Lesson 3 - Communication Skills for Structured Information Gathering
1. Lesson Overview
Effective communication helps patients and families provide clear and accurate information. It also helps them feel respected and understood during the appointment.
The assistant practitioner does not need to conduct a clinical interview. Their role is to guide the person through an approved form or questionnaire. This requires more than simply reading questions aloud. The practitioner must listen carefully, explain unclear wording and ask neutral follow-up questions when further detail is needed.
Good communication should help the person give their own account without being led towards a particular answer.
Suggested duration: 60 minutes
Delivery method: Self-directed learning followed by discussion and role-play
Practical requirement: Observed role-play using an approved WMI Psychiatry form
2. Learning Outcomes
By the end of this lesson learners should be able to:
Establish rapport while maintaining professional boundaries.
Use clear and accessible language.
Distinguish between open, closed and clarifying questions.
Ask neutral questions without suggesting an answer.
Use active listening to improve the accuracy of information.
Request relevant examples without interpreting them.
Adapt communication for children, young people and neurodivergent people.
Respond appropriately when a person becomes upset or overwhelmed.
Keep an appointment focused without making the person feel rushed.
Manage differing accounts respectfully.
3. The Lecture
The purpose of communication in these appointments
Communication during a structured information-gathering appointment has three main purposes:
To help the patient or family understand the questions.
To help them provide a clear and accurate account.
To ensure that their account is documented without distortion.
The aim is not to persuade the person to give a particular answer. It is also not to test whether their account is correct.
The practitioner should remain interested, calm and neutral.
Establishing rapport
Rapport is a professional connection that helps a person feel comfortable enough to share information.
The practitioner can support rapport by:
Introducing themselves clearly.
Explaining their role and the purpose of the appointment.
Using the person’s preferred name.
Speaking in a calm and respectful manner.
Showing interest in what the person says.
Avoiding judgemental reactions.
Giving the person time to think.
Acknowledging that some questions may be difficult.
Checking whether breaks or adjustments are needed.
Rapport does not require the practitioner to agree with everything that is said. It means listening respectfully and helping the person participate.
A suitable opening
A clear opening may sound like this:
“Hello. My name is [name] and I am an assistant practitioner with WMI Psychiatry. I will help you work through the form today and record the information you provide. Some questions may need examples so I may ask you to tell me a little more. The clinical team will review the information after the appointment.”
The practitioner can then ask:
“Before we begin is there anything that would help you feel more comfortable or make the questions easier to answer?”
This gives the person an opportunity to request adjustments.
Using plain language
Clinical forms sometimes contain unfamiliar or complicated wording. The practitioner should explain questions in straightforward language while preserving their original meaning.
For example:
Original wording:
“Does the individual experience difficulty sustaining attention during tasks?”
Plain-language explanation:
“This is asking whether they find it difficult to keep their attention on something until it is finished.”
The practitioner should not add examples that strongly suggest an answer unless the approved guidance provides them.
For example they should avoid saying:
“This means losing focus in lessons, forgetting homework and leaving chores unfinished. Does that happen?”
The examples may cause the person to agree even if these were not difficulties they had considered themselves.
A more neutral approach is:
“Can you think of any situations where keeping your attention is difficult?”
Open questions
Open questions allow a person to describe something in their own words.
They often begin with:
What
How
When
Where
Who
Tell me about
Describe
Examples include:
“What happens when you try to complete a long task?”
“How would you describe their concentration?”
“Tell me about their experience at primary school.”
“What usually happens when plans change?”
“How does this affect everyday life?”
“When did you first begin to notice this?”
“What would somebody else see when this happens?”
Open questions are helpful at the beginning of a topic because they allow the person to identify what feels important.
Closed questions
Closed questions usually produce a short or specific answer. They may be answered with yes, no or a factual detail.
Examples include:
“Did this happen before the age of 12?”
“Does this occur at school?”
“How many hours do you usually sleep?”
“Are you currently taking medication?”
“Was anyone else present?”
“Did the school raise concerns?”
Closed questions are useful for confirming factual information. They are less useful when the practitioner needs a detailed account.
A structured appointment will usually require a combination of open and closed questions.
Clarifying questions
Clarifying questions help make an answer more precise.
Examples include:
“When you say ‘often’ approximately how frequently do you mean?”
“Could you tell me what ‘a meltdown’ looks like for them?”
“You mentioned that school was difficult. What were the main difficulties?”
“Was that during primary school or secondary school?”
“Who first noticed this?”
“What do you mean when you say they shut down?”
“Can you remember a recent example?”
“Does this occur in any other situations?”
