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5.1.4 Limiting Your Use of Open and Closed Questions
We cautioned earlier about the indiscriminate use of questions and stressed the
importance of not interrogating patients. We elaborate on these points in this section
because we believe it is very important for beginning counselors to recognize both
the potential benefits and limitations of questions. Two specific reasons to ask ques-
tions are to learn about patients and to cue patients about the types of information
you need. When you want your patient to elaborate, an open question may be more
effective (e.g., “What types of options do you believe you have open to you?”). If
you need to efficiently gather specific information, then a closed question may be
more effective. Closed question are particularly useful for gathering information for
family and medical histories (e.g., “How many siblings do you have?”).
Before asking questions, consider their potential impact. Open and closed ques-
tions may have different effects on patients and the counseling process. As noted by
Spitzer Kim ( 2009 ), “Closed ended questions are questions that typically can be
answered with one or two words (yes or no). These questions are useful for obtain-
ing specific information. They tend to keep the discussion to a minimum and do not
encourage expression of emotion. Open ended questions invite a client to say more
about a subject and give a more nuanced response” (p. 84).
Too many questions can lead to an interrogation in which you control the pro-
cess, with the patient becoming less rather than more communicative. Excessive
questions may also result in patient passivity (e.g., “I will just sit here and wait for
my genetic counselor to ask me the next question”). Bertakis et al. ( 1991 ) found that
patient satisfaction was highest when physicians communicated interest and friend-
liness and avoided behaviors that were dominating, such as excessive questioning.
Over-reliance on closed questions has been found to lead to lower patient satisfac-
tion during medical appointments with physicians (Bertakis et al. 1991 ), during
mental health counseling sessions (Hill 2014 ), and during genetic counseling
(Guimarães et al. 2013 ).
Guimarães et al. ( 2013 ) interviewed 22 patients in Portugal undergoing pres-
ymptomatic testing for Huntington disease, spinocerebellar ataxias, or familial
amyloid polyneuropathy. They explored patients’ perceptions of the testing process,
the extent to which their personal expectations and needs were met, their views of
the decision-making process, and the counselors’ engagement and counseling skills.
They found excessive questioning was negatively associated with patient satisfac-
tion. They cautioned against excessive questioning, especially if the questions are
challenging and/or redundant. They also noted the potential for patients to become
defensive in reaction to numerous questions about life changes, possible advantages
and disadvantages of performing presymptomatic testing, and/or potential conse-
quences of the test results: “Under these circumstances, the counsellor will be per-
ceived as a ‘gate keeper,’ a barrier in front of the decisional process, and not as a
facilitator. This may be overcome by the appropriate use of counselling skills, such
as the ability to create empathy, the use of open questions and responses...in
5 Gathering Information: Asking Questions