Tag Archives: emotional intelligence

Phatic Chat: embiggening small talk.

Small talk is a big deal.

Small talk is the oil that keeps the machinery of interpersonal relationships running smoothly.

Small talk even has its own name. It’s called “phatic chat”.

Phatic chat has been described as “A type of speech in which ties of union are created by a mere exchange of words”  by Bronislaw Malinowski (no relation to Barry Manilow). This is why I think it’s important that us health professionals be intentional about phatic chat.

Every, “Hello. My name is…” and “How are you today?” serves to create a working relationship between people. Health professionals rely on working, therapeutic relationships.

Academics (god bless their cotton socks) have even gone to the effort of researching and naming 12 functions of phatic communication (source):

(1) breaking the silence
(2) starting a conversation
(3) making small talk
(4) making gossip
(5) keeping talking
(6) expressing solidarity
(7) creating harmony
(8) creating comfort
(9) expressing empathy
(10) expressing friendship
(11) expressing respect
(12) expressing politeness

When we think about phatic chat in the health care setting, it’s not just a social lubricant, we can also see it as a stand-alone form of therapy. Think of phatic chat as the nonspecific factors of psychotherapy

BTW: “nonspecific factors of psychotherapy” an actual thing, let me google that for you: here

Phatic chat/the nonspecific factors of psychotherapy show the person that there is someone who is interested in them and their concerns. It helps people feel understood, accepted and respected. In my current gig – providing mental health support in the general hospital – I often get told by patients how good it is to be nursed by someone who is good at phatic chat.

It’s easy to imagine, isn’t it? Who would you rather attend to your vital signs, IV antbiotics, wound dressings, and pain relief in hospital: a friendly person who chats and listens, or someone unfriendly and officious who just goes about the tasks at hand? There’s more than one way to prime an IV line.

It sounds simple, and (to my ear anyway) pretty patronising. However, it’s clear that many clinicians do not routinely engage in phatic chat.

You may already know the story of Kate Grainger. Briefly, for those who don’t, Kate was a doctor in the UK who tweeted her experience of living with a terminal illness. One of the many observations she made was that it was refreshing, but actually pretty unusual, for hospital staff to introduce themselves by name and role when they came to see you in your hospital bed. That observation lead to this tweet:

That simple idea has been one of Kate’s greatest legacies (she died in 2016).

If you’re not familiar with the #hellomynameis story, I urge you to visit the hellomynameis.org.uk website for more info.

#hellomynameis = a very successful campaign promoting phatic chat in healthcare

I live and work a long way from the UK. Although I don’t wear a #hellomynameis badge, I borrow heavily from the idea that phatic chat is important, and toss-in a few more Aussie-fied ways to go about using it in the hospital setting. As argued above, phatic chat is important for building relationships and can be therapeutic in and of itself. Sometimes to be culturally safe you need to try a little harder to facilitate trust and rapport. With that in mind. here’s 4 ideas that usually (not always) work for me:

One

“Are you Cyril? G’day my name is Paul McNamara, I’m a nurse with the psych team here at the hospital. Is it OK if we sit down and have a bit of yarn?”

Two

Shaking hands is a respectful thing to do. I always offer a handshake when introducing myself to patients (they’re often surprised!).

Don’t worry infection control peeps, I’ve got that covered: meta4RN.com/hygiene

Three (this is my second favourite: I stole it from Professor Ernest Hunter)

Make a cup of tea for the patient. Even if they say “no thanks”, let them know that you’re making one for yourself anyway, so are happy to make them one while you’re at it. Take instructions on how the person likes it . Apologise if you make it too hot/strong/weak or spill it. Sip yours when they’re talking: if for no other reason, it let’s them know you’re not about to interrupt.

This might be the best journal article ever written by a psychiatrist:
Hunter, E (2008) The Aboriginal tea ceremony: its relevance to psychiatric practice. Australasian Psychiatry, 16:2, doi: 10.1080/10398560701616221
Despite the paper’s title, the same demonstrations of humbleness, politeness and respect work for whitefellas too.

