Do you ever find yourself in a situation where you are zooming out rather than zooming in? Your mind disengages. You stop listening. Of course, it happens to all of us. There are many causes of disengagement, several include information overload or looking too far ahead and we can’t see the connection.
In my spin class last week, I found myself doing just that, zooming out rather than zooming in to what the instructor was telling us. No, it wasn’t because it was too early in the morning, (well, it was at 6:00 a.m.) rather, it was too much “what will happen in the next 30 minutes” that my mind could not hold it all in. What I needed right then was a focus. What do I need to know now, in the next three minutes? Do I need to spin faster or add more gear to my bike?
In most trainings I conduct, I often hear, “I was on the phone with her for an hour, the patient kept talking and talking.” The other challenge I often hear is “where do we start, we have so many issues that need to be addressed.” That is often the case when we are working with individuals with multiple chronic health and life issues. It is the patient dealing with diabetes, hypertension, and depression. It is the parent who is juggling a new baby, a toddler going to preschool, a job, laundry, meal planning and all that comes with managing a family and life. The quick response is where do they want to start? What is most important to them? What are they ready for? Where is their focus?
Dr. Miller and Dr. Rollnick, in motivational interviewing (MI), have identified Focusing as one of the Four Processes (Motivational Interviewing, Miller & Rollnick, 3rd Edition, 2013). Focusing in MI is an ongoing process of seeking and maintaining direction in the conversation. Our ability as practitioners to work together on setting the focus is key. We can direct the conversation with the patient both in terms of overall, global focus, as well as specific topics, and action steps.
This can involve a 30,000 foot view (see the whole picture of a condition) and a pinpoint focus on what is most important to you right now to discuss. Dr’s Miller and Rollnick call this structuring in agenda mapping. Structuring is where we step back from the conversation for a moment to talk about its direction.
“Would you mind if we consider some topics that we could discuss.”
“Let’s step back and consider what’s most important to focus on.”
“I’ve started making a list and would like to hear from you what is on your mind.”
After we have agreement on the agenda, one of the next steps in Zooming In. To move from hypothetical, big picture, to the practical, next step. Zooming In can also involve tuning in to the here and now. We have the big picture, now what is our immediate next step?
This made me ponder as to how we often give too much information and look too far ahead that the patient/client disengages and losses their ability to focus with information overload. What we know is after structuring the conversation together with the individual, guiding them to look at the “right now,” the “one small step you can take today,” has validity and value.
Once a shared Focus for the conversation has been established with our patient/client, be reminded of the value of the focus so our conversations have direction and we can zoom in together.
Transform conversations. Transform healthcare.
Dr. Becky Lang