The Art of Challenging Beliefs

Working with patients or even staff who have strong beliefs that conflict with your own can be both stressful and difficult.

In this post I present some concepts to consider about when you feel the need to have the person you're with agree to your way of thinking.

Before I start I'd like you to consider the quote below taken from "How Minds Change: The New Science of Belief, Opinion and Persuasion" by David McRanney

"There is no superior argument, no piece of information that we can offer, that is going to change their mind... The only way they are going to change their mind is by changing their own mind - by taking themselves through their own thinking, by processing things they've never thought about before, things from their own life that are going to help them see things differently."

Three important things to consider before we move onto challenging beliefs:

1. Before you begin, ask yourself "How are you so sure that you are right?"
2. Respect the other's beliefs and only assist in changing them with informed consent
3. Are you fully aware of the what the belief does for the other person? If not, aiming to have them think the way you do is fraught with danger and possibly more of an ego trip than a willingness to help.

Steps to Help Minds Change

At all times the aim is to avoid getting into an argument. When arguing there has to be a winner and a loser and nobody likes losing. Your goal is to stay curious at all times even when you're struggling to understand the perspective of the other person.

The other person must feel safe to explore their thinking and the motivations behind their thinking. The focus must stay on their processing, on how and why they see what they see, not what.

Step 1: Why do you need to change then mind of the other person?

What's to be gained by you changing the mind of the other person? If you don't have a very valid reason DON'T move forward.

Consider how you can work with the other person whilst holding different beliefs.

Understand that challenging beliefs is not a quick process unless the other person is at the 'tipping point' of changing their mind. Minds change through reflection of thinking and that takes time.

Step 2: Build rapport

Express both curiosity and compassion towards the other person. They must be open to discussing their belief. Ask for consent to have the discussion. Demonstrate your openness and respect and work to collaborate on a shared goal of understanding why you disagree with their position.

Don't move forward until you have established trust even if this takes a few conversations.

Step 3: What is their belief?

Ask them to identify their belief so that both parties can agree on what is being discussed.

Do not challenge the belief. Your aim is to make the other person feel heard and respected.

Step 4: Repeat the belief

Confirm your understanding by repeating back their belief in your own words. Allow them to correct you if necessary and repeat this process until you are bother clear that your understanding is correct before moving forward.

Step 5: Identify Definitions

Clarify their definitions and use these, not yours in the discussion.

As an example: if a patient says "because of this injury, I'll never be able to work again", they may be referring to a specific job they think they can't do and you're thinking about all the work options that might be available to them.

If you assume you're both talking about the same understanding of the word 'work', then you can end up arguing with yourself rather than focusing on the other person's ideas.

Any terms that are important but vague will need clarifying

Step 6: Confidence level

Ask them to put a number on their feelings of confidence in being right. You can use a scale of 1-10 or 1-100. The scale is not important, only the number they give you.

Ask them why that number feels right.

Explore further by asking them "Why not higher?" The answer to this question will provide some insight into their thinking.

Identify the reasons they feel support their confidence level.

Step 7: Questions to encourage reflection

Ask them what method they used to determine their reasons are good.

Ask them if someone else were to look at the same evidence but reached a different conclusion, how would a third person looking at the same evidence determine which was true?

The goal is to have the person judge the quality of their reasoning process when it comes to the certainty of this particular belief.

Step 8: Clarify, reflect and connect to their values

Paraphrase as best you can and ask if you've heard them correctly. Repeat until you agree.

At this point in the discussion, feel free to share your own beliefs on the matter.

Ask if the other person wants to explore your beliefs in the same way you explored theirs.

Step 9: Close with appreciation for their openness

Wrap up by suggesting you have more conversations like this in the future.

Wrap Up

It's important to note that this is a guide in working with beliefs and not a prescription. Use judicially understanding the principles.

Your focus is on the other person's reasoning, not on your logic for why they should change their mind and agree with you.

What I've presented here is loosely based on David McRanney's book "How Minds Change: The New Science of Belief, Opinion and Persuasion."

I highly recommend reading this book as there is so much more to learn than the points I've summarised in this post.

Book Review: Head First by Alastair Santhouse

When people do not respond to treatment “it is a failure to understand people - why they develop symptoms, why the come to see a doctor - and often a failure to understand what they want from their interactions with healthcare.” Santhouse

Personally I found this book very thought provoking. Even though it is written by a psychiatrist with respect to medical problems, there are many cross overs for physiotherapists. It is written in an way that endears the reader to each situation both Dr Santhouse and his patients find themselves in.

If you manage a high percentage of patients struggling with their health care or inpatients, then I highly recommend this book to you.?

Dr. Santhouse believes in the importance of empathy and understanding when working with patients, particularly those with mental health issues. He emphasises the value of active listening and using open-ended questions to encourage patients to share their experiences and concerns.

In addition, Dr. Santhouse believes in the importance of collaborative care, working closely with other healthcare professionals to provide comprehensive care for patients. He recognises that mental health issues can be complex and that a team-based approach that includes psychiatrists, therapists, and other specialists can be most effective.

Overall, Dr. Santhouse's philosophy is focused on providing patient-centered care that is tailored to each individual's unique needs and circumstances. He recognises the importance of treating the whole person, rather than just focusing on specific symptoms or diagnoses.

Here are 10 important things that a physiotherapist can learn from the book "Head First: A Psychiatrist's Stories of Mind and Body" by Alastair Santhouse:

1. The importance of taking a holistic approach to treating mental health issues, which includes considering lifestyle factors such as exercise, nutrition, and sleep.
2. How to recognise the signs and symptoms of common mental health disorders such as depression, anxiety, and bipolar disorder.
3. The role that stress plays in physical health and how to help patients manage stress.
4. How to communicate with patients effectively, including listening actively and using open-ended questions to encourage discussion.
5. The importance of empathy and understanding when working with patients with mental health issues.
6. How to work collaboratively with other healthcare professionals to provide comprehensive care for patients.
7. To be aware of your biases especially when you think you know what the presenting problem is. As Santhouse says in his book "... once your mind is made up about the patient in front of you, it is easy to stop noticing your biases."
8. The importance of keeping an open mind when assessing problems that are not progressing as expected. Your questioning may be taking you down the wrong path. "What doctors see as 'non-compliance' with treatments is usually a point of view that the doctor has not yet understood.”
9. The value of incorporating humour and storytelling into treatment approaches to engage patients and make difficult concepts more accessible.
10. The importance of self-care for healthcare professionals, including strategies for managing stress and preventing burnout.

Overall, "Head First" can be a valuable resource for physiotherapists looking to expand their knowledge of mental health and how it relates to physical health. But also for those who are keen to explore their own biases when managing patients.

"All behaviour is communication." Santhouse