Four (this is my favourite: I made this one up myself)

I nearly always use when Google Maps when introducing myself to people who have come to the hospital from out of town. “Oh you’re from Aurukun? I’ve been to Wujal Wujal, Laura and Hope Vale, but I’ve never been there. Do you mind if we use this map on my phone to see where you live?” It’s nearly always a great way to break the ice, especially when meeting with someone from a different culture. It sets the right tone of showing that you’re interested and approachable.

I’m lucky to work in a place where I meet with Aboriginal and Torres Strait Islander people all the time. By getting the Aboriginal/Torres Strait Islander person to show me around their community on a map, I’m acknowledging/demonstrating that they know stuff that I don’t know, and I’m prepared to learn from them. Sometimes I’m a bit more skilled at using the Google map app on my phone, so I get to show the person how I can be helpful, in a kind and respectful way. It probably doesn’t hurt that we’re both looking at the map together and working on the same task (it demonstrates that we can work together, and you don’t want to rush into making a heap of eye contact with someone you’ve just met). While we’re using the app to find their house, the local school, favourite fishing or camping spot, and other landmarks we’re getting to know each other a bit. I’m not left in that clumsy position of being accidentally too pushy, too intrusive, too task-orientated.

Spending a few minutes establishing rapport is what phatic chat is all about. The phone/map app is just a prop, but it’s a great prop.

In Closing

That’s it.

A while back I had a gig educating uni students. One of the best tricks-of-the-trade when in a uni lecturer role is to introduce people to words they have not heard before. This makes you look cleverer than you really are, and lends an illusion of credibility.

So, with that in mind, my call-to arms for health professionals is this:

Let’s embiggen phatic chat!
It’s a perfectly cromulent thing to do. 🙂

Acknowledgement

The phrase/notion of “phatic chat” as a defence against the forces that seek to turn nurses into unempathetic box-ticking robots came to my attention via Professor Eimear Muir-Cochrane’s keynote presentation at the ACMHN 39th International Mental Health Nursing Conference, held in Perth, Western Australia, 22nd-24th October 2013.

Storify of the keynote here: storify.com/meta4RN/zero

Follow Professor Eimear Muir-Cochrane on Twitter here: @eimearmuirc

End

As always your thoughts/feedback is welcome in the comments section below.

Paul McNamara, 12th October 2017

Short URL https://meta4RN.com/phatic

 

 

Nurse can’t take Pulse. Seriously.

This week in Australia ABC TV screened Episode 1 of a new medical drama called “Pulse“. It is said to be inspired by a true story of a transplant patient who became a doctor. Sounds cool, right? Well, it isn’t. From my perspective it’s pretty crappy, even for TV fiction. I started my career as a nurse in 1988. I’m not fond of nurses being ignored or misrepresented. Pulse does both. In spades.

Following are four reasons why I can’t take Pulse seriously (complete with Episode 1 timings, for those who want to check via iView):

1.  The cast. 

See how in the cast photo there are nine doctors and two nurses?

source: http://www.tvtonight.com.au/2017/06/gallery-pulse.html – I’ve added the labels

How does that compare to the actual health workforce in Australia?

In 2014 there were 610,148 registered health practitioners. Over half of these (352,838) were nurses or midwives – over 3 times the size of the next largest group [source: www.aihw.gov.au/workforce]. So, if we put gender-mix aside for a moment (about 90% of Australia’s nurses are female, about half of our new doctors are female) this would be a more accurate visual representation of what a real-life Australian health drama cast photo should look like:

source: http://www.tvtonight.com.au/2017/06/gallery-pulse.html – I’ve duplicated the original and added the labels

2. The patient is critically unwell, but the nurses are nowhere to be seen.   

At about 7:00 into Episode 1 there is a large group of doctors (no nurses) at the bedside of a patient. One doctor asks (referring to the patient), “What’s her oxygen saturation?” Another doctor looks around bewildered and is the prompted by yet another doctor to use the oximeter. He does and (instantly!) announces that O2Sa is 88% (this is spookily low for most people).

