JANET: OK, maybe some people can learn from FAILING to quit smoking, but I’m not “some people.” I’m not sure learned I anything from MY experience.
CLARK: Well, you managed to stay cigarette free for two whole days at a pack a day, thats forty cigarettes you didn’t smoke!
JANET: I was pretty miserable. Though I get what you are saying. I was determined. I guess that’s a positive.
CLARK: It is.
COACH: Great! Instead of disagreeing with Janet’s assessment of her past attempts, you’ve reframed them as contributing to her future success.
JANET: It’s just, quitting is already hard to even think about. So to actually do it again and deal with all the other crap that happens to your body? Please. I do not need that in my life.
CLARK: Tell me about the challenges you faced quitting in the past.
COACH: Great! By exploring Janet’s challenges in an open ended manner, you’re taking her concerns seriously while also identifying circumstances and symptoms that may be addressable.
JANET: I suppose the biggest one was I would get cranky. Like Frankenstein cranky. And I’m supposed to be the nice grandma! (laughs) You seem nice enough to me! Besides getting cranky, were there any other issues you were concerned about?
JANET: Well, not to be superficial or anything, but I really don’t want to get, well, fat. It ain’t easy for a lady to lose weight at this age, you know.
JANET’S THOUGHT: How am I supposed to even consider quitting knowing I have to go through all this all over again?
CLARK: Tell me more about how you’re concerned you’ll gain weight.
JANET: Well, I’ve never quit long enough to experience it myself. But my pal Susie managed for about a month. Blew up like a blimp and kept it.
CLARK: You’re worried when you quit smoking you’ll put on a significant amount of weight, and have difficulty losing it afterwards.
JANET: Yeah, poor Susie. She was so stressed from the weight gain, she started smoking again.
COACH: Great! By asking Janet to tell you more about how she’s concerned she’ll gain weight, you showed you’re taking her concerns seriously.
CLARK: I have some information about weight gain after quitting smoking that I can share, if you like?
JANET: Sure.
CLARK: There is a chance you’ll gain some weight, that’s true. Though the average person who quits smoking only gains around 5 to 10 pounds. How do you feel about that?
JANET: Oh, well, that’s not so bad. I thought I’d need to buy a whole new wardrobe.
COACH: Good! You asked permission before sharing information with Janet. She felt like her opinion was being taken into account and she was more receptive to hearing what you said.
CLARK: Even if you gain weight, the exercise you’ve been doing could help you lose those pounds. And exercise is something you’ve been able to keep up and even enjoy!
JANET: Right. Hmmm.
COACH: Great! You affirmed the specific efforts Janet has already made for her health.
JANET: Something to think about, I guess.
JANET: What about me becoming a grinch? And all that other junk that’ll happen to my body?
CLARK: What other withdrawal symptoms have you experienced in the past?
JANET: Well, besides getting cranky, my hands shake, which makes it hard to paint. And after a long day of not smoking and not painting, I end up not sleeping. Which makes it even harder to concentrate on anything the next day.
COACH: Great! You asked an open ended question to learn more about Janet’s specific experience with withdrawal symptoms and how they impacted her life. This allows you to discuss options that may address her specific concerns.
CLARK: So in the past when you’ve tried to quit, you’ve found you get cranky, your hands shake and you have trouble sleeping. Which all makes it difficult to focus.
JANET: Yeah.
CLARK: Those symptoms are common nicotine withdrawal symptoms experienced by many people when they quit smoking.
JANET: Great. I don’t take a lot of pleasure in being in the majority.
CLARK: The good news is, these symptoms will become less severe over time. The first few days are the hardest, and for most people withdrawal symptoms resolve within a couple of weeks.
JANET: Hmm, I don’t know about ’good’ news. But I guess you could say it’s ’not terrible’ news.
COACH: Good choice! The accurate reflection of Janet’s experience and subsequent explanation is a first step in partnering with her to address this important barrier.
CLARK: How have you dealt with your withdrawal symptoms in the past?
JANET: Mainly just what I mentioned earlier, the patch, the gum.
CLARK: And what’s your understanding of other options to help quit?
JANET: Well, I know there’s fancy medicines these days, including inhaler thingees.
JANET: I guess there’s a few solutions out there. But, I just,
JANET: UGH. I JUST can’t concentrate on any of this right now. I feel like I don’t know. I hear you, but I need more time to think.
CLARK: Tell me more about what in particular is making it so tough right now.
JANET: This exhibit. I’m excited for it. But it’s getting to me. You know how it goes. The second you have everything handled, something else pops up. The gallery asked me to reschedule after I already sent the invitations. It’s really just not the right time to kick bad habits.
JANET’S THOUGHT: Ugh, so much to think about.
JANET: I don’t know how I let it all get to me like this. I mean, I’ve been through some stuff.
CLARK: You feel like you’ve managed stress better before.
JANET: Yeah. As in, this isn’t the first time I’ve had to. I used to enjoy my margaritas. A lot. Not just happy hour, if you know what I mean. So like we talked about on the previous visit, when my husband died, I had to raise my kids solo. I thought I was okay at first, but when my mother had to take the kids for a few days, I was like, “Janet, no, you are not okay.” It wasn’t easy. But it also wasn’t that hard? I know I didn’t feel like this.
COACH: Great! You used a reflection and Janet felt comfortable sharing more with you about how she managed stress in the past, offering you opportunities to further explore strengths and successes.
CLARK: How were you able to cope with the stress of your husband dying?
JANET: I kinda just knew I had to keep going. My family is everything to me and I knew they needed me. But I don’t really want to talk about this right now. I’m already stressed as it is.
COACH: Open ended questions that explore patients’ experiences are generally a good choice. In this case, Janet shared additional feelings and then indicated she preferred focusing on the present. Consider reflections at this juncture.
CLARK: All the stress of the art exhibit and its unknowns have made it tough to talk about smoking cessation options. Though if the timing were different, it might be something you’d be open to.
JANET: Exactly, at some point down the road, just not now.
CLARK: That’s totally OK. Always ready to talk.
JANET: Thanks, I appreciate it. You’ve given me something to think about. I might even chat to my family a little more before then, see what they have to say.
CLARK: I think that’s a great plan.
COACH: Great job! You used a double sided reflection to acknowledge Janet’s current ambivalence about discussing smoking cessation while also highlighting the her change talk. Janet appreciates that you’re not trying to push her to do something she’s not ready to do.
CLARK: I’d love to summarize what we talked about so far before you go. If I understood you correctly you’re concerned about your chest pains and heart disease, and their connection to smoking.
CLARK: You wish you could quit because you want to save up for that vacation with your family.
CLARK: So much so that you’re willing to talk about quitting smoking, just not right now because of your upcoming art show.
JANET: That sounds right to me.
CLARK: Great. Is there anything else you’d like to discuss today?
JANET: No, I think I’m good.
CLARK: When would be a good time for you to return to talk some more about options for quitting smoking?
JANET: Well, the exhibit is in six weeks. The earliest I could come back here would be two months from now.
CLARK: That would be great! Why don’t you make an appointment on the way out?
JANET: OK. I’ll be back. Probably, eventually. Wish me luck in the meantime!
CLARK: Of course. Good luck with your exhibit!
COACH: Great! You chose to summarize what the two of you discussed today even though Janet wasn’t ready to talk about smoking cessation yet. This allows her to confirm that you understood her correctly and gives her a chance to add anything important that wasn’t mentioned.
COACH: Let’s pause here to look at how effective your choices were in eliciting motivations from Janet. Then you will have a chance to conclude the conversation by discussing her barriers to change and collaborating on a plan.