Engaging Challenging Patients and Clients: Wood’s Example

“I’ll come here to see you.

You know why?

It’s because you treated me

like a human being.” Jose

spoke these words to Wood, at

the end of their first visit.

In a previous article entitled, On Engaging our Patients and Clients: When Everything Else Fails, I described the encounter between Jose and Wood; how challenging it was for Wood to engage Jose, and how, at the end, Wood was eventually successful. In this current article, I am going to describe in more details, the different steps Wood took and how each one of us can implement them in our daily practice.

Below are two principles Wood successfully used to obtain the results that he did with Jose.

1. Wood validated Jose:

Validation is one of the crucial principles of engagement and to successfully working with challenging patients and clients. It is an experience for which we never get enough, and yet, one that we all could use more as an intervention.  Although, at times, you may disagree with your patient and client, and you want to let him or her know, it is always best to first validate.  Is your patient or client irritating you, and you want to voice your discomfort?

First, validate.  Perhaps your patient or client is about to escalate, and you want to prevent any further escalation? First, validate.  Validation is a simple yet powerful intervention.  It helps our patients and clients feel heard, understood, and connected, even when they are not necessarily always getting exactly what they are asking for.

I am not going to give you that Ambien for sleep, or that Klonopin for anxiety until we, together, understand the nature of your insomnia or anxiety. But before my explanation, I need to make sure to validate first.  Jose’s request of Wood was for him to, “Just read my records. You have everything you need already.”  Wood, however, wanted to hear Jose’s story, in his own voice, and he wanted to convey that to him, but first he validated him, “Jose, thank you for coming to see me here today. I understand you have already told your story … “

Wood could have used an even more powerful validating statement, but the fact that he thought of and used the principle of validation is a good example worth illustrating.

2. Wood explained what he was doing:

Another principle of engagement that Wood implemented with Jose, he explained what he was doing. “I always prefer to hear it in your own voice in order to record things accurately. That’s why I am asking you again,” he told Jose.

Wood’s explanatory statement followed his validating statement; explanation is another crucial principle of engagement when working with patients and clients. Explaining what we do and why we do it is a key principle used in any good psychoanalytic or psychodynamic psychotherapy treatment, by any good coach, and by any great leader and manager of any great organization. I also encourage the use of this principle of explaining what we do and why we do it when I work with parents in dyadic therapy and when I work with families and couples. A good politician also knows that the best way to get others to rally behind his or her cause is to explain the what and the why.  This principle can be further explained by Simon Sinek’s powerful message and book, entitled, Starting with Why.

As with his validating statement, Wood’s explanatory statement could have been more powerful. But again, he thought about it, he used it, and this is another intervention worth illustrating. Next time you sit with your patient or client, with your coachee or mentee, with your staff, or your partner, or your child, explain what you are doing and why. You will be glad you did.

“I’ll come here to see you. You know why? It’s because you treated me like a human being.” Jose spoke these words to Wood, at the end of their first visit.  This visit did not have a smooth start. Jose had been very “guarded,” very “resistant,” very “defiant” and “oppositional.” However, Wood persisted. He validated and he explained what he was doing and why.

References:

1. Secretary of State for Health. The NHS Improvement Plan – Putting people at the heart of public services. Cm 6268. 2004. London, Department of Health.
2. Report of Working Party prepared for the Director of Research and Development NHSME. Quality in Health Care1993;2:117–23.
3. Thompson J, Barber R, Ward PR, Boote JD, Cooper CL, Armitage CJ, Jones G: Health researchers’ attitudes towards public involvement in health research. Health Expect. 2009, 12 (2): 209-220.