The fact is that nurses are the ones who are usually at the bedside, and are the ones who monitor the progress/deterioration of a patient, including measuring vital signs regularly. This monitoring would have been very frequent in someone who has low oxygen sats. The nurses would have the info on hand, and most likely would have been discussing care options with the doctors. Maybe the Pulse scriptwriters haven’t heard about multidisciplinary health teams, and don’t know that Australia’s largest union is the Australian Nursing and Midwifery Federation (ANMF) [source: anmf.org.au].

3. When you do finally see/hear the voice of a nurse it’s just two gossipy snippets. 

At about 8:40 the nameless character listed in the credits as “Scrub Theatre Nurse” (played by Lara Lightfoot), stands around doing nothing while the doctors perform surgery. Her role seems to be solely to deliver these two consecutive bits of dialogue:

“I heard from the head of department there’s an MVA that didn’t make it upstairs. There may be a potential donor.”

“The head of surgery is retiring, right? Guess they’ll be looking for a replacement.”

It’s important to note that Scrub Theatre Nurse is not depicted as actually doing anything (other than gossiping). For the non-nurses out there, please be reassured that your tax dollars are not being wasted on employing nurses to just stand around in operating theatres doing bugger-all. The roles and skills of peroperative nurses are many and varied: visit the Australian College of Perioperative Nurses website www.acorn.org.au and/or follow their link to “A day in the life of a preoperative nurse“.

Logo from @ACORN_org Twitter page

4. The only other two lines of nurse dialogue portray her as an unprofessional unethical antisocial bitch 

Carol Little RN (played by Penny Cook) has just two lines of dialogue, as below:

At about 13:00 Carol Little RN says to Dr Tabb Patel (in front of the patient and another doctor): “This time do not catheterise the cliterous, intern.” Lead character Dr Frankie Bell (correctly) advises the intern that female catheterisation is usually a nurse’s role and that the nurse was bullying him. Carol Little’s behaviour is not just a breach of common decency, but also of about 27 different aspects of the codes of conduct and ethics that set the standards for all health care workers, nurses included.

At about 17:30 lead character Dr Frankie Bell enquires on the whereabouts of a man who was meant to be receiving haemodialysis. In reply Carol Little RN gets her only other line of dialogue: “Do I look like a fucking concierge?” Is that verbal abuse or just lalochezia? The former, I think.

It’s interesting that Australians have voted nurses as the most ethical and honest profession for 23 consecutive years (1994-2017) [source: www.roymorgan.com], but the Pulse scriptwriters think otherwise.

Winding-Up

Look, Pulse is just TV fiction. The hilariously fanciful depiction of lead character Dr Frankie Bell leaving hospital to jump on her bicycle and visit the home of a dialysis patient who didn’t show-up for treatment, then stay at his bedside overnight after he receives a kidney transplant is evidence enough of creative imaginations at work. Pulse is not pretending to be a documentary. It is very clearly just another hospital TV drama. An old formula, acted well, shot beautifully, just scripted awfully.

I guess it’s not really all that important whether people watch Pulse or ignore it in the big scheme of things. My bias is such that I’d rather watch Australian TV than imported shows – it’s good for us Aussies to hear our own voices and see our own stories on the telly. However, this isn’t anything like an Australian story. Bananas in Pyjamas does a better job of portraying an Australian reality.

I will not bother watching any more episodes of Pulse because it insults nurses and nursing. Nevertheless, we should give credit where credit is due. In one simple seven-word sentence the Pulse scriptwriters managed to capture the sentiment of what it feels like to be a nurse who is angry about their skills being misunderstood, underestimated and devalued:

Dialogue scripted for the character Carol Little RN in Episode 1 of “Pulse”

End

Thanks for reading my first outing as a television critic. As always, your feedback is welcomed in the comments section below.

Paul McNamara, 22nd July 2017

Short URL: meta4RN.com/pulse 

 

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: prezi.com/skmu0lbnmkm5/first-thyself/#

This page serves as a one-stop directory to the online resources used to support the discussion.

