A patient needs to trust you before sharing personal information. One way to develop this trust indirectly is for you to share personal experiences in an informal and friendly way, this builds rapport. It is unwise to share information about any personal problems that you may have as this will reduce your patient’s confidence in you. However, you can share personal strategies or resources used to overcome a problem.
Towards the end of the information gathering stage it is always useful to go over the important points raised. You can build rapport by re-capping on the information shared and reflecting back your own understanding of your patient’s problem. Some patients will want to know why they have their problem. Your job is to help your patient overcome their problem and this is often done without really knowing why the problem started. If your patient insists on knowing “why”, then first consider whether there is any possibility of identifying the real cause, but this is not always possible or necessary. Your patient should be reassured that overcoming the problem is the primary concern and that identifying the reason why they have it can be addressed later.
After summarising, identify outcomes that your patient wants from therapy. Sometimes your patient’s outcomes are not the same as your own. You can try to achieve both outcomes if they are compatible and both beneficial. Usually you both can agree on the same outcome. Throughout therapy and especially when you are interviewing the patient for the first time, you should keep your mind open to other possible problems that may lie behind the presenting problem. If you feel there is a secondary problem then you should ask open-ended questions and not suggest in any way to the patient your suspicions about other possible problems. Remember, your patient may need time before they are willing to talk about their real problem. If they have an undisclosed problem, and if you try to rush them, they may clam up altogether and you may never see them again. Whenever possible you should let the patient set the pace, especially at the beginning of treatment.
A forty year old woman came for therapy to lose weight. She was reluctant to talk about herself and her problem. She was overweight and looked drab. Her weight problem had apparently started in her teens, yet none of her family had been overweight. She had three brothers, one sister and a psychotic mother and she was no longer in contact with her father. She was seen for a number of sessions over a period of six weeks and despite a few pounds weight loss during the first week she did not respond to any intervention with hypnosis. Despite her failure to lose weight she remained confident and kept all of her appointments.
After about ten sessions of unsuccessful therapy she ‘mentioned’ that she had been abused as a child by her father. This had been withheld during earlier questioning, or deemed to be not relevant by her earlier in the therapy. During the next six sessions she worked on her feelings about her father and the abuse. The weight problem was never mentioned again, yet slowly, as she seemed to come to terms with her feelings about the abuse, she stared to lose weight. She started to take pride in her appearance. It seemed that by becoming overweight as a teenager she had discovered a way of making herself unattractive, which stopped her father abusing her. Her fear had generalised itself to all of her relationships with men and she was never able to lose weight because of her unconscious fear of being abused again. As soon as she was able to learn how to trust men, initially by trusting me, she was able to lose weight.