Clarification should help the clinician understand the person’s account. It should not change the account.
Asking one question at a time
Long or combined questions can be difficult to follow.
For example:
“Does he become distracted and leave his seat and interrupt people when he is at home or at school?”
This contains several questions. The person may answer only one part.
A clearer approach is:
“Does he become distracted?”
After the person answers the practitioner can ask:
“Does he leave his seat when he is expected to remain seated?”
The practitioner can then ask:
“Does he interrupt other people?”
One question at a time improves clarity and reduces misunderstanding.
Avoiding leading questions
A leading question suggests the answer that the practitioner expects.
Examples include:
“She finds changes very difficult. Is that right?”
“He must have struggled to make friends?”
“Would you say this happens most days?”
“It sounds like sensory overload. Would you agree?”
“You probably had the same difficulties during childhood?”
“That made you very anxious. Did it?”
These questions may influence the person’s response.
Neutral alternatives include:
“How does she respond to changes?”
“What was his experience of friendships?”
“How frequently does this happen?”
“What happens when the environment becomes noisy or busy?”
“What were you like during childhood?”
“How did you feel at the time?”
Avoiding either-or questions when other answers are possible
An either-or question can restrict the person’s answer.
For example:
“Does this happen because he is bored or because he does not understand?”
There may be another explanation. The person may also be unsure.
A more neutral question is:
“What do you think may contribute to this?”
The person should always be able to say that they do not know.
Asking for examples
Examples help turn general descriptions into useful information.
A person may say:
“She cannot concentrate.”
“He has no social skills.”
“They are always overwhelmed.”
“His behaviour is terrible.”
“She is very impulsive.”
The practitioner should not accept or reject these descriptions. They should ask for examples.
Useful prompts include:
“Could you describe a recent example?”
“What would somebody else notice?”
“What happened the last time this occurred?”
“What was the situation?”
“How did they respond?”
“What happened afterwards?”
“How does this affect them in everyday life?”
The purpose of asking for examples is to clarify the person’s meaning. It is not to determine whether the example meets a diagnostic criterion.
Exploring frequency
Words such as sometimes, often and always can mean different things to different people.
The practitioner can ask:
“Approximately how often does this happen?”
“Would that be most days, every week or less frequently?”
“Has the frequency changed over time?”
“Does it happen during every task or only particular tasks?”
The practitioner should record the person’s estimate. They should not create a precise frequency if the person is unsure.
Exploring duration and onset
Forms may ask when a difficulty began or how long it has been present.
Useful questions include:
“When did you first notice this?”
“How old were they at the time?”
“Was this present during primary school?”
“Has it always been present or did it begin more recently?”
“Was there any particular change around the time it started?”
“Has it remained the same or changed over time?”
If the person cannot remember the practitioner should record this uncertainty.
Exploring context
A behaviour may differ between environments.
The practitioner may ask:
“Does this happen at home?”
“What happens at school or work?”
“Does it happen when they are with friends?”
“Are there situations where it is less noticeable?”
“Does it depend on the type of activity?”
“What happens during activities they enjoy?”
“What happens when the environment is busy?”
The practitioner should not assume that a difficulty must occur everywhere to be important. The clinician will interpret the pattern.
Exploring impact
A person may describe a symptom or behaviour without explaining how it affects everyday life.
Neutral questions include:
“How does this affect them?”
“Does it cause any difficulty at home?”
“What effect does it have on school or work?”
“Does it affect friendships or family relationships?”
“Does anyone need to provide additional support?”
“What happens if support is not available?”
“Does this cause distress?”
The practitioner records the reported impact. They do not decide whether it is clinically significant.
Active listening
Active listening means giving full attention and demonstrating that the person has been heard.
It includes:
Allowing the person to finish speaking.
Using brief acknowledgements.
Reflecting key factual points.
Checking that the practitioner has understood correctly.
Noticing when an answer is unclear.
Allowing pauses.
Avoiding unnecessary interruption.
Recording information without losing engagement.
Useful phrases include:
“Thank you. I have recorded that.”
“Let me check that I have understood correctly.”
“You said this began during primary school. Is that right?”
“You described the difficulty as mainly happening at home.”
“Please take your time.”
“Would you like a short break?”
Active listening should not become clinical interpretation.
For example the practitioner should not say:
“What you are describing is clearly emotional dysregulation.”
They can instead say:
“You described becoming very upset when plans change. I will record the example you gave.”
Summarising
A short summary can help check accuracy.
For example:
“Let me check that I have recorded this correctly. You first noticed the concentration difficulties during primary school. They now happen most days at school and during homework. They are less noticeable when he is playing football. Is that accurate?”
