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Missing the meaning & provoking resistance; a case of ME

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By Butler C, Rollnick S • www.ProHealth.com • February 5, 1996


BACKGROUND. The interaction between a clinician and a patient
who put his problems down to myalgic encephalomyelitis is
described. Despite attempting a patient-centred approach, the
doctor acted on his own understanding of the meaning of this
diagnosis without gaining proper insight into what it meant
for the patient. This failure not only led to damaged rapport,
it may have contributed to delayed recovery.
OBJECTIVES. The
unsatisfactory nature of this encounter led the clinician to
consider more effective consulting techniques.
METHODS AND
RESULTS. A hypothetical interaction is constructed in which
the clinician uses reflective listening statements to
understand the patient's true meaning of this self-diagnosis.
CONCLUSIONS. Despite well intentioned attempts to be
patient-centered through widening the consultation beyond the
biomedical to include personal and contextual factors,
clinicians may still end up imposing their own medical meaning
on patient's words. Damaged rapport is a signal that another
track could be more fruitful and reflective listening is one
strategy which enables clinicians to check that they fully
understand the patient's meaning. Provoking resistance by
following strategies which are not appropriate for the patient
might then be avoided.




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