A hard lesson in psychological care: Being nice is not enough
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LEADER A hard lesson in mvcholoaical care: I I U being nice is not enough few years ago, as a participant at a diabetes educa- A tion workshop, I had to interview a woman with insulin-dependent diabetes who received her insulin continuously infused through a pump. I was watched by several physicians and specialist nurses as I asked her endless questions about her diabetes management. Checking through her knowledge (and demonstrating mine!) I carefully avoided asking too much about the pump, of which I had no experience; anyway there were plenty of other things to ask about. As the interview ended she let slip that she hated the pump. Too late, I had used the allocated ten minutes asking her too many probably irrelevant questions and I had not given her the opportunity to discuss this highly significant revelation. Her feedback (to two psychologist.) on my interview technique was not good. It had really been a bit of a waste of time. “She was nice but . . . .” What does being nice mean? Well, I smiled and was warm towards her, I nodded periodically in response to her answers, I tried to understand her diabetes. It was not enough. I had missed the point. Brian Thorne, a British authority on person-centred counselling, writes of his realisation that the qualities of warmth, genuineness and being non-judgemental actually need to be communicated using specific verbal skills and not left to the chance that, somehow, the person on the receiving end might become aware of theml. To enable patients to focus on their difficulties, health professionals may need to use these same skills. There are many papers on diabetes education and psychology which promote concepts such as person-centredness, collaboration and empowerment, and which speak of the importance of recognising the part that psychosocial influences play on glycaemic control. How can we put into practice this body of psycho- logical knowledge? The idea that these concepts can be applied therapeutically to patients once the health pro- fessional has acquired knowledge of them is as naive as hoping that all patients might change their behaviour once they have been informed of the ‘rules’ of diabetes management. In this issue of the journal the Practice Point article ‘Feeling stuck. Some useful questions for a diabetes team?’ offers a framework of questions that give direction to dealing with difficult management issues. The wording of each question is structured in such a way that a dialogue is allowed to develop which is person-centred, collabora- tive and empowering whilst sensitive issues are discussed with someone who is having difficulties with their dia- betes. Later this year another paper will suggest similar open questioning techniques and other verbal skills that can be used in routine consultations which can also help health professionals develop the philosophies of diabetes care advocated by educationalists and psychologists2. Two common concerns that health professionals have about getting involved in psychological care are that it might be too time-consuming and that they might become ‘consumed’by the pressure of psychological demands that are impossible to meet. At the Northampton Diabetes Counselling Course, partici- pants role-play five minute scenarios, introducing nine or ten skills (over three days), and discover the reality that skilled communication can prevent time-wasting by allowing patients to focus on what they see as significant. The wording of open questions and subsequent responses not only encourages patient self-responsibility but reduces the sense that many health professionals have, of needing to come up with solutions for every problem proferred by patients. What of my experience with the woman and her insulin pump? It was a painful experience for me to learn in a relatively public way that I had not been helpful and, despite ‘being nice’, had let her down by focusing only on the disease and my own agenda. If only I had asked her, “What is it like to have a pump?” But then, maybe, I would not have learned my lesson! Brown RGNRMNW, Diabetes Specialist Nurse, Glasgow, UK References 1. Thome B. Person-centred counselling: therapeutic and spiritual 2. Brown F. Counselling in practice. Pruct Diabetes Int (In press) dimensions. London and New Jersey: Whurr Publishers 1991 143 Practical Diabetes International September/October 19% Vol. 13 No. 5
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Transcript of A hard lesson in psychological care: Being nice is not enough
LEADER
A hard lesson in mvcholoaical care: I I U
being nice is not enough few years ago, as a participant at a diabetes educa- A tion workshop, I had to interview a woman with
insulin-dependent diabetes who received her insulin continuously infused through a pump. I was watched by several physicians and specialist nurses as I asked her endless questions about her diabetes management. Checking through her knowledge (and demonstrating mine!) I carefully avoided asking too much about the pump, of which I had no experience; anyway there were plenty of other things to ask about. As the interview ended she let slip that she hated the
pump. Too late, I had used the allocated ten minutes asking her too many probably irrelevant questions and I had not given her the opportunity to discuss this highly significant revelation. Her feedback (to two psychologist.) on my interview technique was not good. It had really been a bit of a waste of time. “She was nice but . . . .”
What does being nice mean? Well, I smiled and was warm towards her, I nodded periodically in response to her answers, I tried to understand her diabetes. It was not enough. I had missed the point.
Brian Thorne, a British authority on person-centred counselling, writes of his realisation that the qualities of warmth, genuineness and being non-judgemental actually need to be communicated using specific verbal skills and not left to the chance that, somehow, the person on the receiving end might become aware of theml. To enable patients to focus on their difficulties, health professionals may need to use these same skills. There are many papers on diabetes education and psychology which promote concepts such as person-centredness, collaboration and empowerment, and which speak of the importance of recognising the part that psychosocial influences play on glycaemic control.
How can we put into practice this body of psycho- logical knowledge? The idea that these concepts can be applied therapeutically to patients once the health pro- fessional has acquired knowledge of them is as naive as hoping that all patients might change their behaviour once they have been informed of the ‘rules’ of diabetes management.
In this issue of the journal the Practice Point article ‘Feeling stuck. Some useful questions for a diabetes team?’
offers a framework of questions that give direction to dealing with difficult management issues. The wording of each question is structured in such a way that a dialogue is allowed to develop which is person-centred, collabora- tive and empowering whilst sensitive issues are discussed with someone who is having difficulties with their dia- betes. Later this year another paper will suggest similar open questioning techniques and other verbal skills that can be used in routine consultations which can also help health professionals develop the philosophies of diabetes care advocated by educationalists and psychologists2.
Two common concerns that health professionals have about getting involved in psychological care are that it might be too time-consuming and that they might become ‘consumed’ by the pressure of psychological demands that are impossible to meet.
At the Northampton Diabetes Counselling Course, partici- pants role-play five minute scenarios, introducing nine or ten skills (over three days), and discover the reality that skilled communication can prevent time-wasting by allowing patients to focus on what they see as significant. The wording of open questions and subsequent responses not only encourages patient self-responsibility but reduces the sense that many health professionals have, of needing to come up with solutions for every problem proferred by patients.
What of my experience with the woman and her insulin pump? It was a painful experience for me to learn in a relatively public way that I had not been helpful and, despite ‘being nice’, had let her down by focusing only on the disease and my own agenda. If only I had asked her, “What is it like to have a pump?” But then, maybe, I would not have learned my lesson!
Brown R G N R M N W , Diabetes Specialist Nurse,
Glasgow, UK
References 1. Thome B. Person-centred counselling: therapeutic and spiritual
2. Brown F. Counselling in practice. Pruct Diabetes Int (In press) dimensions. London and New Jersey: Whurr Publishers 1991
143 Practical Diabetes International September/October 19% Vol. 13 No. 5
