There are some clients who truly challenge us as professionals and as people for various reasons. When they have an overly negative perception or unrealistic expectations of their animal’s diagnosis or outcome, it can set us up for an unsuccessful veterinary rehabilitation programme, along with a huge knock in our confidence.
As Vet Rehab professionals, we need to meet the needs of both the patient and the client during rehabilitation. Learn to recognise the signs or triggers of ‘catastrophisation’ – the act of viewing or presenting a situation as far worse than it actually is – so that you can uplift and empower them throughout the rehabilitation journey of their animal.
Ansi van der Walt recently shared a webinar on how we can manage the expectations of the catastrophising client. Below, I share some of the most prominent take-home points.
Two parts of one whole
Many of us enter this field because we want to work with animals more than with people, only to discover that working with people is a very large part of the rehabilitation of every patient. This is even more relevant when we have a client or caregiver who is facing mental or physical challenges in their lives that can and will impact their perception of their animal’s condition.
The hard truth is that today most people are facing emotional, physical and mental challenges. Stress, anxiety and depression are anything but rare.
As we consider the rehabilitation journey that the patient needs to embark on in the coming weeks and months, we need to ask ourselves the same question from three different perspectives:
- What do we think this patient needs?
- What does the client think the patient needs?
- What does the patient think that they need?
There is a fairly good chance that we will come up with three very different answers to those questions. This can lead to expectations being unmet, unsatisfied clients and unmotivated patients.
In addition, how the client experiences their pet’s diagnosis, rehabilitation and symptoms will ultimately determine their compliance and the outcome for the patient. In cases where the client has a strong negative perception about the patient’s condition, we need to consider that rehabilitation consists of 50% treating the patient, and 50% supporting, educating and empowering the client. If we do not consider these two individuals (patient and client) as two parts of the same whole, we may be setting ourselves up for failure.
When the client comes to the worst possible conclusion
‘Catastrophising is a cognitive distortion that causes us to look at a set of facts and come to the worst possible conclusion. This leads to extreme worry or anxiety.’ Ansi van der Walt
There are certain psychological flags that allow us to identify a client that may be prone to catastrophisation; certain character traits and beliefs, along with possible challenges in social contexts. To identify these, we need to remain curious, asking questions of the client throughout the session. As they answer your questions, look for signs of:
- Depression or personality disorders
- Negative beliefs or judgements around pain or injury – they may believe that any injury will only worsen with time, or that pain will continue to get worse.
- Emotional responses such as worry, anxiety or fear
- Pain behaviours, coping strategies, or avoidance of activity due to fear of re-injury or causing pain
- A tendency to magnify or exaggerate the scenario, situation or condition.
A client may also directly share with you their expectation of the worst possible outcome.
Remember that you are not here to judge, diagnose or treat your client’s mental state or conditions – but you do need to support and uplift them so that they can facilitate the rehabilitation of their animal.
These clients will likely lack compliance with a home exercise or treatment programme because they are afraid of doing something wrong, causing pain or reinjury. These negative perceptions of home exercise may increase their dependency on in-house rehabilitation, which is great from a business perspective but is not very empowering for either the client or the patient.
Our role in the story
Catastrophisation happens when a client tells themselves a negative story about the situation which does not match the facts. The story will focus on the problem and will highlight that no change is possible for the patient.
There are many things that help or cause a client to create this story; individual personality, frame of reference, perspective, environment and beliefs all play a role. We also may unwittingly contribute to the creation of this negative story, in the way we present diagnostic imaging, for instance, our use of medical jargon, or the possible dependency we create on ourselves and our services.
We need to be very aware of not creating systems, practices and processes that cause the client to become more and more dependent on us, as this will promote helplessness and will further feed into a negative narrative. We really need to impress upon our clients that the role they play in helping to rehabilitate their animal at home can make a huge difference; they are not utterly without resources, as we can guide them in how to do this.
Ultimately, with clients inclined to catastrophising, we have a responsibility to help them distinguish between the facts and the story in their minds and to help empower them in their role as the caregiver of their animal.
Are we taking responsibility?
In addition to the helpless, negative thinker who quickly concludes that all is lost, we may encounter clients who blame and complain, become frustrated and aggressive, or shift the responsibility for a situation away from themselves. When this happens, we have a tendency to follow them into this space of blame, which is not healthy for the relationship or for our own mental wellness.
Let’s be honest. We too, can be negative about clients. How often have you complained about a client, or blamed them (even if only in your mind) for not sticking to a home exercise programme? How often do you place expectations on your clients and make assumptions about their abilities?
My guess is you can think of a few clients where you have done exactly this, and there is a good chance the outcome of that rehabilitation programme did not go according to plan.
We need to make a conscious and deliberate choice in these situations to take ownership and responsibility for the situation. Clients can be difficult, but we can only change our own assumptions and responses, not theirs. We need to acknowledge our own prejudices and recognise difficult client situations for what they are. They’re usually a combination of poor communication skills and stressors that have nothing to do with us.
Once we show a little understanding of the client, remaining open to their needs, we can find better ways to encourage and empower both them, and ourselves.
Instead of a rescuer, be a coach!
Ansi van der Walt shares two different relationship dynamics with us. The first is the drama triangle, where we can show up in one of three roles – the rescuer, the victim or the persecutor. When a client first comes to us, they may view us as the rescuer and themselves as the victim. Over time, or if something does not go according to plan, either one or both might become the persecutor where blame and accusations are made. It is very easy to become trapped in this drama triangle.
The second relationship dynamic is much more empowering. In this dynamic, we show up as the coach who empowers and encourages our clients to make the decisions and changes that their animals need. When we consciously reject the rescuer role and position ourselves firmly as the coach, our clients no longer respond as victims. Instead, they gradually (or quickly) move into becoming the creator of positive change in their animal’s life. This way, neither party is likely to slip into being the persecutor. Instead, if problems do arise, we can be challengers, helping our clients to overcome the obstacles they may face.
Be the coach and, occasionally, the challenger, rather than the rescuer, victim or persecutor!
Being the change
‘All behaviour is driven by emotion, which is driven by a need that is usually unmet.’ Ansi van der Walt.
In order to shift both ourselves and our clients into a more positive and constructive mind space, there are a few things that we can do.
Create a safe space
Ansi recommends starting with an attitude of ‘I’m OK, you’re OK!’ in our interactions with clients. Be very aware of creating a judgement-free, safe space in your practice and in your presence that allows the client to share their ideas, thoughts, problems and solutions. As you listen to and discuss the case with your client, be aware of not making them out to be ‘wrong’ and overruling them with your expertise or expert opinion.
Create mutual purpose
You want to create a space where you and the client are working together to come up with solutions, in a therapeutic alliance. Keep an open mind, and ask questions as you share your perception of the facts and ask for their perceptions of the scenario. Ask them what they think the implications of the diagnosis are, and how physiotherapy can help or change their animal’s life. Encourage as much feedback and participation as you can.
Spend time identifying the needs and goals of the patient and the owner, and set outcome measures according to those needs and goals together with the client. Make sure that the outcome measures are specific and measurable.
Successfully rehabilitating a patient needs to include the owner, caregiver or client in the process, especially if they have a negative perception of the situation and the outcome for their animal. We need to accept that we have a great deal of responsibility in this scenario, and to play an active role in empowering and uplifting our clients without making judgements, shifting blame or becoming frustrated with their actions. That way, we coach our clients, no matter how difficult they may be, into becoming key role players in their pet’s health. This makes for better outcomes for our patients, and happier working days for us.
The catastrophizing client: Managing client expectations, with Ansi van der Walt.