Clinical interviewing techniques and skills - Functional neurological disorder

OPRO acronym

Open questions

Example
"I understand that you experience many different symptoms that affect your daily functioning. What do you wish was different?
The purpose of
This allows the patient to do most of the talking while the clinical psychologist learns more about the patient, his values and goals.
Confirmation of power

Example
"Thank you for sharing this with me. I understand that it is very difficult to talk about."
The purpose of
Building a trusting relationship and giving the patient a sense of validation.
Reflection

Example
"You felt like you were simulating and that nobody really believed you."
The purpose of
Paraphrasing the patient's sentences to give meaning, which can also serve as a stimulus or trigger for change.
Renewal

Example
"Let me renew to see if I really understand everything you have told me."
The purpose of
It enables mutual understanding of the conversation and indicates active listening.

Motivational questions

1. Inclusiveness

Example
"How important is it for you to make this change and why?"
The purpose of
Open the conversation with a two-way discussion. Focus on the open questions.
2. Focus

Example
"What are the specific aspects you would like to improve?"
The purpose of
Focus the conversation on the specific behaviour the patient wants to change.
3. The Challenge

Example
"I can see that you are finding it difficult to commit to the psychotherapy process at the moment. What do you need to change to make a difference?
The purpose of
Encourage the patient's motivation to change by using language that favours change.
4. Planning

Example
"So what's the next step?"
The purpose of
Build a clear plan that will lead to change; the goal should be based on a SMART formulation.

Follow-up session

Discussion points

Symptomatics
Explore the impact of symptoms on "good days" and "bad days". Ask how they cope with symptoms at home, work/school, in the context of their symptoms.
Discussion points

Positive changes
Ask them what they have changed to cope better with their symptoms.
Discussion points

Give them confirmation
Praise progress as it is directly related to the patient's hard work. Reassure them that occasional setbacks are normal and that as long as the overall trajectory of progress is successful, everything is under control.
Discussion points

Identifying problems
Ask them if they have identified any problems that make their symptoms worse. Together, explore the barriers to treatment.
Discussion points

Reassessment of triggers and maintainers
Regularly update the biopsychosocial model of factors influencing the course of the disorder.

- Finkelstein, S. A., Adams, C., Tuttle, M., Saxena, A., and Perez, D. L. (2022). Neuropsychiatric treatment approaches for functional neurological disorder: a how to guide. In Seminars in Neurology (Vol. 42, No. 02, pp. 204-224). Thieme Medical Publishers, Inc..