The person should be given an opportunity to correct the summary.
The practitioner should not add conclusions that the person did not provide.
Using silence
Some people need time to process a question or organise their answer.
The practitioner should not assume that silence means the person does not understand or does not wish to answer.
They can wait before repeating or changing the question.
If needed they can say:
“Take your time. There is no need to answer immediately.”
Too many additional prompts may overwhelm the person or influence their response.
Tone of voice and non-verbal communication
The practitioner’s tone and body language can affect how safe the person feels.
Helpful communication includes:
A calm tone.
An appropriate pace.
An attentive posture.
A neutral facial expression when sensitive information is disclosed.
Appropriate eye contact without demanding it.
Giving the person enough physical space.
Avoiding visible shock or disapproval.
Avoiding signs of impatience such as repeatedly checking the time.
Some neurodivergent people may use limited eye contact. This should not be treated as evidence that they are not listening or being truthful.
Communicating with children
Questions should be appropriate for the child’s age and level of understanding.
Helpful approaches include:
Using short sentences.
Asking one question at a time.
Avoiding abstract language.
Explaining unfamiliar words.
Allowing extra processing time.
Offering breaks.
Checking understanding.
Allowing the child to say that they do not know.
Avoiding a test-like tone.
For example instead of asking:
“Do you experience difficulties with executive functioning?”
The practitioner might ask:
“What is it like when you need to get ready for school?”
The practitioner should not use childish language with an older child or teenager. Communication should remain respectful.
Giving the child or young person a voice
When a parent attends it can be easy for the conversation to focus entirely on the parent.
If the appointment structure allows it the practitioner should give the child or young person an opportunity to answer.
They might say:
“I have heard what your mother thinks. What is it like from your point of view?”
The practitioner should not pressure the young person to disagree with their parent.
If the young person does not want to answer this should be respected and recorded.
Communicating with parents and carers
Parents may have spent a long time seeking support. They may feel anxious, frustrated or worried that they will not be believed.
The practitioner can acknowledge this without making clinical promises.
For example:
“It sounds as though this has been difficult for the family. I will make sure the information you provide is recorded clearly for the clinical team.”
The practitioner should avoid statements such as:
“I am sure we will be able to diagnose them.”
“The clinician will definitely prescribe medication.”
“This assessment should have happened years ago.”
“The school has clearly failed them.”
These statements go beyond the practitioner’s role.
Neurodivergence and communication
Neurodivergent people may communicate in different ways. The practitioner should adapt without making assumptions.
A person may:
Need longer to process a question.
Interpret language literally.
Find broad questions difficult.
Give a very detailed answer.
Find it hard to identify or describe emotions.
Prefer written information.
Become distracted by sounds or movement.
Find eye contact uncomfortable.
Need movement during the appointment.
Become overwhelmed by uncertainty.
Need to know how many questions remain.
Benefit from a clear structure.
Helpful adjustments may include:
Explaining the structure at the beginning.
Giving an approximate finish time.
Asking specific questions.
Breaking broad questions into smaller parts.
Allowing movement or use of a sensory item.
Reducing environmental distractions.
Offering a short break.
Avoiding figures of speech.
Giving additional processing time.
Checking understanding without appearing to test the person.
The practitioner should ask what would help rather than assuming that everyone with the same diagnosis needs the same adjustment.
Responding when a person becomes upset
Some questions may bring up difficult experiences.
If a person becomes tearful or distressed the practitioner should:
Pause the questions.
Acknowledge what has happened.
Allow time for the person to respond.
Offer a short break.
Check whether they feel able to continue.
Consider whether clinical support is needed.
Escalate any risk or safeguarding concern.
Record the situation and action taken.
Helpful phrases include:
“I can see that this is difficult to talk about.”
“We can pause for a moment.”
“Would you like a short break?”
“Do you feel able to continue?”
“I need to make the clinician aware of what you have told me.”
The practitioner should not begin counselling the person or explore traumatic experiences beyond the approved questions.
Validation without interpretation
Validation means recognising the person’s experience. It does not mean agreeing with every conclusion.
Helpful responses include:
“That sounds as though it was difficult.”
“I can understand why you wanted the team to know about that.”
“Thank you for explaining it.”
“I will record the concern clearly.”
“It sounds as though this has had a significant effect on daily life.”
Responses to avoid include:
“You are definitely right.”
“The other person was completely wrong.”
“That proves the diagnosis.”
“I know exactly how you feel.”
“Everything will be fine.”
