Behavioral Health Minute

December 2008 - Useful conversational approaches, Part 1

The short summary

Two conversational approaches help people move from presenting symptoms to ownership of a search for solutions.

The modestly longer reflection

Much of the ways that we look at behavioral health care is at the level of defined intervention packages… cognitive behavior therapy, relaxation training, couples counseling, and so forth.  These are worthy approaches, but I am also fascinated by thinking about behavioral health care at the line-by-line level of how we have conversations with people.

This month (and periodically), I want to suggest some specific phrasing of questions at this conversational level that seem to help me to move forward with people. 

People typically present with symptoms or complaints.  “I’m anxious,” “I’m depressed,” “I’ve been flipping out,” “I’m in terrible pain.”  Two approaches that often help me to move beyond complaints:

• What is your theory about what is going on and why this is happening?

People may not always have “theories” about these things, but if they do, it can move things forward efficiently to hear them.  “I think I’m anxious because of all the things I have on my plate.”  “I think I’m depressed because I always spend so much time doing stuff for other people and don’t pay enough attention to me.”  If you can get theories like these “out there,” it gives you some directions to work with.

• What are you trying to figure out (or) What questions are you trying to answer with this that we can work on together?

People bring to us all sorts of troubles.  Pt says “I’m really depressed.”  Now the ball is in your court to say or propose something wise that will fix them.  Asking what they are trying to figure out puts the ball back in their court; it moves pts into a position where they take some responsibility for organizing the conversation around where they want to go with the symptoms they are giving you. 

What I am looking for is a question from pts along the lines of “How do I…”  Examples:  “Well, what can I do to get less depressed?”  “How do I deal with this?”  It is not hard to have pts state questions like these, and as they do, it moves them into the first step in taking ownership of the search for solutions.

Follow-up

Try these out when pts present with lifestyle-related problems.

Fred Craigie, PhD, 12/08