Welcome to today’s communication solution podcast. We love talking about motivational interviewing, and about improving outcomes for individuals, organizations, and the communities that they serve. We have an interesting topic to talk about today: Open Ended Questions and the quality and complexity of what’s being talked about. 

• Open ended questions vs close ended questions
  
• How do you ask open-ended questions?
  
• Reflective listening and empathy
  
• Motivations and the quality of curiosity
  
• Learning curves
  
• Mindset
  
• Perspectives
  
• Connections and values
  
• Real life examples of differences in questions
  
• Skill building
  
• And so much more!
  

The Communication Solution – Open Ended Question

Tammy: Hello, and welcome to the communication solution podcast today. We’ve got Casey Jackson on the line, John Gilbert, and I’m Tammy here at IFIOC. We love to talk communication. We love to talk motivational interviewing, and we love talking about improving outcomes for individuals, organizations, and the communities that they serve.

Welcome to the conversation.

John: All right. Welcome back everyone. We have interesting topic to talk about today. At least for me, maybe not for everyone, but we’ll see how it goes. I know that Tammy, you had particularly wanted to talk about this topic and subject because you were thinking of a situation that just starting at the basics we can talk about. But then I was like, well, we can go deep into this with multiple layers. So, I’m looking to hopefully do that with you Casey and Daniel. Today and just see how far we can get in a shorter podcast we have today. So, Tammy, what was the original kind of thinking you had for this topic? What is it, you were thinking?

Tammy: The original topic was open ended questions, 101. And the reason why is because I think some people get stuck into. A lack of curiosity sometimes because we don’t really know what to talk about. And then there’s a difference between open ended questions versus close ended questions. You closed ended questions are. Yes, no, you expect a certain specific answer. Open questions, allow for the person to openly share their thoughts and ideas. Opinions could go so many different ways. The more that we can create open ended questions, the more we can hear people’s thoughts, ideas, beliefs, all that type of stuff. So that’s kind of where my mind was at when I was like, let’s do open ended questions.

Casey: Well, what’s so funny to me is. I feel myself having a natural bias and a natural writing reflex this topic which I shouldn’t it’s so weird. And I think because so many people I’ve heard so much more lately that people are talking about, well, yeah, I went to a motivational interviewing training and it’s like, how you ask open ended questions? It’s like, oh my gosh, we’re drifting so far away from empathy and accurate, reflective listening, but. I know it’s my bias because I know I over correct on leaning so heavy into teaching people. What is high, accurate empathy? And the reality is that smart, strategic, evocative eliciting open ended questions are critical.

 Skill set to master in motivational interviewing. And I know I overcorrect towards teaching reflective listen. And so, so I’m getting over my bias and listening to that, cause it’s just like, oh, I don’t want people to think that it’s open-ended questions, you can’t do motivational without really smart, strategic open-ended questions.

Tammy: Yes. It’s part of the equation. And I think that’s a really good point, Casey, because reflective listening is critical to motivational interviewing, but there are those times where you need to elicit and draw out from people. Their thoughts, ideas or beliefs too.

Casey: Well, it, just, when you say that, I even think of the MICA, you know, the motivation incompetency assessment. And I think when we’re writing a thing about evoking in the intentions, we, measure open ended questions. We measure, evoking and, you know, I always share this and if you’ve heard other podcasts, me talking about evocation, but it just is so profound about how important open-ended questions. when I share that example of, in the cloudy cup, there’s pearls in a cloudy cup, we tend to want to throw our pearls of wisdom when people are confused when their brains are overwhelmed and again, in. The era of COVID people are under profound stress. And when they’re under profound stress, you know, they’ve got lots of pearls of wisdom. They get covered up by the trauma and stress response. And so, we can reflect that. But part of moving people from that trauma response up into their executive functioning is how do we draw out their thoughts and their ideas? Because just reflecting in circles or reflecting what’s going on inside. Doesn’t necessarily open the pathway to get them up into their executive function in the prefrontal cortex. It is the quality of a great open-ended question that, has that curiosity that evokes or elicits their thoughts and their ideas. And you see their brain work through the cloudiness to get to those pearls of wisdom inside of themselves. So, it just, even as we’re starting this topic, it’s like it’s making my brain kind of go back around with that. What we’re really talking about with, with open ended question.