Keeping the appointment focused
Some people provide a great deal of detail or move between topics. The practitioner may need to guide the conversation back to the form.
This should be done respectfully.
Useful phrases include:
“Thank you. I am going to bring us back to the question so that we can cover the remaining sections.”
“That sounds important. I will record it and return to the question we were discussing.”
“We have several questions left so I may need to keep us focused.”
“I am going to pause you for a moment to make sure I have recorded the main point.”
“Could you give me one example that best shows the difficulty?”
The practitioner should not say:
“You are going off topic.”
“That is not relevant.”
“We do not have time for this.”
“Can you hurry up?”
If important information cannot be completed within the available time the practitioner should discuss this with the clinical team.
Managing limited answers
Some people may give brief answers such as “fine”, “normal” or “I do not know”.
The practitioner can gently clarify:
“What does a usual day look like?”
“What would ‘fine’ mean for you?”
“Can you think of the most recent time this happened?”
“Would it help if I explained the question in a different way?”
“Is there somebody else who may remember?”
“Would you prefer some time to think about it?”
The practitioner should not repeatedly pressure the person if they cannot or do not wish to provide further detail.
Managing different accounts
Patients, parents and carers may disagree.
The practitioner should remain neutral and allow each person to give their account.
Helpful phrases include:
“I will record both views.”
“It is helpful for the clinician to understand that you remember this differently.”
“I will make clear who provided each account.”
“Let us give each person an opportunity to speak.”
“I am not here to decide which account is correct.”
The practitioner should not take sides or try to settle the disagreement.
If the disagreement becomes aggressive or prevents the appointment from continuing safely the practitioner should pause and seek support.
Sensitive and potentially embarrassing questions
Forms may include questions about mental health, relationships, substance use, toileting, sleep or risk.
The practitioner should:
Use the same calm tone as for other questions.
Explain why the information is being asked if this is not clear.
Avoid showing surprise.
Avoid joking about the subject.
Give the person enough time.
Remind them that they may say if they are unsure.
Record the answer accurately.
Escalate concerns where required.
A neutral manner helps communicate that the person will not be judged.
Ending a topic
Before moving on the practitioner can check:
“Is there anything else about this question that you think the clinical team should know?”
This gives the person a final opportunity to add relevant information.
The practitioner should not use this question after every small item if it makes the appointment repetitive. It is most useful at the end of an important section.
Ending the appointment
At the end the practitioner should:
Check that all required sections have been covered.
Ask whether the person needs to correct anything.
Ask whether they have any relevant information that was not covered.
Explain that the clinical team will review the information.
Clarify that they cannot provide an immediate clinical conclusion.
Record any questions for the clinician.
Explain the next step if this has been confirmed by the team.
Thank the person for their time.
A suitable ending might be:
“Thank you for working through the questions with me. I will complete the record and make the information available to the clinical team. They will consider it alongside the other parts of the assessment. Before we finish is there anything important that you feel has not been covered?”
The practitioner should not promise a diagnosis, treatment or timescale unless this has been formally confirmed.
4. Clinical Perspective
Clinical pearl: Curiosity should be neutral
The practitioner should sound interested without sounding as though they expect a particular answer.
“Could you tell me more?” is usually safer than “Was that because of ADHD?”
Clinical pearl: Examples are more useful than labels
A detailed description of what happened gives the clinician more useful information than a broad label such as “meltdown”, “hyperactive” or “antisocial”.
The practitioner should record the family’s wording and ask what it looks like in practice.
Clinical pearl: Do not fill every silence
People may need time to remember early experiences or organise their thoughts. A short silence can improve the quality of the answer.
Clinical pearl: Clarify without interrogating
Follow-up questions should help the person explain their account. A rapid series of questions may feel like a challenge or cross-examination.
Common pitfall: Giving examples too early
Examples can be helpful when a person does not understand a question. They can also influence the answer.
First ask the question neutrally. Only clarify when needed.
Common pitfall: Turning the appointment into a conversation about the practitioner
Brief warmth can support rapport. The appointment should not become focused on the practitioner’s experiences or opinions.
Common pitfall: Praising particular answers
Statements such as “That is a really good sign” may suggest a clinical conclusion. A neutral response such as “Thank you. I have recorded that” is safer.
Common pitfall: Treating uncertainty as a problem
“I do not know” is a valid answer. Uncertain information should be documented as uncertain.
Common pitfall: Correcting the family’s language too quickly
Families may use informal or outdated terms. The practitioner can model respectful language without interrupting the account unless the language is harmful to someone present.
When to seek support
The practitioner should seek support if:
Communication needs cannot be met.
An interpreter is required but unavailable.
