In the world of physiotherapy, effective communication is the bedrock of successful rehabilitation. Understanding the nuances of patient language can be a game-changer. In my previous article, I explored DARN language (Desire, Ability, Reasons, and Needs) and how it provides valuable insights into a patient’s motivations and readiness for change.

Now, in this article, I dive deeper and discuss specific linguistic strategies for guiding patients from DARN to CATs language (Commitment, Activation, and Taking Steps). It’s about turning those desires and motivations into concrete actions for improved health and well-being.

When working with a client who expresses themselves in DARN language and you aim to move them towards CATs language, it’s helps to use certain communication strategies. 

Here’s how you can approach this as a physiotherapist:

Reflective Listening:

Begin by listening attentively to the client’s DARN language. Your aim is to reflect back their statements using open-ended questions and simple or complex reflective statements. 

Here are some examples of complex reflective listening and the use of ‘labels’:

Client: “I wish I could exercise more, but I’m too busy,”

You: “It sounds like finding time for exercise is a challenge for you.”

Client: “I wish I had more motivation to start exercising.”

You: “You’re expressing a desire for more motivation to initiate exercise.”

Client: “I don’t think I have the skills to maintain a workout routine.”

You: “It sounds like you’re concerned about having the necessary skills for a consistent workout routine.”

Client: “I’m not sure I can commit to exercising regularly.”

You: “It sounds like you’re uncertain about making a commitment to regular exercise.”

Elicit Change Talk:

Encourage the client to express their thoughts and feelings about change. Ask open-ended questions that stimulate their motivation to move from DARN to CATs language. 

Here are some examples that you might use:

“What would be some reasons for you to consider incorporating exercise into your routine?”

“Why might you want to incorporate exercise into your day?”

“Tell me more about why exercising might be important to you?”

“What would it mean to you if you could successfully incorporate exercise into your life?”

“What would be the positive outcomes of incorporating exercise into your life?”

Explore Ambivalence:

Recognise and explore any ambivalence the client might have about change. Often, clients are stuck between their desires and perceived barriers. In would use discretion in discussing obstacles with very negative clients.

Here are some examples you might use:

“It seems like you want to exercise, but there are things getting in the way. Tell me more about those barriers and how I can support you in overcoming them?”

“I hear you both want to exercise and feel challenged by it. Tell me more about what makes it challenging so that we can find a way to work through this?”

“It’s normal to have mixed feelings about change. What are some of the things you enjoy about your current routine, and what would you like to see change?”

Emphasise Autonomy:

Respect the client’s autonomy and allow them to make their own decisions.

Instead of telling them what to do, ask questions like:

“What steps do you think you can take to start exercising more regularly?”

“Considering your preferences, what type of exercise or physical activity do you think would be most enjoyable for you?”

“How would you like to incorporate exercise into your daily life in a way that feels manageable?”

“What role do you see yourself taking in creating a plan to start exercising?”

Affirmation and Support:

Provide positive feedback and affirmation for any commitment or willingness to change that the client expresses. 

Here are some examples you might use:

“I appreciate your willingness to explore options for improving your health.”

“I want to acknowledge your openness to discussing this topic and your willingness to explore potential changes.”

“It’s evident that you’re thinking seriously about your health. That’s a positive step towards making improvements.”

“I appreciate your honesty in sharing your thoughts and feelings about exercise. It’s important for us to work together on this.”

Summarise and Set Goals:

At the end of the conversation, summarise what you’ve discussed and collaboratively set realistic goals with the client. Ensure that these goals reflect the shift towards CATs language. 

Here are some examples you might use:

“So, it seems like you’re committed to finding time for exercise. What’s the next step. If any?”

“In summary, you’re uncertain about committing to exercise, but you’re open to exploring ways to make it happen. What specific steps do you think we should include in your action plan?”

“To recap, you see the benefits of exercise and are aware of the challenges. Let’s establish some achievable goals together. What would be a good starting point for you?”

“So, you’re motivated to improve your health through exercise. Let’s collaborate on creating a plan tailored to your needs and preferences. What’s your first goal?”

Remember that the key in productive communication is to facilitate a client-centred conversation, allowing them to discover their motivations for change. By using these communication techniques as a guide, you can help guide the client from DARN language towards CATs language in a respectful and supportive manner.

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