John: Well, and I’d like to speak to the learning curve here, just working with so many different people and my own learning curve and still working on empathy myself, and that there’s a certain degree of. Who are we interacting with and where are they at with their degree of expression of empathy? Because there seems to be this crossover of like, if you can go deep, complex, rich reflections that are very provoking of the person to speak more. There’s something there that when you can guide that conversation, standing shoulder John: to shoulder, that someone like yourself seemingly Casey, that’s not just you. It’s about the skill I realize, but. Has this tendency, this ability to go there in ways that are worth training to, and it’s just hard to go there for various people. And so, in the learning curve of this, how do we help people transition from something that you weren’t necessarily saying at the beginning of this Tammy, but that we talked about offline before, which is out of that, fix it mode into a curious mode and just that alone is a shift. Empathy is a shift at a fix it mode, but even myself as Casey, you’re being transparent about your writing reflex. I’m having the writing reflex of what like Terry Moyers and some of these other researchers have found in recent history, which is that open verse, closing into questions matters significantly less than the quality of your curiosity. It’s less about. Do you think this, or what do you think about this? Versus I know that the quality of my curiosity is I’m asking them what they make of this situation to engage them, to get oriented to their reality, to engage and be engaged with them. I know that it doesn’t have a lot of direction to it. But I know that right now, this is going to be engaging for them. And then I can come in with the demonstration of I get you versus I don’t get you, which is the thing we’re kind of alluding to here, Casey, that you trained me in is questions, communicate. I don’t quite understand. And the person then has to, and microseconds go, what do I want to share with this authority figure usually? And then instead the empathy gets at that information maybe in a different angle. But if you are going to ask a question of, I don’t understand, I don’t get you versus demonstrating. You understand? What are you trying to understand? Are you trying to understand a sense of their reality more generally, which is a part of empathy, but it’s more demonstrating is what we focus on, but it’s seeking to understand, are you just trying to understand their reality more general? Are you trying to gather information, because that’s a part of your job and assess their situation. That’s a different curiosity. Are you focused on the problem and trying to problem solve with them? There’s a place for that. And motivational Interviewing we tend to jump to that pretty quick with the premature planning trap. but that’s different asking is different than telling. At least we got that down. That’s a different quality of curiosity. And then even different than that, that seems to come later for people. But the whole term of motivational Interviewing means to interview someone about their motivations and the quality of curiosity, to just be curious. Why do you do what you do? Or why would you even want to change to see something different? Or what does it matter if things change and why does that matter? And just the curiosity of motivation is one of those key things in motivational Interviewing that can get lost in the fray of all these acronyms and all these other things.

 John: And it’s so much to why I’m grateful to Casey talking about the physics of this, the mindset and the intentionality of this versus the technique components of it. Because if I’m not aware of where I am putting my curiosity. I’m not necessarily being as mindful as I could be to guide this conversation. And I am getting paid most of the time in the helper role to guide this conversation. So, it’s that quality of curiosity, spectrum that I was lit up to talk about with all this. And I have a lot of different examples we could get through, but I’m just wondering if that resonates or any thoughts that any of you have on any of that?

Casey: Yeah, I, I think that’s why my natural tendency is to over correct. Away from questions is because it’s to pull people away from what we’ve been trained to do, because questions, the nature tends to be more self-centered I’m asking a question, because I’m curious and I want to find something out. And when you’re, when you run it through a healthcare or behavioral health lens or any of the other lenses that use motivational interviewing it’s because we’re gathering data or we’re gathering demographics, we’re gathering information most of the time that we never use, but we gather all of this stuff from people, but it’s for our own purposes. Motivational Interviewing being is so other person centered. And so, I think everything you’re articulating John is the nature of what open ended questions are in motivational interviewing, but I think that we are so trained, and I think it’s just natural instinct out of curiosity, but the curiosity tends to be about us and how these people relate to us or how their information relates to us or how their lives relate to us. Because we may ask the question, oh, what do you do for work? But mostly we ask the question to listen so we can bring it around to ourselves. I mean, it’s just, it tends to have that quality to it. But what you’re articulating is that is not the quality. Of curiosity. It is curiosity about how the person’s brain works in relationship to their life. What are their ideas in relationship to their life? And that is just substantively different than asking kind of the traditional closed ended questions. Or we need to gather data to, to come up with a plan or an intervention here, or we need to assess their life and their health and their safety. We need to assess all these things so we can come up with an intervention that tends to be the questions we ask. And like you said, the more we ask questions and the more data we get, the more opinions we have on somebody else’s life. And so, then we ask more questions and the more opinions we get, which is again, more of a self-centered process. So, I think delineating this and distinguishing what we’re talking about with this quality of evocation eliciting. Is I think is really value added.

