First, let’s look at an interaction that goes poorly. Dr. Wornik will appear from time to time with observations and advice.
DR. DENKE: I want to remind you, anything you say to me is totally confidential. I won’t tell anyone unless you ask me to. Or unless you or someone else is in danger, okay? (Cody nods) So what can you tell me about the changes in your mood recently?
CODY: I’m fine.
DR. DENKE: Your parents are concerned you’ve been getting angry more easily.
CODY: (slightly annoyed) I get angry because everyone still treats me like a kid.
DR. WORNIK: Dr. Denke tries the blunt approach. Let’s see how that goes.
DR. DENKE: I have to ask, Cody, are you using drugs or any other substances?
CODY: What?! No!
DR. DENKE: When parents are concerned about a teenager’s outbursts, a lot of times it’s because they’ve been experimenting with--
CODY: I’m not on drugs! I spent all this time trying to get healthy. I’m not gonna… throw it all away and become some strung-out junkie.
DR. WORNIK: Many users don’t think of steroids as “drugs” like meth or cocaine; they view them more like supplements, as something they’re using to enhance their health. Also, Dr. Denke backed Cody into a corner with a direct, judgmental question, so it’s no wonder he responded defensively.
Now Dr. Denke switches to the somewhat-effective tack of bringing up the warning signs he noticed in the exam, and then puts Cody back on the defensive by accusing him of using steroids.
DR. DENKE: I’m concerned about some of the symptoms you’ve been experiencing.
CODY: (dismissive) What “symptoms”? I’m fine.
DR. DENKE: I noticed a few things during your exam -- your breath has a strong smell to it, you’ve got extensive acne on your back and shoulders, and you said you were in the ER with a tendon strain in March. And now your parents are concerned that you’ve had a few outbursts.
CODY: (defensive) So what? Lots of guys have acne. And my parents need to just stay out of my business!
DR. DENKE: I’m going to be honest. The symptoms I’m seeing in your exam today usually come from taking anabolic steroids.
CODY: Screw this. I’m out of here.
DR. DENKE: Are you taking steroids, Cody?
CODY: I’m not gonna just sit here while you accuse me…! What are you gonna say next? I’m on meth?
DR. DENKE: As your doctor, I can’t give you proper care unless you’re honest with me. (very deliberate) Have you tried steroids?
CODY: I’m not talking about this.
DR. DENKE: If you’re using steroids, you need to stop right now, Cody, before you do any worse damage to yourself.
CODY: I’m not using.
DR. DENKE: I can’t care for your health if you don’t trust me. I need to know you’ll listen to my recommendations.
CODY: Stop it! You don’t know anything about me!
DR. WORNIK: Dr. Denke’s attempts to bully Cody into admitting steroid use fell flat. This conversation won’t be helpful for anyone. A better approach would have been to use indirect questions, validating statements, and a non-judgmental tone to build trust with Cody.