Managing Your VT Room – Part 2 – Can You Hear Me Now?

A few years back, I enrolled in a Dale Carnegie class for leadership and public speaking. The class taught many important lessons, perhaps the most important of which was understanding how your own language sounds to others. I think so many of us get caught up in our routine questions, we sometimes don’t recognize it as part of the problem during a challenging session. For this entry, I’d like to offer ideas on what we refer to in our office as “changing the channel”.  The idea, similar to changing the channel on TV, is to find a different input which the patient may be stimulated or find value. Here’s some ideas on how to accomplish this.

Watch Your Language

Have you ever reported to your doctor of a patient’s struggle with a particular activity, only to find out the next week that the patient did very well while trying that activity with a different therapist?  It’s happened to me so many times.  While we are always happy for the patient’s success, it’s hard not to feel frustrated with ourselves. Sure, different levels of therapist training will help produce different results in the therapy room, but that explanation only takes me so far.  If these different levels of training could be the primary explanation for a difference in results, communication style has to be a close second.  Maybe all that really happened was the other therapist asked the questions differently, which changed the outcome enormously.

Anyone who has ever been in a committed relationship for longer than 4 minutes knows how easy it can be for your words to be misconstrued.  How often does what your spouse understand have nothing to do with what you actually said? Your intention with the spoken message passed through their filter and became something totally different, and you have no idea how.  Sound familiar? Unfortunately, this breakdown in communication doesn’t end with intimate relationships.  So often it occurs with family members, friends, co-workers, and patients. Especially patients.

After many “failures” (i.e. learning experiences)  in communicating with patients, always considering the language aspect has become part of my daily approach in the therapy room, because I’ve found that many times this is where a gap forms.  At the first sign of trouble, I consider the following in my head:

  • Do the patient’s struggles have anything to do with how I am asking the questions?
  • If I come at this problem from a different angle with different questions, would that change the result?
  • Is my physical position in the room somehow a factor?  I don’t consider myself an intimidating presence, but perhaps I’m hovering over the patient (or in their perceived personal space) and somehow changing their perception of what I am looking for, and in turn affecting their willingness to take a shot at solving a problem.  Body language is so often an overlooked factor in communication.
  • If I let someone else ask the questions, what would happen?
  • Have I asked enough questions?
  • Have I asked the right questions?
  • Am I giving the patient enough time to formulate an answer?
  • Am I REALLY listening to their answer?

So often I find myself saying to patients “I do this all day, every day and I use words which make sense to me because they’re the only words I can remember…(insert your favorite old person joke here).  If I say something that doesn’t make sense, please tell me so YOU can teach me a new way to ask my questions”.  At that point, hopefully they feel safe enough to “teach me” – to speak up and say they don’t understand the question. In essence, communicate to me I have lost them in the language – spoken or otherwise.  Sometimes this strategy works immediately, and other times results are down the road.  Either way, I’ve established that we are working together, and I value their input. Usually though, they have a flood of input to offer.

During our time working together, my friend and mentor Linda Sanet would always remind me to “speak to their listening”, when working with patients.  Basically find the level and location of their listening, and meet them there.  Sometimes simply changing the channel of communication can make all the difference in the world.  Of all the gifts of knowledge I have received over the years, time has proven Linda’s message to be one of the most valuable ever handed down.

So next time you’re “stuck”, consider if part of the challenge is the way you’re asking the questions.  Since communication truly does belong to the speaker, if our listener doesn’t understand, we need to find another way to communicate our message.

If you ever need help determining where to take the communication, there’s a sure fire equation to help map it out.  Simply ask a question…

And then listen.


Posted on June 22, 2016, in From My Perspective.... Bookmark the permalink. 2 Comments.

  1. Thanks for this blog Robert. It arrived very appropriately today. I worked with a teen age boy who has been diagnosed with fragile-x syndrome. This was my first time working with him and the therapist who usually sees him told me he was a “difficult” patient. I found out that in spite of his many challenges, he was sweet, cooperative, and had a wonderful smile. He tried very hard at everything we worked on. Until this point no one had been able to get any “fusion” work accomplished with him in VT – I was told “he probably doesn’t have the capacity to understand.” After several minutes I found his “listening” and was able to determine that he indeed saw size and distance changes (though not always the ones I like to hear) and had reasonable spatial localization. Your point about giving the patient enough time to formulate an answer was THE key for this young man. He left the VT session very excited – and I did too!


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