John: Well, there’s so many thoughts I go through with that too Casey, because one of them is this place of it depends, so much of the context and what work environment, when I think of a healthcare situation you’re trained to, call it the medical model, assess. Assess because we are the people that know. And if someone’s ready to go and willing to do all the work, the information that comes from that, or if you’ve been in a car accident, if you, as you’ve talked about in trainings or something like that, where it’s acute short term, that information to inform the intervention really, really matters. It’s that when we’re talking about motivational interviewing context with this particular technique, it’s that there seems to be something to people coming to their own sense of a oh crap or an aha or a lit up something in their brain when you can guide that process. And that can happen through reflections. Or questions or ideally a combo of both with more reflections than questions. But when we’re trying to get to the heart of it, it’s getting less self-centered to me, Casey’s what you’re speaking to that we were just talking about in another podcast of compassion that I care more about you and your outcome, and you aligning with your values than you aligning with my values or me talking about my reality versus you talking about your reality. Danielle, you were alluding to this as us, as egocentric being us talking from our perspective. It’s just easier. I enjoy it. You enjoy it. We come across authentic and genuine with each other. It’s fun. We get a sense of connection. So, for me to shift that and now go, oh, let me stand shoulder to shoulder from your perspective and say something from your perspective. That can be a hard shift.  So, for me to just go, I am curious about your perspective is one shift into getting. Ideally less focused on us. And then as you shift that deeper, ideally, you’re going to get oriented and you can give voice to their perspective, give voice to what’s going on for them, regardless of what you think. And as you do that, you’re going to get more likely expansion and information and get more curious about a particular something. Well, what that could be you paying attention to their motivations or their change talk, or them doing something about something different in their life? Well, if your curiosity shifts to that all about them and their values and how much they’re aligned with that, or not, at least you’re making this less self-centered approach more of your approach. And Casey, to your point, I think to get really less self-centered you would have more statements about what’s going on for them than questions. That’s what the motivational Interviewing would point to with two to one ratio or three to one ratio of. Reflections to questions. And that is something that when people hear that have even been through in my trainings, they’re like, wow, I don’t think I ever heard. I didn’t realize how much

John:  reflection and reflective listening is a part of this, but there is a point to not just open-ended questions. When you do ask a question that as you’ve taught me, Casey, you’re teeing up the question with reflections. Yes. You’re getting more information. What their reality is what’s accurate or not so that you can ask it for their brain and their mind as much as we possibly can. But I do want to bring it back to, there is a place for assessment questions. For orienting to someone’s reality. If they’ve had trauma or not had trauma, if they have gone through this thing or that thing with an autoimmune issue, there is information to be on the table. So, I don’t want. Negate that’s a part of, of being a professional to help someone is assessing information to get oriented to their reality. It’s just that that’s less a behavior change conversation. Casey, as you’ve talked about, it’s assessed. So that this can be fixed. It’s not let’s get into your reality and help you align your behaviors with your values. So that’s so much of what I think you just spoke to is, is really critical. Making it as much about them aligned with their values or not is what the motivational Interviewing curiosity is trying to be about.

Danielle: I was just going to say I sat in, on one of your trainings, Casey, and the, the biggest takeaway many, but was about the quality of curiosity, because I had not realized how important reflections were to take that guess of how that person might be looking at the world. And it, you had mentioned something about it’s the quality with which you make. That statement, that reflection. Yes. That will allow that person to respond. Even if you got it wrong. That’s okay. because you just got information now, but you did it with that quality of curiosity that did not make them defensive.