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

It’s OK if you forget everything about today’s talk, just don’t forget that there is 24 hour support available via 1800 667 877 or https://nmsupport.org.au

End

Please have a play with the pretty Prezi prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself

 

 

The Hearing-Voices/Car-Driving Metaphor

A while ago I met a lady who had a fantastic way of describing and understanding her experience of auditory hallucinations/psychosis. It goes a bit like this:

My body’s a car. I’m the driver.

In the back seat are the voices. They’re like naughty kids, always chatting away amongst themselves. Often they’re taunting me. 

Usually I can just ignore them and get on with driving the car.

However, every now and then the voices get real loud.

It’s distracting. Driving becomes difficult and that’s when I’m most likely to drive badly or, if I’m unable to concentrate properly, I could even crash the car. 

It’s pretty scary, but I usually don’t have to come into hospital at that point. I just need more support to get control back, and maybe a change to my medication. 

The worst time for me is when the voices get so distracting that I can’t focus on driving at all. I turn to the voices in the back seat and try to get them to shut up. But they’re like naughty kids yelling and jumping around the car, and I can’t get them to stop. 

I take my seatbelt off and turn to face them, then somehow – I don’t even notice it happening – one of the voices will slip into the driver’s seat and take over control of driving the car.

Thats when it gets REALLY dangerous.

I’m not out of control – it’s worse than that – I have lost control entirely. I haven’t even got my hands on the steering wheel anymore, and I can’t reach the brakes. 

That’s when I need to come into hospital.

At the time I met this lady she was make a tentative recovery from one of these acute episodes of psychosis. On admission she had been experiencing command auditory hallucinations, paranoid delusions, racing thoughts and suicidal ideation.

When we met the intensity of these symptoms was settling. The lady’s articulate insight helped us both communicate effectively when she had a relapse in symptoms. To keep her safe we needed to stop her from leaving the hospital, and provide an increased level of supervision/support. To get a shared understanding of this I was able to return to the lady’s metaphor:

I’m worried that you’re at risk of losing control of the car again. What I’m planning to do is take the keys away for now, and hand them back to you when you’re safe to drive again. 

That’s a good way to think about using the Mental Health Act – it’s a mechanism to decrease risk/stop people from a foreseeable crash if they’ve lost the capacity to drive. 

However, the real story here is about the intelligence, insight and articulate communication of a young woman who experiences symptoms of psychosis.

An impressive person, and a fantastic metaphor. 

Hopefully other people will be able to make use of this lady’s metaphor as a way to understand psychosis/hearing voices. 

car
End

Thanks for visiting. As always your comments/feedback is welcome below.

Paul McNamara, 20th February 2017.

Short URL: https://meta4RN.com/car

Mental Health and Cognitive Changes in the Older Adult

This afternoon I’m presenting at Ausmed’s Cairns Nurses’s Conference. The title of the presentation is “Mental Health and Cognitive Changes in the Older Adult”.

The only real point of this blog post is to leave a copy of the powerpoint presentation online, so that those attending the conference can revisit the slides PRN. Here it is:

And here’s the spiel from the Ausmed website
www.ausmed.com.au/course/cairns-nurses-conference

Mental Health and Cognitive Changes in the Older Adult

As we get older, the likelihood of undergoing alterations to brain function is high. This may include normal neurodegenerative changes as well as abnormal deteriorations. Separating normal from dysfunctional degeneration when screening and assessing an older adult is essential for quality nursing care planning. This session will look at:

  • What are normal age-related changes to the brain and consequent behavioural signs?
  • How are these changes different to the onset of mental health disorders such as schizophrenia, psychosis or bipolar disorder?
  • Age appropriate assessment tools for effective mental health assessment
  • Benefits of brief psychosocial interventions
  • What practical behavioural strategies may improve outcomes for a person with a mental health disorder and cognitive changes?

About the presenter:

Paul McNamara has extensive experience providing clinical and educative mental health support in general hospital and community clinical settings. He holds hospital-based, undergraduate and post-graduate qualifications, is Credentialed by the Australian College of Mental Health Nurses (ACMHN), and has been a Fellow of the ACMHN since 2007. Paul is a very active participant in health care social media, and is enthusiastic about nurses embracing “digital citizenship” – more info via his website http://meta4RN.com

ausmed16

End

That’s it. Short and sweet.

