Effective 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: Sounds like it was a little scary for you, last time you were here.
GREGORY: I know you folks are professionals and all, but when you all rushed me in. I wasn’t sure what was happening to me. I remember the doctor saying she had to put stents in to keep me from having a lot more damage to my heart. Didn’t expect to hear that when I woke up that morning!
GREGORY’S THOUGHT: When they wheeled me in here, I wasn’t sure I was going to make it out.
COACH: Great! This empathic reflection built rapport and spurred Gregory to elaborate.
CLARKE: It can certainly be disorienting coming in here, which is why I was so happy when Dr. Cantwell told me today that you’ve been doing a lot better.
GREGORY: Hasn’t been easy, that’s for sure! But you do what you gotta, I guess.
CLARKE: That’s a good way to look at things.
GREGORY: (nods)
COACH: Great job! Your reflection normalized Gregory’s fears and acknowledged that his health has improved. As a result, Gregory feels more comfortable in this conversation.
CLARKE: How have things been at home since your procedure?
GREGORY: Oh, you know. I’m doing fine, but my wife is always bugging me about this or that.
CLARKE: And what’s that like?
GREGORY: I mean, she gets on my case about the same thing, over and over again.
COACH: Good job! By asking an open ended question about Gregory’s home life, it shows that you care about his “whole health,” not just his heart condition.
CLARKE: I hear you, it feels like your wife is looking over your shoulder when you’re the one in charge of managing your recovery, and that’s frustrating.
GREGORY: Exactly! I got it covered, and she’s worried all the time. (sigh) She’s a good woman. But after all this time, she really knows how to piss me off!
CLARKE: (laughs) So you two are pretty close?
GREGORY: I know exactly what she’s thinking, and she knows exactly what I’m thinking, it’s that kind of thing.
COACH: Nice! You responded with a complex reflection to show you’re interested in Gregory’s perspective and how he feels, which encouraged him to open up about his wife with you.
CLARKE: Well let’s get started. What do you know about why Dr. Cantwell wanted us to talk today?
GREGORY: Honestly? I’m not sure why Dr. Cantwell sent me your way, I’ve been feeling pretty good since the procedure, back to living the way I want, for the most part. Pretty fast recovery for someone at my age, huh!
CLARKE: Glad to hear you’re feeling better. What do you think you need in order to keep your recovery going in the right direction?
GREGORY: I dunno. I guess if you’ve got some recommendations, I’ll hear you out, but I think it’s just a matter of time before I’m feeling like myself again.
CLARKE: It’s great you’re feeling better, and you’re open to talking about keeping your heart strong.
COACH: Great job! Gregory’s attention shifted to planning and collaboration as he considered your open ended question.
COACH: Good! Gregory’s attention shifted to planning and collaboration as he considered your open ended question. Though Gregory would’ve felt more comfortable if you had first acknowledged his fears and struggles from his past procedure.
GREGORY: Sure. Can’t hurt to talk. But y’know, like I said, I’m just healing up as time goes on.
CLARKE: What have you been doing to strengthen your cardiovascular health the last three weeks?
GREGORY: Well, when I left the hospital, the plan was to get exercise when I could, whether by walking with my wife or playing golf with my buddies. They also talked to me about giving up smoking, trying to eat less fried food, and drinking less.
CLARKE: And how’s all that going?
GREGORY: Okay, I suppose. I haven’t had a cigarette for 23 days now, and I’ve been taking all my meds, the blood pressure ones and the new ones to protect my heart. So I’ve been starting to live the way I like to live. Feeling pretty good about it.
CLARKE: Staying smoke free is a very important way to improve your cardiovascular health.
GREGORY: Exactly. And as time goes on, I’m just going to keep getting stronger.
GREGORY’S THOUGHT: It’s been a pain in the ass, but I feel good about what I’ve managed to do. Not everyone can just quit smoking, cold turkey!
COACH: Great job! You asked an open ended question that encouraged Gregory to share the positive changes he made for his cardiovascular health.
CLARKE: It’s great that you’ve stayed smoke free. It’s the most important way to keep your heart healthy and prevent another heart attack. And it’s great that you’ve been consistently taking your meds.
GREGORY: Yeah, they told me the medication would help keep the stents open, so been takin’ ’em. And I know how important it is for me to stay smoke free. But also, I’m just healing up over time.