Casey: That’s it? And, you know, as we’re talking about this and I think this is going to be a whole separate podcast, it just strikes me is. When you’re talking about the side by side, and that curiosity, what that requires is a brain that’s not under its own stress or trauma, the amount of energy and, chemical reaction in your cortex and prefrontal cortex that has to exist. And your mirror neurons, the amount of energy that, that takes to leave your experience and enter someone else’s experience accurately is not going happen when people under stress and it’s not going happen when you’re traumatized because your brain science is set up to keep you surviving. like your default is going to be survival. So, when people under stress and pressure and there, productivity’s dropping and their, child has COVID again and, now we’re getting more pressures and now our funding streams have shifted and, now I’m supposed to be empathetic. And now I’m supposed to be shoulder to shoulder in somebody else’s reality. Damn, I can barely manage my own reality. Like I think, putting Casey:  that in that context, and I think that’s going be a whole separate podcast that just struck me because There’s so much more complex than thinking about open ended questions, affirmations, reflections, and summary statements. That’s all accurate, but the depth and the quality and complexity of what’s being talked about when you’re talking about the complexity of the human brain and human behavior is just mind blowing to me. and the example that I tend to use and that we can use it with open ended questions. is you can, give a first-year resident a scalpel and have them kind of remove sutures using a scalpel. And they’re fine with that. But given that same scalpel and have them go in and try to do advanced surgery on the heart. They’re not as adept at that. It’s the same scalpel. It’s just how. Skilled are you ailing it for what things? I mean to, to snip a couple of sutures is not difficult, but to get in there and actually navigate around human organs is way more complex. And I know I overstate this, but I genuinely believe the work you do. If you’re genuinely working on behavior, change is as complex or more complex than heart surgery or brain surgery. These are moving pieces of human beings whose thoughts and feelings are adjusting. Moment to moment and day to day, the human heart has some basic structures that aren’t going change. The human brain has some basic structures that people know how to navigate, and even that’s a new horizon, I don’t think it’s overselling it for people to understand when we’re talking about the quality of empathy and accurate empathy, which is usually leans into things like reflective statements and validation in these, you know, these techniques. It’s the same thing. I guess when we’re looking at open ended questions that it’s not about a question it’s like, John, you’re talking about that Moyers at all are writing about that. It’s just the quality of curiosity and the authenticity that you’re bringing to that on what opens people up to their own thought process. And that is extremely complex. It’s beyond a worksheet it’s beyond, you know, a recording of, did you use questions or reflections? Did you use open questions or close questions? There’s so much more, mindset and intention behind that.

John: That will be helpful in, I think, a future podcast as we do looking at time that I’ll be wrapping for this one here, but I do want to mention that the less time you have, the more, it’s important to be aware of. What is the quality of your curiosity? What is the quality of your [00:18:00] empathy and the depth of it? Because the less time you have. The more precise you need to be.  So, when I think of brief MOTIVATIONAL INTERVIEWING or doctors or people in healthcare that have that less time, and then Tammy’s saying, well, now they’re going open up about everything. Well, it’s like, oh my gosh, I don’t want them to open up about everything. I’m curious about this particular thing for it to serve them for their change. And so, I just wanted to end with that sense of it’s functional, it’s effective. It’s efficient that we’re talking about. Not just feel good, but Tammy go.

Tammy: Perfect. I just wanted to end with like three real life examples so people can distinctly see kind of the differences. So, we’re, we’re talking about a lot of people start with close ended questions, which are like have, have you had any thoughts about this topic? Yes or no. And then people start to evolve their skillset and do more open-end questions. Like what are your thoughts about this topic? And that starts to get people to talk. What their thoughts are, but the next level, which is what we’re talking about, how reflective listening can sometimes replace open ended questions is doing a statement like, yeah. And you’ve had a lot of thoughts around this already. and that can come sometimes lead people to then share what some of those thoughts are. So, I just wanted to give a distinct example of the show, like close ended and open ended and a reflective statement. You can get to the same ending point or outcome with an open-end question versus a reflective statement. But the reflective statement is much more of that empathetic place where you’re coming.

John: So that’s and we, we, we go over that even in some skill building stuff in our trainings, if people are interested in going through that from questions to reflections, we’ve got different handouts or different professionals. So just a, a heads up with that, that can be a very helpful skill building. Also, that I’ll be putting together something I’m working with this expert group, or we’re working with some expert group people right now. And the reason I was saying I is because I’m putting together this list of different types of questions, of engaging, focusing. Pursuing and planning. And so, with that we’ll have some stuff posted on our motivational Interviewing plus or anyone that is interested in that for some more resources, some more skill building that you can find on our motivational Interviewing plus membership as well. So that I point people in that direction. But for now, that’s all I have unless anyone else has anything else for wrapping it up?

Casey: Sounds good. Thanks everyone.

John: Everyone was helpful. See you next. All right.

Tammy: Thank you for listening to the communication solution podcast as always. This podcast is all about you. So, if you have questions, thoughts, topic, suggestions, ideas, please send them our way at casey@ifioc.com. That’s casey@ifioc.com. For more resources, feel free to check out. IFIOC.com. We also have a public Facebook group called motivational interviewing every day. We have an amazing blog and we have lots of communication tips on our website. In addition to all these amazing resources we do offer online public courses. On our website on motivational interviewing and effective communication strategies. Thanks for listening to the communication solution by IFIOC.