—this destroys trust and prevents future disclosure. 1
Avoid information overload: Provide information in small doses, stop frequently, and check for comprehension using "teach back" (e.g., "In your own words, what does this mean to you?") 1
Don't assume family members will speak up about their own concerns—ask explicitly: "I know you want to respect [the patient], and I'm guessing you have your own concerns too?" 1
Building Ongoing Trust
Establish clear expectations and mutual respect:
- Set boundaries respectfully: "We're here to help, but it's also important that we're safe with each other and respect each other" 1
- Assure availability: "We can talk about this again—people have many different kinds of thoughts over time" 1
- Be honest, genuine, and respectful throughout all interactions 1
Consider asking about occupation early in the conversation, as this can help set tone, focus explanations on everyday experiences, and address ideas, concerns, and expectations more comfortably. 2