How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 91
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the way of them doing what they want and what they value in the world, and how they might live
what they value.”
Explore how it affects them (4/28)
Some interviewees tentatively suggested trying to explore with the thought disordered patient the
effect it was having on them, and on their relations with others.
Upset/distress
Acceptance and listening (25/28)
Nurses’ responses on this topic emphasised giving time in a quiet, private environment, ‘allowing
them to be upset’ and ‘just being with them’, eventually moving to asking ‘if they want to talk about
it’ or suggesting that it might ‘help to talk about it’. Gentle prompts and questions then allowed
nurses to draw out from patients their thoughts, feelings and the events which were distressing
them. Taking a distressed person to a private place could also usefully prevent other patients from
also getting distressed in sympathy. Time had to be spent with someone in being with them and
hearing them, before it was possible to move on to talk about coping, otherwise ‘the person can feel
invalidated’ and that ‘you are trying to push their feelings away, sweep it under the carpet’. The
interviewees were also careful to state that patients’ wish to speak should be respected, and that they
shouldn’t be put under pressure to expose the causes of their upset, or as put by one nurse: ‘not
prying’. Being with some ‘in silence’ and ‘not saying anything’ can be perfectly acceptable ways to
respond, instead ‘waiting until they are ready to talk’. If a person is upset and angry, too many
questions might ‘increase their distress’.
Give time alone (3/28)
If it was what the patient wanted, and an offer of comfort and listening came too soon or was
rejected, a distressed patient could be given some time alone, ‘but not indefinitely’.
Stay calm and neutral (4/28)
Hearing upset was difficult, but in order to patients to be able to share the depths of their feelings,
nurses had to be able to tolerate the distress without becoming ‘uncomfortable’ themselves. If the
nurse themselves can’t contain their response to the patient’s distress, then the patient will feel less
able to be distressed, and communication is hindered. If the nurse responds with overly sympathetic
distressed feelings, it can unhelpfully amplify the patient’s distress as opposed to helping resolve it,
or patients can feel they ‘have to protect’ the nurse ‘from their distress’. The correct response was
therefore ‘remain calm and show you are interested’.
Don’t close them up (11/28)
Perhaps because it is hard to tolerate distress, the interviewees noted that acceptance and listening
were sometimes avoided. They therefore suggested that responses to the distressed patient should
not include fatuous reassurance, such as ‘stop crying, don’t worry, everything’s going to be OK’, or
‘it’s not that bad, you’ll get over it’. Nor was it acceptable to dismiss how someone was feeling,
make light of it or try to coerce a better mood through shouting at them or ‘telling them to pull
themselves together’.
“And I think you’ve got to be careful, as the practitioner, you’re not shutting them up because
you’re finding it difficult to be around.”
Persist to find out cause (7/28)
While patients should not be put under pressure to reveal all, nurses did recommend gentle
persistence in order to find out what underpinned patients’ distress. Overcoming reticence could be
done by repeated contact and offers (‘putting in opening gambits every now and again’), spending
time in silence with the upset person (‘understanding that it might take quite a long time to get to
the bottom of it’), finding the right place on the ward, or just homing in on the right moment when
the patient was ready to talk.
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