Ineffective Path:
SUSAN: It’s good to see you again.
LISA: Good to see you too. Sorry, I meant to get myself here last month, things have just been busy at home.
SUSAN: I know how that can be. I’m glad you’re here now.
SUSAN: It’s important to check in with us every few months, for your health. What kept you from the last one?
LISA: I, I had a lot going on. Not sure what, the days all kind of blend together.
SUSAN: I can understand that. Well, you’re here now.
COACH: Your question, although well intentioned, came off as more of an admonishment. An effective open ended question’s message is neutral and avoids judgement.
LISA: Exactly.
SUSAN: All right, let’s get started.
SUSAN: Today, we should focus on how you’ve been managing your diabetes.
COACH: By setting the agenda for the visit with Lisa, you pushed her into a discussion she may not be interested in having. Asking an open ended question about her agenda would give her some control and help you to learn about the issues she cares about.
LISA: Okay, sure. I’ve been doing fine. As fine as I can be, that is. Sometimes I don’t remember to take my meds. And don’t get on my case for that, I know I’m supposed to be taking ’em.
LISA: But I’m so busy, it kind of gets lost. It’s just not what I’m usually thinking about.
SUSAN: Maybe you could be eating healthier.
LISA: What’s that supposed to mean?
SUSAN: I’m just trying to understand what’s been making you tired.
LISA: Well, you coulda just said that.
SUSAN: Right. Sorry.
LISA: Well.
COACH: The closed ended question about eating was judgmental, though Nurse Bell recovered by apologizing, validating Lisa’s feeling, and asking permission to explore her experience with fatigue.
LISA: I mean for the past, (sighs) I don’t know how long, I’ve had so much on my mind. My kids always need to be driven from place to place, my mom is always critical of how I’m living my life, and I’m working long hours at the diner which throws me out of whack.
SUSAN: Sounds like you have a lot going on. It’s understandable that’s impacting both you and your diabetes.
LISA: Right.
SUSAN: Can we explore those areas of your life a bit more, and see how they might be connected to your health?
LISA: Sure. Why not.
SUSAN: So your kids are keeping you busy that seems normal for a parent. How can you better manage that?
LISA: It’s not easy. I don’t think you get how hard it is.
SUSAN: Okay. Sorry.
COACH: Your effort to understand her is admirable, but your reflection (“that seems normal for a parent”) was off target and felt dismissive to Lisa. Instead, consider validating her points of stress to help her feel understood and more willing to collaborate on a course of action.
SUSAN: As far as I know, the best way you can be there for your kids is by looking after yourself.
COACH: Encouraging Lisa to focus on her own needs is admirable, though she finds your advice dismissive. Instead, consider undoing and trying to reflect and validate her feelings to help Lisa feel understood and perhaps more willing to explore and collaborate on possible strategies and solutions.
LISA: Easier said than done. It’s hard to find time for both.
LISA: I, you know what? Let’s stop talking about my kids. If I’m being real, it’s putting me a little on edge.
SUSAN: Uh, okay. You sure?
LISA: Yes. I’m sure.
SUSAN: Your mom has a point, you should be looking after yourself.
LISA: Really? You’re taking her side?
SUSAN: I’m not taking anyone’s side. I’m just saying she’s right, taking care of your health is important.
LISA: Gotcha.
COACH: Your effort to help Lisa focus on her own needs is admirable, though instead of telling Lisa what she ’should do,’ consider reflecting and validating her feelings and using questions to explore HER ideas for addressing her needs.
SUSAN: I think your mom is in a tough situation, you know? This can’t be easy on her.
COACH: Your choice to speak on behalf of Lisa’s mom felt dismissive and critical to Lisa. Instead, try using open questions and reflections to explore Lisa’s feelings and ideas about how she might manage her relationship with her mom.
LISA: (sarcastic) Uh huh.
SUSAN: I’ve had fights with my mom before where we don’t talk for months. I don’t want that to happen to you.
LISA: I’m good. Thanks.
LISA: Actually, I’m not really in the mood to talk more about my mom right now.
SUSAN: Uh, okay. You sure?
LISA: Yes. I’m sure.
SUSAN: I think the best thing you can do right now is stay on top of your diabetes, which will make you feel less tired.
LISA: Maybe, but I think my feelings of tiredness are mostly connected to my tiring life.
