Expert: R. Scott Malone L.Ac. - 7/15/2010

Question
working with the unwilling

Hi, I do have a question I hope you can help me with, perhaps some tips/ideas/opinions.  I am staring a new position where I will be jointly working with therapists, administrators and doctors helping people get better and manage their pain levels.  I was initially asked how I would deal with someone that really didn't want to get better.  I was surprised and unprepared but I have, in the past, worked with people that were skeptical they could get better, but they were not opposed to the idea.  I told them that I try to make the experience pleasant and fun.  That I also try to do things to get them to smile.  Once I can do that I can usually persuade them to give it a try on an ongoing basis so that we have at least tried it and given it a fair shot.  I also suggested that working outside in an open pleasant area, as opposed to medical offices, might be conducive to motivating them to try what we are going to do.  They advised me that these are the kinds of people I'd be working with.  I have 2 questions.  1) do you think my response was good one and methods that can work and, 2) if this is not the best approach what would a positive and constructive approach be to get a person who "does not want to get better" motivated.  I felt that perhaps there were some techniques or ideas you could share/suggest that might help.  It is difficult for me to believe that down deep inside a person can't, somehow, be motivated on at least some small level towards healing and getting better.  Oh, by the way, I am using alternative methods such as Qigong, breathing methods, etc., to compliment the therapy they are currently receiving.  Thank you in advance for your response and your assistance!

Answer
Hey Rick,

I think first you should differentiate between 2 groups, those that don't believe they can get better and those that don't want to get better.

If someone doesn't believe they can get better then you have something to work with.

If somebody doesn't want to get better it probably doesn't matter what you do, it will be next to impossible to help them.

If someone doesn't want to get better, that is their choice and maybe it's best not to try to overrule someone's choice, even if in your eyes it's the wrong one.

It's not our right to choose for someone else, even if we believe they are being dense or stupid about something.

Perhaps a patient believes that because of their religious or family upbringing that they need to and deserve to suffer. You might be able to show them that they don't, but again is that really your job?
that is up to you to decide. If it's a, "treat at all costs", scenario and that's your job, that makes things a bit tough. If it is a malady that has a negative progression and you know where it's headed, you might let them know what will happen next if left untreated and then when that comes to pass they could rethink their position. Again, they choose whether or not to seek help.

For the most part people that don't really want to get well, don't want to pay to come see me for no reason. I also have patients that drag a spouse in because they got great results and want the person they care about to benefit as well. That goes either way. If they are very resistant, I make it easy for them not to come back without laying blame or guilt on them, let them know, (if I think I can help them), that I believe I could help them and that I'll be available if they need help in the future.
Many times a patient actually has to really feel terrible before they are willing to do something about it, then maybe they will remember the door that I left open for them.

Often after the first treatment, they feel a marked change and are glad to come back. I do what I can without over stepping bounds and giving them the option to return in the future if they wish.

If someone doesn't believe they can be helped then whatever modality would give them the quickest visceral experience of even slight relief is a good way to go. The patient ends up realizing,
"hey if I can actually feel a little better, perhaps I could feel a lot better."
At that point actually getting better becomes a real possibility for them.
I also find it useful if I've treated their issue before successfully to let them know.
If someone has had migraines all their life, they may be under the belief that it's not possible for them to have relief. By letting the patient know that I've treated many, many migraines successfully, the patient starts to be open to the possibility that they can be helped.

Since you do breathing work and qi gong, you could even get the recalcitrant patients perhaps to do a few exercises and see if it changes their view. Breathing and qi gong can be very powerful for changing, balancing and settling the mind, as well as energize the body.

Have a good one Rick,

R. Scott Malone L.Ac.