I had some interesting responses to my last retirement blog about my diabetes review which was encouraging because, when I looked at it again, it felt like a bit of a whinge. With these responses in mind I decided I should seize the moment and try and write a more positive blog around the topic although initially it may seem from the title, that this isn’t going to be the case. I suppose it’s almost going to be written for the professionals to read but, of course, it’s highly unlikely that is going to happen so look at it as some guidance on what to look out for from your professional if you’re finding your review meetings to be unhelpful. It’s based on my diabetes experiences but may have relevance to those of us working with health professionals whatever our ‘condition’ (a much loaded word but now is not the time to dig deeper into its connotations). It’s going to be a bit higgledy piggledy but bear with me.
The first thing the professional needs to understand (and that’s the last time I’ll write that, it’s implied from now on) is that the psychological side of the meeting needs at least as much attention as the ‘factual’, a term to which I shall return in a moment. If this takes more time then so be it because, without this attention, some ‘patients’, shall I call us that, are never going to make any progress so resources will be wasted. In an area like diabetes the client’s (is that better) attitude to their condition is going to be significant in making or failing to make, any progress towards a healthier life style.
Let me make a few further points about the psychology of the meeting. First, there are no such things as facts, simply the interpretation we put upon them. Many philosophers and psychologists have made this same point, probably starting with Nietzsche. It’s a massive area for debate and this bald statement will have to do for this blog. Simply put, what may appear like the cold, hard facts to the professional – this biscuit contains x calories – may mean something entirely different to the client – is that all, I thought it would be more.
Presenting the ‘facts’, then giving the advice based on these is working on a false premise. Of course health professionals see their job as diagnosis and then giving advice. That’s the whole basis of the medical profession – diagnose / treat. To repeat myself the diagnostic process is often not as secure as it appears to the client as an outsider. Often no more than a score on a checklist. If the client finds the basis for their diagnosis questionable they are unlikely to act on the advice bit. Diabetes has a good deal of variability in the diagnosis part and a huge amount of difference in the nature of the advice given. As variable, for example, as the advice given about the nature of an effective diet. Facts are not actually as factual as they might seem.
Health professionals go too fast. They have their allotted time slot and their ‘agenda’ to get through. One of the very basic premises that I and a few of my colleagues used to operate by was, don’t go faster than the client is able or willing to go. You’re wasting your and the client’s time. We liked to think of what some would call a counselling session as a conversation where all the usual ‘rules’ of a conversation applied. For example, you use your listening skills, you ask a question and listen to the answer and reflect, in some way, what the other person has said back to them, you make eye contact, maybe nod every now and again, show interest, throw in a little of your own experiences. A conversation is essentially a two-way process. Sounds obvious but many health professionals don’t operate like this. They don’t have the time you might say, well, without the above, you are wasting time and resources, I say.
Professionals underestimate the power of, what psychologists call, the client’s irrational beliefs or, faulty thinking. These are often unstated and even unrecognised by the client, but they are killers of the improvement process. For example, you tell me I need to lose weight but I don’t want to lose weight because I believe it will make me look old, if I’m male it will make me look weak, skinny, I may even get bullied more often than if I look big even if that only means I’m fat rather than strong. Being over-weight, for some people, can be a comfort against loneliness, depression, it’s a shield against the world. A diabetic person may resent the label they have been given and resist intervention as a result. Alternatively, they may welcome it, they belong, they have a label (labelling is a dangerous business but I don’t have the time to discuss this now, simply put a label can inhibit rather than promote progress).
Another form of possibly unhelpful thinking is – I don’t believe the science, it’s not proper science. We have learned to distrust information that comes with the scientific label because we have come to realise that research is often impure, funded by the drug companies with the intention of increasing their profits rather than helping me. Don’t give me the statistics, we all know about lies, damned lies and statistics. Of course none of the above may be true but if the client thinks it is then that’s what determines their motivation, their commitment. Again the variability of recommendations / treatments can have the same undermining effect. The professional needs to recognise this attitude, any faulty (if they are) cognitions, and work with it.
Trust is a big part of any support relationship. Trust can come over a period of time which can be undermined if the professionals change without any reference to the client as happened to me. If the relationship doesn’t have the time to develop then the basics of conversation, as above, become even more important. I briefly mentioned questions as part of a conversation but this is not quite as straightforward as it might at first appear. There are good and bad questions. A conversation in which one participant bombarded the other with a series of questions followed by apparently unvalued or no responses, wouldn’t last very long. It wouldn’t be trusted. I’ve lost 5lbs (in my case it was, ‘I walk the dogs for two hours each day’), the professional replies, great, and moves on to the next item without proper acknowledgement. A good question then becomes, ‘great, how did you do that?’ or ‘What would need to happen for you to continue in this way?’ or ‘Where did your motivation come from?’ I used to value my ability to ask good questions more highly than any of my skills as a psychologist. Again a topic for a whole other blog.
Finally for now (and there is much I’ve had to leave out),if we are interested in the client’s motivation then it is essential to find their plus points, their strengths and build on these, use these to get to where you and the client wants to be. Identifying the client’s strengths (the good bits of their life style) means there is the opportunity to give the person positive feedback and there is a whole other blog about this area of psychology. I’ll finish with a brief, but I think powerful, example, one I’ve mentioned before in these blogs but it bears repeating. My dentist, when he inspects my teeth, says, ‘good brushing, Peter’. The power of motivation of this simple statement, and I’m sure he could find much to criticise, is huge. I make sure I continue with my good brushing.
I’m going to stop now, I’m well over my 1000 words, though this blog, which I had intended to be more directly about motivation, has wandered somewhat. Hopefully food for thought though if not for calories.