For many patients, an aesthetic clinic is a special place to feel pampered and have a one-on-one chat about holidays, fashion, work or even relationship issues. In most cases, they will be a light-hearted conversation on several well-worn topics. In some cases, when a trusting relationship has been established, it can be beneficial to have a basic understanding of motivational interviewing techniques. This will help patients gain clarity on an issue they raise, enabling them to come up with a potential solution, and lets a clinic be where both practitioner and patient leave feeling pampered and focused.
Conversation starters
The most important factor is to have a light conversation with your patient that makes them comfortable and valued, as opposed to a bland mention about the weather or an uncomfortable silence. Below are some examples of good conversation starters:
» If they do want to move forward, suggest that they write down the advantages and disadvantages of making the change now that they have aired the problem. This is a good way of helping the patient without losing your neutrality with them «
- What is one trip or holiday you would do again?
- What song always puts you in a good mood?
- What do you consider to be the most underrated or overrated TV show or film?
- If you were to move, which city would you go to?
- What film would you want to watch again for the first time?
- What is the last TV show you binge-watched?
- What is the most relaxing place you enjoy going to?
- Do you like documentaries? Do you have any recommendations?
- What was the last book you read?
- When you do not know what music to put on, who is your go-to band or artist?
- Do you have any pets?
Some patients might not want to talk and, instead, wish to use the time to relax—it is important to know when they want a break from socialising. If they do want to talk, use the same standards that would be applied when meeting your partner's parents for the first time. There are some topics worth avoiding, particularly politics, religion or finances, as any single one can lead to a heated debate instead of a light-hearted conversation. Avoid gossip or questions that could appear personal, too, as that will likely appear unprofessional. Remember that patients visit a clinic for an experience, and topics that make them uncomfortable will not do you or your business any good. Try to keep the conversation light and redirect the mood, if appropriate (Bélisle-Springe, 2018).
Guiding conversations using motivational interviewing
However, in some cases, a relationship with a patient may involve serious issues that make the practitioner feel more like an agony aunt than an aesthetics professional. Although being a therapist is certainly not the clinician's primary role, there are a few ways of therapeutically guiding a conversation to help the patient to take stock of their options and form a plan, if appropriate. Motivational interviewing is an approach that was developed by clinical psychologists William Miller and Stephen Rollnick in the 1990s to help alcoholics come to terms with their addiction and take control. It is used in health visiting, coaching, classroom management, parenting and addiction (Rollnick et al, 2008). It is based on the assumption that most people are ambivalent about changing; instead of being weak or resistant to it, they simultaneously see both the need for change and the reasons not to. The objective is to resolve the ambivalence by eliciting and talking about change. The practitioner is not suggesting a path of action, they are just guiding the patient to turn it into an actionable plan. The approach is built around the following four communications skills, also known as OARS, and these skills can be used several times in a conversation.
Open-ended questions
Open-ended questions allow the interviewer to learn more about the patient's perspective, potential ideas and motivation for change. They are phrased to require more than a yes or no response and usually start with language such as ‘How’, ‘What’, or ‘Tell me about…’. This should not feel like a question-and-answer session—the patient should be the one doing the talking.
Affirming
Affirming can be done by recognising the patient's abilities and strengths and then affirming and validating their emotions.
Typical responses include: ‘That sounds really challenging’, ‘That is a good idea’ and ‘No wonder you feel overwhelmed’. Responses should not sound effusive, patronising or over the top, as they will not sound genuine. However, they should acknowledge and support the patient's hard work and struggles.
Reflective listening
Reflective listening is a form of engaged listening and reflecting elements of the conversation back to the patient as a statement rather than a question. Sometimes, this will involve asking the patient questions to see how they perceive things, but the key here is not to turn into an interrogation. Typical listening responses start with ‘So you feel like…’, ‘It sounds like you…’ or ‘You are wondering if.’.
Summarising
Summarising is a collection of those reflections to the patient that lets them identify their story's core concepts around transition points. If done correctly, the patient finds they hear their thoughts about change, which can be a powerful method for evoking that change. Invariably, they will set goals for themselves that they believe they can achieve. The summary usually is brief and consists of three to four sentences. You might start a summary with ‘Let me see if I understand so far…’ or ‘Here is what I've heard. Tell me if I missed anything’.
At the end of a motivational session, there may not be a sign of the patient's readiness to move forward and come up with a plan. If that is the case, do not force them into a plan of action. Change has to come from the patient, not you. If they do want to move forward, suggest that they write down the advantages and disadvantages of making the change now that they have aired the problem. This is a good way of helping the patient without losing your neutrality with them.
Crossing the boundary: is your patient at risk of harm?
Sometimes, serious issues may be raised. If a patient raises issues where they or another person is at immediate risk of harm, and you are a registered nurse, your obligations are clear under the Nursing and Midwifery Council (NMC) code of conduct: you must raise concerns immediately, even if your aesthetic role is secondary to your nursing role (NMC, 2018).
In 2017, Kerri McAuley was murdered 2 weeks after confiding to her hairdresser that she thought her abusive partner would kill her. Her hairdresser did not act on the warning signs due to a lack of training and has since campaigned to raise awareness. The #CutItOut campaign was launched in 2019 to teach hair and beauty professionals about the warning signs of domestic abuse and how to safely refer patients to relevant organisations that can help them (Black, 2019) (ITV News, 2021).
As a responsible clinic owner, practitioners should have a clear policy and training for staff regarding what constitutes a safeguarding issue and how to escalate it. To patients, a clinic may be perceived as a safe place where they can confide in you—do not ignore a cry for help.
Summary
Having a great conversation with a patient helps build rapport and trust, which in turn will help turn them into loyal and regular customers. On occasion, having the ability to help patients explore their ambivalence and direction on a topic can help build a deeper relationship. Having a basic understanding of motivational interviewing will help with this. JAN