Staff Perspective: Are we “Pushers”, or “Adaptive” with patient understanding?

Staff Perspective: Are we “Pushers”, or “Adaptive” with patient understanding?

Deb Nofziger, Psy.D.

I catch myself in a trap every so often, as my colleagues have, getting so caught up in selling the phases outlined in a treatment modality that I haven’t taken the time to hear the words from the patients’ perspective. And, working with an all military culture, I’ve found that when this happens I’ve usually lost the patient. I’ve used terms that simply don’t resonate with them and they are less willing to engage in whatever awesome thing I’m trying to get them to try.

Take the term “mindfulness”, for example. The first couple of times I’ve used this with hard-core front line soldiers I got looks that ranged from skeptical, at best, to eye-rolling, at the other extreme. Rapidly, I found myself in stuttering pauses, searching for some kind of word that would get them to open back up to the idea. “Doc, all that ‘mindfulness’ stuff is just too new age for me. I’m a down to earth guy.” Or, better yet, “That other doc tried to teach me 'mindfulness’ but it was just too weird. It sort of worked, I guess, but I couldn’t keep it up.” “Forget the mindfulness,” I’d then say. “Let’s work on ‘grounding’ exercises instead, to get you more in tune with the here and now.” Same stuff, different language. It is amazing that I have yet to find a Service member who isn’t all for “grounding.” It is something they know, understand, and resonates with their culture and sense of machismo and strength. True, I then proceed to do the exact same mindfulness exercises with them, but they embrace it.

My experience is not unique. It seems to happen repeatedly in our clinic. True, not all Service members have an aversion to “mindfulness” or other psychological terms we use. But enough have that it calls into question our own verbal flexibility. This has opened a discussion among ourselves and our trainees around the language we use with patients, and how to rephrase things in a way that resonates better with them, instead of words that can bounce right back at us, never truly sticking with the patient and causing us to lose them even before we begin. Maybe we all need to listen better to our words. Synonyms, after all, can be true blessings.

I recently read a new book by Gary John Bishop, titled “Unfu*k Yourself.” Catchy title, right? Enough so that it was actually introduced to one of our providers by a patient who picked it up just because of the title. Of course we then had to go out and get it ourselves. How did I spend the recent hurricane? Reading this book, of course, and getting so excited about it I had to hold myself back from ordering it for multiple patients. The reaction of other providers in our clinic? To quote one, “it looks like we finally have a tool to get ‘mindfulness’ infiltrated into special forces.” Yes, this book has some swearing in it, although not nearly as much as you would think considering the title. That aside, the most important part of this book, in my opinion, is it is written in a way that real people talk, salty people at that. It was easy to read, easy to understand, and absolutely full of some of the best ideas that I try to get across to patients. While I was reading it, it was as if another soldier was simply talking to me. I “heard” it like I haven’t heard so many other books that are intended to be read by the non-psychologist. While there was limited psychobabble, it very closely paralleled Acceptance and Commitment Therapy (ACT).

As more of our providers and students are picking up this book, it is lending more credence to the idea that we often need to put aside our professionally cherished terms and consider first the words that will best be accepted by our patients. After all, isn’t it more important that the patient learns skills that help and mean something to them? Can you teach any protocol without its catch phrases, instead inserting other synonymous terms? Are we flexible enough as a profession? Or have we become an army of “pushers”, trying to force terminology instead of the concepts behind them?

Debra Nofziger, Psy.D., is a deployment behavioral health psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Located at the Brooke Army Medical Center, she trains and supervises pre-doctoral interns and post-doctoral fellows in providing evidence-based treatment to active-duty service members and their families.

Book Citation:
Bishop, Gary J. (2016). Unfu*k Yourself. New York: HarperCollins.