Session Organizational Skills

AGENDA SETTING

The purpose of agenda-setting at all encounters is to collaboratively structure how time and effort gets spent. Agenda-setting involves patient input in determining ahead of time how to both focus the intervention and ensure that patient’s priorities are addressed. Setting an agenda at the start of each encounter helps to manage time throughout the encounter. Agendas typically include behavioral health symptom review, homework review, and new goal setting and homework.

Elements of agenda setting include the following components:

• Set agenda collaboratively with the patient as a first topic of the meeting, or as clearly as possible
• Ask patient if they feel they have improved since the beginning of treatment, and
• Briefly review the symptom questionnaire or behavior checklist, and ask the patient which symptoms have bothered them the most

Less helpful ways to start a session in the absence of agenda setting include the following examples:

• Ask unfocused, open-ended questions about the past week
• Review symptoms or behavior checklists before setting an agenda, and
• Review homework before setting an agenda

REDIRECTION

At times during our encounters with patients, we may need to redirect them back to the task at hand. We use redirection skills to ensure that patients focus productively on one issue at a time. Good time management starts with agenda-setting at the beginning of an encounter and is maintained by ongoing redirection and focus throughout the encounter.

A helpful redirection will include the following elements:

• Reflect or briefly summarize the patient’s concern
• Talk about the connection, or lack or connection, between the patient’s new concern and the task at hand, and
• Suggest returning to the task at hand, or prioritizing the current concern as more important

Qualities of responses that do not redirect the patient include:

• Ask follow-up questions about the new concern
• Let the patient keep talking without interrupting them, or
• Ignore the patient’s concern and abruptly return to the task at hand