I hope this is of some use/interest to those who are attending the conference, and (maybe) some people who are not able to get along.

As always, feedback is welcome in the comments section below.

Paul McNamara, 15 December 2016

Short URL: https://meta4RN.com/Ausmed16

 

Hand Hygiene and Mindful Moments

Nurses and other health professionals are expected to attend to hand hygiene about eleventy seven times a day. The WHO and HHA recommend 5 moments for hand hygiene: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings. 57.4% of Australia’s nurses/midwives are hospital/ward-based [source], they’re doing A LOT of hand hygiene. 

On top of that, while they’re going about their business and busyness, ward-based nurses are interrupted 10 times an hour [source]. Yep, every 6 minutes there’s something or somebody distracting us from our tasks and thoughts. Dangerously disorderly much? Hopefully that doesn’t happen to neurosurgeons, commercial airline pilots, tattoo artists or Batman.
Especially Batman. 

batman

Pro-Tip: most of us can not do this at work. Only respond to distractions with face-slapping if you are Batman.

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others.

poster1

5 moments for hand hygiene & head hygiene!

Turn the 5 moments of hand hygiene into mindful moments. Make the 5 moments for hand hygiene 5 moments for head hygiene too. Yes, clean hands save lives – let’s not forget that clear heads save lives too!

Come up with a process/script that works for you, maybe something a bit like this: 

Mindful Moment (The 30-Second Handrub Version) 

  1. Step towards the pump bottle with intent. This is my mindful moment. I’m taking a brief break. 
  2. Squirt enough to squish. 
  3. The rub is slippery at first. Frictionless fingers feel fine.
  4. Feel the product texture and temperature. The rub is cooler than the air. The rub is cooler than my fingers. It feels nice. 
  5. Start with cleaning. The first half of my hand hygiene routine is about rubbing stuff off. Let the stuff I want to get rid of float away. 
  6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
  7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
  8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
  9. Smile.
  10. Breathing slowly, its time let the air rinse off the residue. 
  11. One more slow breath. Its time to get back to work. 

Mindful Minute (The 60-Second Handwash Version)

  1. Step towards the sink with intent. This is my mindful minute. I’m taking a brief break. 
  2. Let the water flow.
  3. Feel the water flowing over both hands. The water’s warmer than the air. The water’s warmer than my fingers. It feels nice. 
  4. Add soap. It’s slippery. Frictionless fingers feel fine.
  5. Start with cleaning. The first half of your hand hygiene routine is about washing stuff away. Let the stuff you need to get rid of flow down the drain. Let it flow away. 
  6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
  7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
  8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
  9. Smile.
  10. Breathing slowly, its time rinse both hands. 
  11. Breathing slowly, its time to thoroughly dry both hands together. 
  12. Throw the towel in the bin.
  13. One more slow breath. Its time to get back to work. 
poster2

Clean hands save lives. Clear heads save lives too!

Acknowledgements & Context

This is not my original idea. I first stumbled across the idea of combining hand hygiene with head hygiene via Ian Miller‘s November 2013 blog post “mindfulness during handwashing”: http://thenursepath.com/2013/11/18/mindfulnurse-day-8/. I’ve been using the idea myself and suggesting it to colleagues and students ever since. When I left the clinical environment for a few months, I found myself really missing intentionally punctuating my day with mindful moments. Since returning to clinical practice I’ve come to appreciate the strategy even more than I did when I first started using it 3 years ago.

So why am I blogging about it too? Why now? Well, on Monday I attended the Australasian College for Infection Prevention and Control 2016 conference to chat about Twitter [link to that presentation here. Also, check-out the #ACIPC16 hashtag here and here]. Luckily I was there for the opening plenary sessions, and was pleasantly surprised at the emotional/psychological literacy that was being displayed and advocated for. The opening presentations by Peter Collignon, Mary Dixon Woods and Didier Pittet all went to some lengths to emphasise the importance of emotional intelligence, constructive communication and building relationships. It was really impressive stuff; giving the hand hygiene and mindful moments idea a remix is my way to give recognition/thanks to the #ACIPC16 conference delegates and organisers.