COACH: While you may want to prescribe the best course of action for Lisa, it’s important to “tune in” and ask about her perceptions, ideas, and feelings about the tiredness.
SUSAN: How does your work schedule, “throw you out of whack,” like you said?
LISA: Well, it all adds up. Money is a little hard to come by these days, so I kind of have to take the shifts I can get. And after being on my feet for sixteen hours, working a double. I just don’t have much left in me.
SUSAN: I think this job might be making it difficult for you to keep up with other things in your life. Are you looking for other job opportunities?
COACH: Though you may have intended to help Lisa, she felt your suggestion was off target. Try using reflections and open ended questions to explore her ideas/feelings to deepen understanding and foster collaboration. Consider using these strategies when exploring other aspects of her life.
LISA: I (sighs), that’s just not something I can afford to look into right now.
SUSAN: Okay.
SUSAN: It sounds like work can be tiring for you. What are things like after you get home?
LISA: (sighs) Well, I try to talk to my mom, or play with the kids. That helps me unwind a little. But then there’s always dishes to do, food to cook, kids need help with the homework, my mom has an errand that she’s too tired to run. After all that, I might get a little time to myself.
COACH: Great choice to offer an affirmation about Lisa’s efforts to support her family! It led to Lisa’s disclosure of other important information about her situation that will help both of you collaborate on a plan.
SUSAN: What if you talked to your boss about all this?
LISA: (scoffs)I could try that, but there’s not much to be done about it. Waitressing is a grind, and you gotta put a pretty face on the whole time, which is draining after a while. I, I appreciate the thought though.
COACH: Great choice to offer an affirmation about Lisa’s efforts to support her family! It led to Lisa’s disclosure of other important information about her situation that will help both of you collaborate on a plan.
LISA: Things just add up for me. And to make it all worse, I don’t usually get a good night’s sleep.
SUSAN: Tell me more about that.
LISA: Well after I finally get the kids down I try to lie down, I mean, I’m used to getting bladder or yeast infections a couple of times a year, and that would keep me up. Now it’s a regular thing, it’s awful.
SUSAN: That sounds frustrating.
LISA: Yeah. And it’s a bit embarrassing to even be talking about it. But not getting enough sleep definitely adds up.
LISA: All right, I can definitely see how things have been more difficult recently. Thanks for talking everything through with me. I’m good.
SUSAN: Okay, let’s move on then.
SUSAN: So, these feelings of exhaustion could be connected to high blood sugar levels, which are caused by both lack of enough insulin or insulin resistance. That means your body isn’t responding to the insulin, and can’t get the blood sugar into your cells. In addition, over time, high blood sugar levels cause vascular disease in both large and small vessels which makes it harder for blood to flow.
SUSAN: High blood sugar levels increase the amount of urine you produce so it may explain why you’ve been needing to use the bathroom at night.
SUSAN: What do you think of that?
LISA: Well, I feel like you just went “all doctor” on me, which is never easy to get used to. But I get what you’re saying.
COACH: When you shared information with too much jargon, especially without asking for permission first, Lisa had a harder time understanding and felt confused about how it related to her health. Using plain language can help foster both understanding and collaboration.
LISA’S THOUGHT: I knew a lecture was coming.
SUSAN: I think there’s more you can learn about how your diabetes is affecting your health.
LISA: I’m fine. Thanks.
SUSAN: It’s just based on the choices you’ve been making recently, I’m not sure that’s true.
LISA: You know what? I do have a solid understanding about what’s going on. It’s just. hard to do something about it.
COACH: Telling Lisa she had more to learn about her diabetes came off as condescending and disempowering. Consider undoing your decision and choosing another option. Ask more questions about her understanding and about her ideas for improving self care to build motivation and confidence to make a change.
SUSAN: Seems like we’re ready to move on and talk a bit more about how diabetes is affecting your life.
LISA: Yeah, gotta figure out some way to keep up with all this.
LISA: I, I’ve heard for years about going blind, getting something amputated. It’s hard to think about stuff like that.
SUSAN: If you look after yourself, that probably won’t happen any time soon.
LISA: Uh huh.
SUSAN: Definitely worth keeping in mind though.
COACH: Though you may have been trying to reassure Lisa, it came off as vague and dismissive. Try using reflections to help Lisa feel like you’re listening to the specifics of what she’s saying.
SUSAN: So let’s talk a bit more about how we can keep you healthy.
LISA: Sounds good.