The person becomes significantly distressed.
The discussion moves into trauma that is outside the form.
Risk or safeguarding information is disclosed.
Conflict between attendees is escalating.
The practitioner cannot understand the person’s account.
The person requests clinical advice.
The practitioner believes that continuing may be unsafe.
The appointment cannot be completed within the agreed structure.
5. Case Examples
Case Example 1: A broad description
A father says:
“His behaviour is terrible.”
The practitioner should not record only “terrible behaviour”.
A helpful response would be:
“Could you describe what happens when you are concerned about his behaviour?”
The father may then give an observable example that can be accurately documented.
Case Example 2: A leading question
A practitioner asks:
“She becomes distressed whenever plans change. Is that right?”
This suggests an expected answer.
A more neutral question would be:
“How does she respond when plans change?”
Case Example 3: A long answer
A parent provides a detailed account that moves away from the question.
The practitioner might say:
“Thank you. I have recorded the concerns about school. I am going to bring us back to the question about sleep so that we can complete each section.”
This acknowledges the information while restoring the structure.
Case Example 4: The young person disagrees
A mother states that her daughter has no friends. Her daughter says that she has three close friends online.
The practitioner should record both accounts and clarify what each person means. They should not decide whether online friendships count as genuine friendships.
Case Example 5: Distress during a question
An adult becomes tearful while discussing childhood bullying.
The practitioner should pause and acknowledge the distress. They can offer a break and check whether the person feels able to continue.
They should not begin exploring the bullying in detail unless the approved form requires it. Any risk or safeguarding concern should be escalated.
Case Example 6: A request for reassurance
A parent asks:
“You have spoken to lots of families. This sounds like autism to you. Does it not?”
The practitioner might respond:
“I understand why you are asking. My role is to collect and record the information rather than interpret it. The clinician will consider it alongside the rest of the assessment.”
6. Summary
Effective information gathering depends on clear, respectful and neutral communication.
The assistant practitioner should:
Establish rapport.
Explain their role.
Use plain language.
Ask one question at a time.
Begin with open questions when a description is needed.
Use closed questions to confirm factual details.
Ask neutral clarifying questions.
Request examples.
Explore frequency, onset, context and impact where required.
Listen actively.
Allow processing time and silence.
Adapt communication to the individual.
Record different accounts without taking sides.
Respond calmly to distress.
Maintain the structure of the appointment.
Escalate concerns when required.
The practitioner should avoid:
Leading questions.
Suggesting a diagnosis.
Giving clinical advice.
Showing judgement or disbelief.
Pressuring the person to answer.
Changing uncertain information into a definite answer.
Treating their own interpretation as fact.
Promising a particular outcome.
7. Further Reading
WMI Psychiatry Assistant Practitioner Role Description
WMI Psychiatry Communication and Reasonable Adjustments Policy
WMI Psychiatry Consent and Confidentiality Policy
WMI Psychiatry Safeguarding Policy
WMI Psychiatry Risk Assessment and Escalation Procedure
WMI Psychiatry Clinical Record-Keeping Policy
Guidance supplied with each approved information-gathering form
8. Reflective Exercise
The learner should consider the following:
What is the difference between a clarifying question and a leading question?
How might your tone or facial expression affect a person’s answer?
How would you respond if a parent repeatedly asked for your opinion about a diagnosis?
What could help a person who needs additional processing time?
How would you redirect someone who gives very detailed answers?
How would you ensure that a child’s views are heard when a parent is present?
What would you do if you did not understand what the person meant?
Which communication habits might unintentionally influence an answer?
The learner should discuss their answers with their supervisor.
9. Practical Competency Activity
The learner should complete a role-play using an approved WMI Psychiatry information-gathering form.
The role-play should include:
A patient or parent who gives a vague answer.
A question that requires clarification.
A long answer that moves away from the topic.
Differing accounts from two attendees.
A request for the practitioner’s diagnostic opinion.
A person who needs additional processing time.
Mild emotional distress.
A question that falls outside the practitioner’s role.
The learner should demonstrate that they can:
Introduce the appointment clearly.
Establish rapport.
Use open and closed questions appropriately.
Ask neutral follow-up questions.
Request a relevant example.
Check that they have understood correctly.
Allow silence and processing time.
Redirect the conversation respectfully.
Maintain appropriate boundaries.
Recognise when support or escalation is required.
The supervisor should review both the communication and the written record before deciding whether further practice is required.
10. Knowledge Check
Complete the short knowledge check below to consolidate your learning and check your understanding of the key principles covered in this lesson. You can review the lesson content again before submitting your answers.
