Two Minute Talks to Improve Psychological and Behavioral Health

John F. Clabby

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000466690
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

'There are important books that focus a full effort on a painful emotion such as depression or panic. Frankly, many troubled people do not directly present with such complaints. Instead, they speak about marital stress, upset about making an oral presentation, dealing with a mean-spirited co-worker, poor nutritional habits, handling uncooperative children or early adolescents, and domestic violence. They want practical guidance about those content areas as well.'- John F Clabby. Health professionals confronted with symptoms of mental and emotional distress often lack knowledge of how to respond to the situations that underlie them, or feel unable to address them in time-limited consultations. This can lead many to either adopt an empathetic listening approach which fails to address underlying causes effectively, or avoid asking their patients and clients about their psychosocial lives at all. Two Minute Talks to Improve Psychological and Behavioral Health takes a unique approach to this common dilemma. It provides concise, pragmatic and matter-of-fact advice which health professionals can use to effectively address the most common underlying causes of distress, such as work, family or relationship difficulties, poor nutritional habits, domestic violence and grief. Although firmly evidence-based, it avoids unnecessary detail to provide a practical reference which can either be read in its entirety or used as a quick reference of clear, accessible advice and strategies that patients can put into use. It is an essential addition to the toolbox of all health professionals who want to provide effective, responsive and empathetic care to their clients in time-limited situations. 'This book will reveal to you talents and results you did not believe possible. It will re-energize your approach to care, and make it fun to talk with and get to know your patients'. - from the Foreword by Kenneth Faistl.

SECTION 1

Practical strategies from powerful psychotherapies

CLIENT STRENGTHS, ADVISOR–CLIENT RAPPORT, AND POSITIVE EXPECTATIONS

People want to talk to someone who can help them with their behavioral and psychological troubles. The person who gives the help is in some circles called the doctor, the psychologist, the counselor, the mentor, or the coach, and in this book is referred to as the advisor. The person receiving the help could be called the patient, the customer, or the consumer, and in this book is called the client.

In a poll conducted by Newsweek, nearly 20% of adults in the U.S. reported that they had had some form of psychotherapy or counseling, and 4% were currently in therapy.¹ A study of 14,000 households found that 3.2% of American adults in 1987 and 3.6% in 1997 sought psychotherapy annually.²

Those fortunate ones are able to obtain formal psychotherapy. Yet today, as well as throughout the ancient history of men and women, and certainly well before the development of the modern era of trained psychotherapists, there has been a rich tradition of a hidden service of psychotherapy and counseling. These are the brief, two minute talks that clients continue to have with people who are often wise elders, who serve as advisors. These talks, which often last around two minutes, have stood the test of time.

What comes from the current study of psychotherapy for behavioral and psychological health that can make such two minute talks even more effective? The scientific literature on the effectiveness of psychotherapy provides some leads. There is no longer any equivocation. The truth is that psychotherapy and counseling work. However, what makes experiences like psychotherapy work has less to do with unique contributions provided by different psychotherapeutic theories, and more to do with factors that are common to all psychotherapies.³ Michael Lambert⁴ cites four characteristics of all effective psychotherapies and ranks them in order of influence. These are the quality of the personal and environmental strengths that the client already has, the quality of the client–advisor relationship, the power of the placebo effect in building hope and positive expectancies, and finally the technique that the advisor uses.

The quality of the client’s personal and environmental strengths counts for 40% of the reason why clients get better after therapeutic talks. These strengths include the client’s determination to get better, their personal commitment to the advising experience, their being aware of having successfully resolved such problems before, and/or their having a meaningful spiritual life. Advisors should notice and reinforce such qualities by complimenting clients on having the maturity and courage to ask for advice in the first place. The advisor can reinforce the client’s determination by acknowledging the client’s energy that is already being put into figuring things out. The advisor can express admiration for the client’s commitment to lessening the emotional pain by reaching out. Other environmental factors that influence whether a client makes progress in psychotherapy or advising include having a job that is satisfying, maintaining a connection with an understanding best friend, or reacting positively to chance events such as a favorite team winning a football game. An advisor can notice these factors and comment that such ingredients are significant, hopeful, positive markers.

