Written by Hadar Naftalovich
[Note: Details have been changed to protect patient privacy]
When I started working at the Center for Anxiety, I quickly learned that some of the inquiries we receive are rather different from the typical phone calls I’d been used to. In some cases, I was surprised by the amount of clinical information that one could gather from a simple conversation. Here is one telling exchange I had with one of our patients who suffered from Obsessive Compulsive Disorder (OCD).
H: Center for Anxiety, Hadar speaking. How can I help you? P: Hello? Is this Hadar? H: Yes, this is Hadar. How can I help you? P: I am a patient at your center. What time is my appointment next week? H: It’s on Wednesday at 12:30 P: What? (rather loudly) What? H: It’s on Wednesday at 12:30 P: Thanks. Wait… What time is my appointment? I couldn’t hear you. H: Your appointment is Wednesday at twelve-thirty in the afternoon. P: Okay. See you then. Actually… Did you say it’s at noon???
Even more interesting, this patient called me one day before her next appointment the following week, and we had more or less the exact same conversation. At that point, I approached her therapist to tell her about the burgeoning pattern, and was surprised to learn that at each of the past two sessions, the patient had been given her appointment time in writing on a business card. We therefore realized the patient was engaging in compulsive checking – in other words, the phone calls were actually a symptom of her OCD.
The question for me thus became how should I handle such calls in the future. I wanted to convey to the patient that I cared about her without giving into her compulsions, which would ultimately make matters worse for her. With guidance from the Center for Anxiety directors, I learned a key skill that I like to call Validation Without Reassurance. I now use this approach every day in dealing with patients and their families. Here’s what it involves:
When patients call our office, it means that either they, or a loved one, are experiencing a problem. Often times, they have tried to find help elsewhere to no avail. I therefore try my best to validate their pain. I reflect back to them what they say to me – to make sure that I have the correct information, and also convey to them that I understand what they are going through. I also try to help them make some sense of their situation. For example, many OCD sufferers call our office after years of non-CBT treatment, which only made their symptoms worse. Validating their experience provides some degree of immediate relief from the pain they are carrying. I also try to instill hope, by conveying what our office can do for them and the results we’ve achieved in similar cases.
However, once I have provided this validation many patients are left wanting more, and will ask questions or make statements geared towards getting me to repeat what I have said. This is called “reassurance-seeking” and consistent research from around the globe shows that, for individuals with anxiety and related symptoms, it is associated with worse outcomes and prolonged suffering. I therefore had to learn to not repeat information that has already been discussed, just to provide temporary relief. If you call my office, you will not hear me say things like “You’ll be fine!” or “Everything will be okay!” This is not because I lack confidence in our services – every day I see patients whose lives have been changed by our clinical team. But telling this to patients serves no benefit, and in fact can cause more problems over time. It’s important for patients – like all people – to learn to accept uncertainty, and providing reassurance doesn’t allow for that to happen. Especially for people with OCD, shortly after receiving reassurance they will start to experience new intrusive thoughts, their doubts return with a vengeance, and they will feel the need to be reassured once again.
While I learned how to validate without reassurance primarily to help our patients, I have found that the same skill has also helped me communicate better with my friends and family. I am able to support my loved ones better than ever, because I realize subtleties in our communication patterns and understand that what they truly need may not be exactly what they say or think they need. Getting into the habit of validating without reassurance did not come without its challenges, but once I was able to integrate these skills into my regular speaking patterns I have found that my ability to listen and communicate has greatly improved.