There’s a lot of talk in the UK at the moment about counselling as a first step before the prescribing of anti-depressants. And the specialist counsellors and psychologists can see lots of work coming their way.
And the general practitioner? Is counselling beyond their competence and context? I heard this story the other day, and it reminds me of the dangers of specialist counsellors plying their trade in primary care and wittingly or unwittingly, reinforcing the illusion that people are best treated by specialists like counsellors. Before people receive fancy treatments like CBT or MI, how about a few simple acts of kindness and just a little bit more, delivered by the general practitioner. What’s the little bit more? Here’s a story that might help.
A friend of mine has been through a rough time. Many years. Got diagnosed with a lifelong condition a few years ago, and for some reason went back to the same general practitioner who broke the news to her, very insensitively. This time it was worse. This Doctor no. 1 hardly listened, and my friend felt like she was gasping to get her concern across. Doctor No 1 found a depression questionnaire on the computer, and elicited the answers from my friend, and proclaimed, “You are suffering from clinical depression, and here is a script for anti-depressants”. My friend left in tears, never took the medicine, and quite rightly felt that the situation was not as simple as this doctor believed. She was in tears with me on the phone, utterly dejected and angry with the doctor.
Then she returned, this time to Doctor No 2, who immediately listened to her concerns, for 3-4 minutes. Mostly asking open questions, very few reflective listening statements. He conveyed very strongly a desire to help. These simple acts of kindness led to a key question: “What do you think is the matter?”. My friend explained. The doctor suggested that perhaps they should do an experiment, and that my friend should come back in 2 weeks to report on progress. “What changes could you make that make sense to you?”, my friend was asked. She came up with 2-3 suggestions, and left after a consultation lasting 10 minutes, elated. And she made the changes and is feeling much better.
It strikes me that change often doesn’t take all that much to guide someone into. This friend of mine had been struggling for years. Besides the simple acts of kindness, what else did Doctor No 2 do that was so effective? I don’t think its rocket science or incredibly complex, so before us therapists and counsellors take on loads of new clients, perhaps we should think a bit about how to support general practitioners to do what Doctor No 2 did.
Kind regards,
Steve
Forthcoming Workshops
Motivational Interviewing: Introduction & Update. 2 day workshop - 11th & 12th June 2012, CardiffBegin: 11.06.12, 09:00
End: 12.06.12, 17:00
This is a repeat one-off opportunity to learn about motivational interviewing (MI), and the latest developments, from its two co-founders, William R. Miller from Albuquerque, New Mexico & Stephen Rollnick from Cardiff, Wales. Professor Miller will return to Cardiff after a successful workshop in 2011. This will be of interest to both to newcomers and those more familiar with MI. A streaming system will be used to ensure that those relatively new to MI will get good opportunity to practice basic skills. It will provide: - Clarification about the common and unique elements of MI - A focus on client change language and how it guides the practice of MI - An update on theory and research - The presentation of a new 4-process framework for MI that allows for easier integration in diverse settings - Opportunity to practice core skills for evoking motivation to change For further details and application form, visit: www.misr2012.co.uk
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