Behavioral Health Minute

November 2010 - What do you want?

The short summary

Exploring what people want with the concerns they present to us helps to focus the direction and collaboration in conversations.

The modestly longer reflection

People often come to the office (yours and mine) presenting us with symptoms or concerns, and rarely saying specifically what they want.

Sometimes this is fine.  You might not have much of a “what do you want” conversation with a laceration or URI, for instance. 

With more complicated biopsychosocial issues, it can be very helpful to define

• Do people want a diagnosis?
• Reassurance?
• Tips on managing?
• “Make it go away?”

… or, in some cases, just to have a chance to talk.

And with more expressly psychosocial issues (I’m depressed, I don’t have energy, I’m not sleeping well, I have these terrible financial problems, my partner is not being very kind, I have a child with ADD) it can be almost essential to define what people want.

Defining what people want focuses conversations and puts people in a position of taking some ownership of our working together.  Sometimes it can also get out on the table when what people want is not viable or within their control or your control (finding a job, have my partner be nicer, having these weird thoughts go away, not having pain).  If what people want is not able to be controlled, then the goal needs to be re-negotiated.

 Good perspectives on what people want are

1. Within their control
2. Functional, not symptomatic (“walking three times a week,” rather than “feel less anxious”)
3. Positive rather than negative (“be more connected to my friends,” rather than “not isolate so much”)

Some conversational handles:

•         With the things you’re describing to me, what do you want… what is the goal?
•         What is it that you would like to accomplish in this visit?
•         How would you put into words a question that you are trying to sort out with the things we’re talking about?
•         If you were doing better with the things you’re describing to me, what would that look like?
•         How are you hoping I might be able to help you with the things we’re talking about?

Follow-up

Try out these or your own conversational approaches to exploring what it is that people are looking for in their visits with you.

Fred Craigie, PhD