The healing nature of the client–advisor relationship has repeatedly and in different settings been reported to be the most important component of care.⁵ Some researchers argue that the relationship is therapy in its own right, rather than just a communication vehicle through which the real formal therapy works.⁶ The quality of the connection between the client and the advisor accounts for about 30% of the reason why clients benefit from one-to-one therapeutic talks. Cultivating and projecting a sense of caring, empathy, warmth, and acceptance is essential to facilitating emotional and behavioral change in a client. This is one of the factors over which advisors have some control, and significant attention needs to be given to learning how to make authentic connections and build rapport.

The power of the placebo effect in building the client’s hopes and positive expectancies about the advisor’s skills accounts for approximately 15% of the reason why clients benefit from advising. Hope is about a client’s expectation that talking with the advisor will lead to success in attaining a personally meaningful and realistic goal (e.g. being happier in a marriage). A client’s hope is also based on the client believing that it is possible to achieve the goal, and it is fueled by such advisor and client attributes as energy, resilience and courage, and the availability of important external resources (e.g. having insurance to cover the costs of marital therapy if it is needed). Hope has four components that the advisor can cultivate:

1 emotions, such as encouraging client trust and confidence in the advisor, making the conversation a positive one because it also includes some small talk and even some appropriate humor

2 intellect, such as the advisor encouraging the client to reflect upon past experiences, to set goals, to plan, and to assess the likelihood of success

3 behaviors, such as the advisor encouraging the client’s motivation to act positively

4 environmental attributes, such as the resourcefulness of the advisor in locating resources such as low-cost marital therapy if there is no insurance coverage, or connecting the client with a support group.⁷

Advisors will also build hope and positive expectations by growing their expertise about the common life and psychological challenges which they can share with clients. People hold advisors in high regard. They will approach an advisor because of his or her social and occupational status. People trust an advisor because of the advisor’s education, training, and professional experience.⁸ Projecting confidence without arrogance is a key component to effective advising.

With regard to the technique or the model of treatment that the advisor uses, both the quality of the procedure used and how well the advisor explains the rationale account for 15% of the client’s improvement.

In summary, the research recommends that advisors comment on the client’s maturity in asking for help, cultivate the connection and rapport, raise the client’s expectations that the advice will help, and raise the quality of the advice by maintaining a continuing education effort to learn about problem-specific content areas. Combining these four elements makes the advisor a powerful agent of positive change.

HEARING THE FULL STORY

Since 30% of the success of therapeutic conversations is explained by the relationship and rapport between advisor and client, how can an advisor establish a positive relationship? Many advisors can recall going to someone for help themselves, perhaps even a healthcare professional, and being disappointed by the lack of connection. Despite an advisor’s considerable interpersonal and professional skills, sincere listening cannot be faked. Qualities such as humility, sincerity, hopefulness, likeability, and even a healthy sense of humor can be a base for rapport. But what are the technical tasks that can support the work of the advisor? These include eliciting the client’s perspective, helping the client to feel understood, explaining what may be happening and what the options might be, handling differences of opinion with grace and care, coming to an optimistic agreement about options that will really help, and using words that are practical and accessible.⁹ Excellent rapport starts with a commitment to be fully available to help this client during the conversation.

Active listening starts with authentic belief that the client has an important story to tell. The client has been working up the confidence to talk for some time. At the beginning of the conversation, the advisor must remain calm and let the story come to them. Stuart and Lieberman¹⁰ advise healthcare providers that the first few minutes belong to the patient. The job of the advisor is to create a safe environment and then get out of the way so that the client can tell the story. The wise advisor holds back on questions, suggestions, interpretations, and interventions until the story is completed. Otherwise the client will be preoccupied with wondering whether there will be a chance to tell the tale, and therefore cannot concentrate on any advice, however brilliant, that they are given. Once the client has had a few minutes to tell the story, the advisor may be tempted to ask a series of closed questions: Who were you with? When did this actually happen? What time was it? The effort to get the facts is well intended, but for the client it can be an uncomfortable interrogation, and they may shut down.

At the beginning of the conversation in particular, the advisor should avoid asking closed q...