Behavioral Health Minute

August 2008 - A brief template for helping people with challenging life circumstances

The short summary

We can help people with problem-solving, coping and healthy/meaningful living.

The modestly longer reflection

People come to us in distress about challenging life circumstances.  These may be external (financial hardships, other people’s behavior etc.) or internal (troublesome emotions, troublesome thoughts etc.).  I think that people have three choices in dealing with distressing life circumstances.

1. Changing the circumstances. 
2. Coping with the circumstances. 
3. Being healthy and whole in spite of whatever is going on with distressing circumstances. 

Changing the circumstances.  Sometimes people can be encouraged to do problem-solving around the aspects of the challenges they face.  In the face of financial difficulties, for instance, one can develop a budget, or trade in the truck on a 1989 Ford Taurus.  Many of the circumstances that I talk with people about involve the behavior of other people… partners, supervisors, children, neighbors… and it may or may not be productive to explore ways to get the other people to change their behavior.  In general, external circumstances are more amenable to changing than internal circumstances.  Often, a screening question like “To what extent do you think this is something that you can change, that you can be making different?” gives a clear indication about whether there may be a productive conversation here.

Coping with the circumstances.  As I have said in an earlier minute a few months ago, the questions

How are you coping with this?

How are you handling this?

can lead to patients talking about what they have discovered that helps them to cope (like the pt yesterday, “I realized there’s nothing I can do about it, so I just have to make the best of it”) and can lead in to your suggesting coping approaches, such as journaling and mindfulness.

Being healthy and whole in spite of whatever is going on with distressing circumstances.  Supporting and encouraging people to live in a health-enhancing and meaningful way as they go along… eating right, exercising, finding some pleasure and joy, learning something new, caring about the people that they love, making choices about how they spend their time and energy consistent with their values.

I try to hold these three directions in my brain as I talk with people about what is going on with them and how they wants their lives to be different.

Follow-up

Think about the three directions as people come to you with reactions to life challenges.

Fred Craigie, PhD, 8/08