Ineffective Path:
CLARKE: Good to see you again.
GREGORY: Yeah, good to see you, too, under better circumstances.
CLARKE: You’re looking good, since the procedure!
GREGORY: Thanks. Been a whirlwind of a month, that’s for sure. Come a long way since the last time I was here, when I was not in great shape.
CLARKE: So, today we’re going to focus on how you’ve been since your procedure.
GREGORY: Sure.
CLARKE: That sound good to you?
GREGORY: Yup.
COACH: By setting the agenda, you missed an opportunity to ask Gregory what he wanted to work on. The more collaborative the conversation, the more Gregory will feel included, and engaged.
CLARKE: On your chart I saw your blood pressure is looking a little high, and you dropped out of our cardiac rehab program.
GREGORY: I’m trying my best. That’s good enough for me.
CLARKE: The results say you could be doing more.
GREGORY: I’m taking my meds, and I haven’t had a cigarette for weeks. Past that, only results I care about is how I feel. And I feel pretty good, to be honest.
COACH: Relying too heavily on the chart, rather than having a conversation, distanced you from Gregory. Instead, explore more of Gregory’s efforts, experience, or perspective before sharing so much information.
CLARKE: You’re feeling better because of your efforts to stay healthy.
GREGORY: Maybe a number of times in my life, I’ve been in a tricky situation and pulled through all right. Makes me think that what I do doesn’t have much to do with how things go.
COACH: Your choice to affirm is a good one, though be careful of statements that are overly simplistic and consider further exploration of Gregory’s beliefs and experience.
CLARKE: I’m proud of what you’ve done so far, Gregory.
GREGORY: Proud of me? Sure.
CLARKE: No really, I’m impressed with what you’ve done.
GREGORY: I guess.
CLARKE: What?
COACH: Though affirmations can build rapport, this one was vague and may have felt disingenuous to Gregory. Instead, identify and affirm specific positive steps he has taken.
GREGORY: I, I don’t know.
CLARKE: Don’t know what?
GREGORY: I’ve tried to look after myself, but I don’t know what that means for me. About what comes next.
CLARKE: It seems like you’ve made some progress with healthy choices, but at the same time, I know you can do a lot better.
COACH: Though you may intend to encourage, pushing Gregory to “do better” triggered some push back and discord. Consider exploring his ideas for making further changes.
CLARKE: I, I don’t know. I’m glad I’m getting better. It’s just, it’s a lot of changes.
GREGORY: What do you mean?
CLARKE: All this pressure to get more exercise, the idea of never smoking again, drinkin’ less, giving up the food I’ve enjoyed my whole life.
GREGORY: I know it’s what I gotta do, but it’s tough is all.
CLARKE: It’s important to look after your heart.
GREGORY: Yeah. I know.
CLARKE: If you don’t look after your cardiovascular health, you could have another heart attack. I get it.
CLARKE: Okay then.
GREGORY’S THOUGHT: Man, you all get so preachy sometimes. Like I haven’t listened to the same thing fifty times before.
COACH: Sharing information without asking permission or exploring what Gregory knows can provoke discord. Consider acknowledging Gregory’s challenges while also exploring his beliefs and motivation.
CLARKE: It sounds like you’re giving it your best, and that’s what matters, right?
GREGORY: That’s how I see things.
CLARKE: I hear how important it is for you to feel better.
GREGORY: Just taking things a day at a time.
GREGORY’S THOUGHT: Why are you talking to me like I talk to my grandkids?
COACH: Vague encouragement can come across as disingenuous and dismissive if challenges are not acknowledged. Consider exploring Gregory’s ideas for making changes for his health.
CLARKE: You should keep in mind your biggest reasons for staying healthy.
GREGORY: Why?
CLARKE: Just something to think about.
GREGORY: Sure.
COACH: Being too direct with Gregory came across as you simply telling him what to do. Instead reflect or ask about his motivations for change.
CLARKE: Given how challenging it can be to make changes to a routine, a lot of patients find it helpful to keep in mind a specific reason for staying healthy.
GREGORY: Carrot on the end of a stick, huh. Sort of, maybe a little more empowering than that.
GREGORY: Just teasin’ ya. Well,
COACH: You normalized Gregory’s challenges with making healthy changes. However, it would’ve been even more effective to focus more on Gregory’s experience and understanding and ask him what would motivate him to stay healthy.
GREGORY: I love my family. I still remember holding my daughter Michelle for the first time. And then her son James. The other day I was tossing a baseball with James and after the first couple tosses back and forth I, it even started to be a challenge to bend down, and pick up the ball. I didn’t like that.
CLARKE: Not keeping up with your grandson is making you think about getting older, and feeling more frail.
GREGORY: Not really. I don’t feel frail. I just got surgery and I’m still keeping up with my grandkids! As best I can at least.
CLARKE: Of course, that makes sense.
GREGORY: I’m just saying. I’m not exactly who I used to be.
COACH: While you tried to reflect Gregory’s desire to keep up with his grandkids, your reflection went a bit too far. Because it was a reflection, it gave Gregory a chance to correct your assumption and provided you with an opportunity to explore his motivations further.
CLARKE: Your grandkids are pretty active, and you don’t want them to think of you as weak.
GREGORY: (scoffs) Weak? I know I won’t be able to keep up with my grandkids forever. Right now, I should be healthy enough, and eventually I know I won’t be. That’s just how getting older works.
CLARKE: But you said you wanted energy. I guess, but that’s probably just a part of getting older.
COACH: While you tried to reflect Gregory’s desire to keep up with his grandkids, your reflection went a bit too far. Because it was a reflection, it gave Gregory a chance to correct your assumption and provided you with an opportunity to explore his motivations further.
CLARKE: Let’s make a plan to help you keep making healthy choices.
GREGORY: Uh, sure. A plan, huh?
COACH: By pushing ahead to make a plan, you’re missing an opportunity to reflect what Gregory has shared and affirm the efforts he has already made. Instead, by reflecting and affirming you can help Gregory feel more ready to make plans.
COACH: Let’s pause here to look at how effective your choices were in eliciting motivations from Gregory. Then you will have a chance to conclude the conversation by discussing his barriers to change and collaborating on a plan