Introduction

As physiotherapists, our ability to effectively communicate with our clients can make all the difference in ensuring successful treatment outcomes. Last week, I had the opportunity to conduct a communication skills workshop for undergraduates in South Australia, where I delved into the fascinating realm of language and its impact on client engagement. 

The insights gained from this workshop have inspired me to share some valuable linguistic tools that can greatly enhance your interactions with clients who may be struggling with treatment plan adherence. 

In this article, I’ll briefly explore the subtle yet impactful effects of words like “but,” “and,” “why,” “what and how questions,” “because,” and phrases such as “I’m not sure this is for you, but…” and “How open-minded are you…?” 

Physiotherapists Managing Resistant Clients: A Delicate Balancing Act

Dealing with clients who struggle with adhering to their treatment plans requires a blend of empathy, communication finesse, and understanding of human psychology. Yes, I know, you’re a physiotherapist not a psychologist! Let me remind you that everything you treat  is connected to a mind and than mind makes choices on what it decides to listen to.

Some clients often need an extra nudge to stay committed to their rehabilitation journey. Let’s explore how specific linguistic tools can be harnessed to achieve just that.

1. “But” and “And”: Navigating Attention and Building Bridges

“But”: The word “but” holds a unique position in communication. It negates everything that was said prior to it’s use in the mind of the listener. 

It can be a subtle tool for introducing an alternative perspective, even when met with resistance.

Example: ”I understand that exercises can be challenging, but they play a vital role in your recovery.”

It can also influence what the client hears when you give a warning.

Example: “For most people this isn’t uncomfortable but for some people it is.”

Versus

“For some people this is uncomfortable but for most people it’s not.”

“And”: The word “and” serves as a bridge, linking various aspects of a conversation. When discussing treatment plans, use “and” to highlight the holistic benefits of following the plan, both in terms of immediate relief and long-term well-being.

Example: “By incorporating these exercises into your routine, you’ll experience some relief from discomfort, and you’ll also be taking a crucial step towards preventing future issues.”

When in a conversation with a client or any other person for that matter, once they’ve finished talking and you’d like to add your perspective, it is more respectful to the other person to use “and” rather than “but”. 

Using “and” implies equal importance of both points of view whereas using “but” implies that what you have to say is more important than point of view of the other person.

2. “What and How Questions”: Fostering Ownership

“What” and “how” questions prompt clients to engage actively in the conversation, promoting a sense of ownership over their treatment. Encourage them to share their thoughts, preferences, and concerns, fostering a collaborative approach.

Example: “What do you envision achieving through this treatment? How can we work together to make this process more workable for you?”

3. “Why” – Unveiling Motivation

Asking “why” questions encourages introspection, making clients contemplate the underlying motivations for their actions. By guiding your clients to explore their reasons for pursuing treatment, you can inspire a deeper commitment to the plan.

Example: “Why might you want to add these exercises into your weekly schedule?” Encouraging the client to connect with their motivations for following your advice can help in adherence.

“Why” questions can also alter the focus of the client.

Example: “Why weren’t you able to get these exercises done?” This question will have the client thinking back to the past and voicing all the reasons they didn’t do the exercises. This type of thinking can reinforce their current behaviour.

“Why might you want to find the time to do these exercises?” This question takes the thinking of the client into the future and connect with the benefits of the proposed exercises.

4. “Because”: Tapping into Rationalisation and Motivation

The word “because” provides a logical link between a request and its reasoning. By explaining the rationale behind specific exercises, routines or advice, you can enhance your client’s understanding and potential compliance.

Example: “Incorporating these stretches into your daily routine is crucial because they target the muscle groups directly related to your pain.”

“Because you want to (insert client’s goal) how might you manage to fit these exercises into your weekly schedule?”

The word “because” creates the frame or link to what follows, the word “how” encourages reflection and the word “might” implies the client has a choice.

5. “I’m Not Sure This Is for You, But…” and “How Open-Minded Are You…?”: Influencing Perspective

“I’m Not Sure This Is for You, But…”: This phrase introduces an element of curiosity and challenges preconceived notions. It piques curiosity and encourages clients to consider possibilities they might have otherwise dismissed. By using the word “but” in this sentence will have the client focusing on what comes after it.

“How Open-Minded Are You…?”: This question invites clients to reflect on their openness to new approaches. It encourages a receptive mindset, making clients more willing to embrace alternative strategies.

Example: “How open-minded are you about trying some new techniques that could enhance your progress?”

6. “What Do You Know…”: Fostering Client Empowerment

“What Do You Know…”: Starting a sentence with “What do you know” acknowledges your client’s existing understanding while subtly introducing new information. This approach can ease the introduction of unfamiliar concepts.

Once you’re familiar with what they know, you can ask them what else would they like to know or how can you add to their current knowledge. This can save a lot of time in providing unnecessary education.

Example: “What do you know about the correlation between consistent exercise and knee joint OA?”

Conclusion

As physiotherapists, we possess the unique opportunity to not only heal the body but also engage the mind through the power of language. By harnessing the subtle yet potent effects of words like “but,” “and,” “why,” and employing strategies such as open-ended questions and positive framing, we can foster a deep connection with clients who may be struggling with treatment adherence. 

Remember, effective communication is not just a skill; it’s a cornerstone of successful physiotherapy practice. So, take these linguistic tools, blend them with your empathetic approach, and watch as your clients embark on a more engaged and empowered journey toward recovery.

What I offer you and your staff?

Skills practice and reflection will be the cornerstone of my training. I am available for both in person and limited Zoom PD for your group.

If you have a staff member who is struggling to keep new patients or confidently present treatment plans, you might be interested in one-on-one coaching for him/her. I take on a limited number of clients each year.

If you would like to engage me to work with your staff or coach a member of your team, click here so that you can schedule a time to discuss your specific training needs.

Contact me to find out when I will be in your city and available for LIVE professional development.