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

Just so you know, a quick google search reveals that others have also thought of using hand hygiene as a mindful moment, eg this paper:

Gilmartin, Heather. (2016) Use hand cleaning to prompt mindfulness in clinic: A regular prompt for reflection could reduce distraction. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i13 (Published 04 January 2016)

and this video:

There are others too. Do you think using hand hygiene as a mindful moment could become mainstream?

5mindfulmoments

End

That’s it. As always your comments are welcome via the space below.

May you hands be clean and your head be clear! 🙂 

Paul McNamara, 26 November 2016

Short URL: http://meta4RN.com/hygiene

The Broken Leg/Psychosis Metaphor

Preamble

Below is a metaphor I heard in 1994 via an impressive man called Greg Holland. Greg is retired now, but when I met him he was a CNC with a public community mental health service. Even after all the years that have followed, Greg remains one of the most skilled communicators and mental health nurses I’ve ever worked with.

Greg was talking with a couple of young fellas who had been diagnosed with schizophrenia. Greg was explaining the importance of trying to avoid relapses of psychosis. The key messages for these young blokes was to keep taking the prescribed medications, and stay away from things that make psychosis more likely: things like cannabis, amphetamines or heaps of alcohol. That’s when Greg used this metaphor (his verbal version was shorter than my written version, but the general story is the same):

The Broken Leg/Psychosis Metaphor

If you accidentally broke your leg skateboarding or playing football, you’d have to have your leg in plaster for about 6 weeks. You would have to be really careful with it during that time, and it would probably get really uncomfortable and itchy most days. Then, if there were no complications, after 6 weeks you’d be able to get the plaster cast off, and start building up your strength in that broken leg. A physio might recommend some exercises, but you probably wouldn’t get back to playing football or skateboarding for a few months. Rehabilitation takes a bit of time and effort, but as a young fit man you’ll make a full recovery. No worries.

If you broke the same leg again, it might be more of a big deal. You might need surgery, and they might need to strengthen the bone with steel plates or rods and screws. Sometimes people need to have external fixation: metal devices that are screwed into the bones, but sit outside the body, above the skin to stabilise the fractures. It will be messier, more painful, take longer to get out of hospital, and your leg muscles will get pretty weak. You’ll probably make a full recovery still, but it will just take more time and effort.

If you break your leg a third time, the orthopaedic nurses and doctors are going to think you’re either really unlucky or stupidly reckless. They’ll suggest that you stop skateboarding and playing football altogether. Your leg will get operated on, and the fractures will get stabilised, but the recovery will be really slow. You could end-up with a bit of a limp.

If you keep on breaking the same leg over and over again, say five, six, seven times, you will definitely end up with a limp. Might need a walking stick or something.

If you break the same leg often enough and bad enough you’ll probably end up lame: permanently disabled and unable to walk. You’ll wish you’d listened to the orthopaedic nurses and doctors, and had never gone back to skateboarding or playing football.

It’s kind of the same with psychosis.

If you lose touch with reality once or twice you’ll probably make a full recovery.

But if you keep on having psychotic episodes your brain might develop a bit of a “limp” – it will still work, but not as good as it used to work.

If you have lots of psychotic episodes you might end up disabled and unable enjoy life to the fullest. You’ll wish you’d never gone back to smoking gunja or getting pissed.

That’s why I’m working with you to prevent or cut down on psychotic relapses. Does that make sense to you?

End

I really like the broken leg/psychosis metaphor. I use a shortened version of the above script a fair bit at work, and people usually respond well to it. I’m very grateful to Greg Holland for introducing the analogy to me. It’s a good metaphor that I hope that others will find useful to use/adapt in their clinical practice too.

As always, your feedback is welcome in the comments section below.

Paul McNamara, 17th November 2016

Short URL: meta4RN.com/leg