How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 81

This book is in B&W, not color - Print page in Grayscale for Correct view!
‘keeping up your everyday activities is going to help you through this, whereas if you let things
slide you’re going to feel worse’. In other words, explaining exactly why the task is important and
what will be achieved by doing it, and how that will help the person restore a normal pattern of
activities and shape to their day: ‘showing them the link between the physical and the emotional and
how they all interact and interplay with each other’. One nurse referred to this operational
psychiatry as ‘some kind of talking economy’, with desired behaviours being purchased by nurses
through interactional investment.
Be flexible (21/28)
“If it's going to bed and you're really wired and irritated, it's unlikely you're going to be able to go
and fall asleep. So maybe there's some middle ground that you can find where you go, well maybe
you're not going to go to sleep, but maybe you can go and read in the, not read probably, listen to
music on your headphones in the smoking room. I don't know, I just think rules and tasks are only
of limited use, they need to be meaningful for people.”
As part of the discussion process, the patients point of view about the task can be explored, so that
they can feel heard and valued, and so that the timing or precise content of the task can be adjusted
to suit their wishes. This generated a participative relationship ‘so that you're not just imposing
something, but they're actually taking part in it’. Talking about the task also allowed the
identification of factors that might be preventing the patient from doing it: ‘I guess I skirt around the
outside it a lot, to see what it is that’s blocking it’. Understanding the patient’s reasoning process
meant that nurses could sometimes find workarounds, or ways of both getting the task done and
satisfying the patient at the same time, reaching ‘common ground’. Flexibility could also be shown
by giving a degree of choice to patients: bath or shower; tea or coffee; now or in half an hour; with
me or with another nurse, etc. Giving such options meant that the interaction was much less likely
to be taken as or descend into an argument, and in addition the task could be made more attractive
by offering different foods if the patient wasn’t eating, or varied bath accompaniments (shower gels,
soaps, towels) if they were reluctant to wash. Negotiation could also be a valuable tool, offering a
range of potentially more desirable options in return for a degree of co-operation. Care had to be
taken, however, to only promise what could actually be delivered, otherwise the longer term
situation could be made worse.
“If we’ve got somebody who doesn’t like sleeping in her bedroom when she experiences certain
types of hallucinations and she prefers then to sleep on the mattress on the floor. And that’s fine, I
think, for that period of time until the woman or the person then feels safer and you, I wouldn’t
necessarily try to change that.”
Break down task into small steps (13/28)
“I find it’s probably simpler to break down the task into simple little bits. And so instead of saying,
OK this morning, well what we intend to do is to either, maybe get your laundry done, it’s probably
easier to say, could you just put your dirty clothes here. And then from there, can we take them to
the laundry room? And then from there, washing powder, so just breaking the task into little bits,
and trying not to get into any more complex conversations during that time, that would distract them
from the task.”
Taking any task in ‘clear, slow steps’, or ‘bit by bit’ was thought to be advantageous, as ‘giving
them too many things to do or too much pressure’ was unhelpful. Another example given, in
addition to doing the laundry quoted above, was taking a bath, which could be broken down into
collecting the towel and toiletries, going to the bathroom, running the bath, getting in etc., or going
to bed broken down into turning down the sheets, taking off your shoes, then the rest of your
clothes, putting on the pyjamas, etc. This mode of approach meant that it was easier for patients to
understand what was required and to succeed at what they were trying to do. One thing at a time
meant that the patient ‘did not have to remember a sequence of tasks’ and cooperation was thus less
cognitively demanding, whereas ‘anything too complex is just going to be bound to fail’. Some
tasks could be broken down into smaller disconnected bouts of activity, in recognition of the fact
that patients might not be able to concentrate over a sustained period. For example conducting a
systematic mental state e