COACH: By affirming Gregory’s specific efforts to live a healthier life and follow through with medications, you let him know that you’re aware of the progress he’s making.
CLARKE: Your effort to stay smoke free and take your medication, these are all impressive accomplishments. Now it’s about building on the good work you’ve already done.
GREGORY: I guess.
CLARKE: What?
COACH: Good job affirming Gregory’s efforts, as it helps him feel that his efforts matter.
GREGORY: I mean, MAYBE the stuff I’ve been doing so far has made a difference. But now that I’m feeling better, that might change what I want to do next.
CLARKE: How are you feeling about the progress you’ve made so far?
COACH: Great! This open ended question tapped into Gregory’s experience in a non judgmental way, which spurred him to respond genuinely and share his feelings.
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: So the steps you’ve taken to look after yourself are challenging, yet you also understand that this is the best way to stay healthy.
GREGORY: Yup. I know what I’m supposed to be doing for my health. But I also know how I want to be living my life, the same way I’ve always lived it.
COACH: Great! You used a double sided reflection to show you are hearing Gregory’s concerns while also reflecting his interest in protecting his heart.
CLARKE: It’s good you know what to do to protect your health.
GREGORY: Yeah, I think I have a good sense of how I should be looking after myself. Just have to figure out what exactly I want to do about it.
COACH: Your affirmation lets Gregory know that you recognize his understanding, which builds rapport.
CLARKE: How would staying healthy make a difference in your life?
GREGORY: It’s probably too late for me to play major league, huh. (laughs) Probably.
GREGORY: Well, I’ve already done a lot in my life.
COACH: Great open ended question to further explore core elements of motivation (desire, reasons, need)!
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: It sounds like you wished you could keep up with your grandson.
GREGORY: He remembers me the way I was ten years ago. I could toss more than a baseball, I could toss him! And it’s not just him, same thing from my grandaughter too. She made the junior varsity basketball team this year!
CLARKE: Seems your relationship with your grandkids has been important your whole life.
GREGORY: I’m lucky. They’re great kids.
COACH: Your reflection gave Gregory the space for him to talk about his important relationship with his grandkids.
CLARKE: So you want to be healthy enough to play with your grandkids, as much as you can.
GREGORY: I know it’s a new stage of my life, and I’m going to need to accept what I can’t do. But if I can feel less tired, have the energy to toss a baseball with my grandson, I’d want that.
CLARKE: Having more energy is important to you.
GREGORY: Well yeah, I don’t want to be some, “old man”. Sorta like you said, I just wanna be me, but older.
COACH: Great! Your accurate reflection led to a shared understanding of Gregory’s motivation and produced more “change talk” from Gregory.
CLARKE: Any step forward is a step forward.
GREGORY: Seems like a pretty low standard, no?
CLARKE: I have plenty of patients who aren’t able to quit and stay quit for as long as three weeks. Kicking a habit like tobacco use isn’t easy, it’s an impressive accomplishment.
GREGORY: Maybe it is.
COACH: Nice work! Affirming Gregory’s specific efforts to live a healthier life helps him understand that you know he’s trying to make progress.
CLARKE: What do you know about the risks of having another heart attack, and what we can do to prevent it?
COACH: Good job! Your open ended question allowed Gregory to share his knowledge without fear of judgment.
GREGORY: I guess. Depends on what I do going forward, right? But if I had to, I’d say,
GREGORY: I could have another. Don’t know any numbers or what have you, but, just know I’m never really gonna, “get better,” you know? Mine’s not a question of if, but when.
CLARKE: Let me go over what we’ve talked about so far, to make sure we’re on the same page.
GREGORY: Okay.
CLARKE: So far I’m hearing you’ve succeeded at staying smoke free and you’ve been taking your meds to protect your heart and keep the stents open. And all that is pretty important to you because,
CLARKE: you want to be able to be active, the way you always have, with your grandkids. For as long as you can.
GREGORY: Yeah. They know I’m getting old, and I know I’m getting old, but I want to keep up while I still can.
COACH: Excellent! Your reflection shows Gregory you not only pay attention to what he has to say, but you care for his overall well being.
GREGORY: (sigh) I don’t know though. All this is so discouraging.
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.