MRCPsych Patient Communication Skills 3 — Questions and Answers
Question 1: A patient with depression consistently deflects personal questions with humor. The most effective therapeutic response is to:
- Match the patient's humor to build rapport
- Gently name the pattern and explore what lies beneath it (Correct answer)
- Redirect to standardized depression screening questions
- Interpret the humor as a sign of improving mood
Correct answer: Gently name the pattern and explore what lies beneath it
Naming the defensive pattern respectfully invites the patient to explore underlying affect without confrontation.
Question 2: When conducting a risk assessment for self-harm, which question is most clinically useful?
- 'You don't have thoughts of hurting yourself, do you?'
- 'Have you ever harmed yourself in the past?'
- 'Can you tell me more about the thoughts you have when you feel at your lowest?' (Correct answer)
- 'Do you understand how dangerous self-harm is?'
Correct answer: 'Can you tell me more about the thoughts you have when you feel at your lowest?'
Open-ended contextual questions invite detailed disclosure and reveal ideation, intent, and planning more reliably than closed or leading questions.
Question 3: A patient from a collectivist cultural background defers all treatment decisions to their family. The psychiatrist should:
- Insist on individual informed consent in line with UK law
- Exclude family from all discussions to promote autonomy
- Explore the patient's own wishes while respecting cultural context and legal requirements (Correct answer)
- Obtain consent from the family as the primary decision-makers
Correct answer: Explore the patient's own wishes while respecting cultural context and legal requirements
Good psychiatric practice explores the patient's own values and preferences while remaining sensitive to cultural context and meeting legal consent requirements.
Question 4: The term 'counter-transference' in the therapeutic relationship refers to:
- The patient's unconscious redirection of feelings from past relationships onto the therapist
- The therapist's emotional reactions to the patient, influenced by the therapist's own history (Correct answer)
- A patient's resistance to engaging with treatment
- Shared emotional responses between therapist and patient
Correct answer: The therapist's emotional reactions to the patient, influenced by the therapist's own history
Counter-transference describes the clinician's emotional response to the patient, which can be used therapeutically when recognized and managed.
Question 5: A patient with mania is speaking rapidly and jumping between topics. The most effective communication strategy is:
- Interrupt frequently to maintain structure
- Match the patient's pace to establish rapport
- Use brief, calm, structured statements and gently redirect (Correct answer)
- Conduct a full psychiatric history before addressing the presenting complaint
Correct answer: Use brief, calm, structured statements and gently redirect
Brief, structured, and calm communication helps anchor a manic patient without escalating their arousal.
Question 6: Motivational interviewing primarily works by:
- Educating the patient about the harms of their behavior
- Exploring and resolving the patient's own ambivalence about change (Correct answer)
- Setting clear behavioral goals and monitoring progress
- Using cognitive restructuring to challenge unhelpful thoughts
Correct answer: Exploring and resolving the patient's own ambivalence about change
Motivational interviewing is based on eliciting the patient's own motivation by exploring ambivalence in a non-confrontational way.
Question 7: A patient discloses that they are experiencing domestic violence but requests confidentiality. The most appropriate initial response is to:
- Immediately contact the police without informing the patient
- Acknowledge the disclosure, explore safety, and discuss the limits of confidentiality (Correct answer)
- Document the information and take no further action to respect autonomy
- Refer directly to social services without the patient's knowledge
Correct answer: Acknowledge the disclosure, explore safety, and discuss the limits of confidentiality
The first priority is to acknowledge the disclosure, assess safety, and transparently discuss what you may need to share and why.
MRCPsych Patient Communication Skills 3
A patient with depression consistently deflects personal questions with humor.
The most effective therapeutic response is to: