Handling the “people pleaser” patient

I'll be honest with you. There's a certain type of patient that for a long time I really struggled with and used to frustrate me a bit. And it's probably not the kind of person you think. So I'll talk through why that was and how I learned to build better rapport with them in just a moment. But first of all, I want to set the scene a little bit. Imagine you have a patient walking into your rooms, maybe the first time you've met them. And they're coming in, they've greeted you, you know, they've made good eye contact, they've walked in, they come in, they sit down, you invite them to talk about whatever it was they want to talk about. And this is somebody who maybe sits back. They're not very upright. They tend to be a little bit more relaxed. They're not leaning in and they're not using a lot of gestures. They're not really high energy like that. And when they talk, they tend to talk a little bit slower. They tend to talk a little bit quieter as well. And they often talk about, you know, subjective things, the things that they're feeling. And maybe once you get to know them a little bit, they start to ask you questions. If you've got a patient especially who fits that criteria and then is asking how you are, what you were up to on the weekend, 95% of the time you have a patient who has an amiable style in front of you. And the amiable style on the surface can seem like a great patient because they're friendly, they will let you talk, they'll listen to what you have to say, they're keen to be a good patient, they tend to follow the advice there. And they can seem very easy to get on with. And most of the time they'll generally stick with the plan. However, there's one thing that amiables do that used to really frustrate me. And in the social style model, this is known as their backup behavior. And backup behavior is the behavior that a certain style will resort to when they feel that their style need is not being met. And for amiable style, the style need is harmony. They need to feel that there's a good dynamic between you and you both get on. They need to feel that you're both happy with each other other if they feel like that might not be met, they're going to slip into their backup behavior, which is people pleasing and the amiable style. They're very, very attuned to other people's emotions. They're very attentive and they will be very worried about being a bad patient. So you might be getting on great, but then maybe you've asked them to do something they don't want to do, whether that is, you know, to come back more than they thought, whether that is to change their lifestyle. Maybe you're asking to do a bunch of exercises that they, they're really not confident doing. Their worry in that moment is that if they tell you, oh, I don't think I can do that, I don't know if I can do it, that you're going to think they're a bad patient and that's going to create judgment and disharmony. That's their big fear. So what they will do is they will people please. And in that moment, because they're afraid of conflict, they will take the easy option to go, okay, like they will say yes, they'll tell you what they think you want to hear and then they're going to go out, they're going to leave your room and they're not going to follow it. And that used to really frustrate me because I used to felt to be honest like I was maybe being lied to. I was felt like I was being misled, a little bit deceived. It's like you said you were fine with this and then you went out and didn't do it and then we have to have this chat and you're like, oh, you know, they have these kind of excuses or sometimes they leave them doubled. I go, oh no, I totally meant to, I will this time. And they don't. Now I'm not obviously coming to them very aggressively going, you said, but it would frustrate me. And the worst thing you can do with this type of patient is to express that frustration at them. So I'd have to bottle it up. But I'd go home just a bit annoyed if I'm honest, because I didn't understand the style. I didn't understand the social style model. I didn't understand why amiables were doing this. And I just thought that they were being a bit dishonest with me. Now I understand that, though I've worked really hard to understand what I can do to improve that. And there's three things I'll share with you when you have an amiable style patient that will help avoid this. The first one is never trust a yes. Now, that doesn't mean assume they're lying all the time, but if you recommend something, a course of action, maybe you've said okay. You know, for this case to get you better, I'd recommend you come in this many times over this many weeks. How does that sound? And they go, yes, don't believe them. It might be fine, but they may be people pleasing you because they don't want to disappoint or upset you. So I only trust the third. Yes. With these types. So I might say that at the start. And they go, yep, that's fine. I know I've got to bring this up and I've got to get confirmation again, so maybe I've gone through what treatment involved this sort of thing, and go. So that's the overall idea. And that's, like I've said, for best results, I'd recommend we see you this many times, this many weeks. You still happy with that? They might go, yes. Sometimes the cracks show because they don't like lying to you either. It's the easy option, the moment. But when you make them do it more, they start to get uncomfortable. So you might notice and be like, yeah, that's fine. There's maybe a little bit of pause, bit of body language that shows they're not totally open. They may be a little bit concerned or a bit unsure. And then at the end of the visit, I would go, right, so that's planned. This is what we did today, this is what we're going to do going forward. So if we go out and I'd recommend that we do this, this and this, are you still happy with that? Would you like to arrange that? Do you have any questions about doing some sort of question at the end? Not an order. And that's often where they'll go, I'm going to have to lie a third time. I don't like it. I'm not so sure. Could we maybe. Is there another option? I just. I don't know if I can do that. And in that moment, you'll get the honest answer. So that's step one is never trust the first or even the second. Yes. Get three yeses. Soon as they've done that, then you need to move on to step two, which is silence. And what I mean by silence is don't sit there awkwardly in silence staring at them, because they're going to feel very judged. But do not rush in to try and fill any silence that might occur. So if you're like me and you're very extroverted and quite talkative, your instinct will be to jump in halfway through, they've said no and reassure or explain or justify or go, ah, and I Used to do that. And you talk over them, they're very easy to talk over because they'll shut up and let you talk. And you actually can end up backing them into the corner that they just started coming out and go, okay, all right, that's fine, I'll do that. And again, they still won't. So do not rush in. Let them share it fully. Use a bit of silence. Don't be afraid for a couple of seconds to go by with neither of you saying anything. That silence is an invitation for them to say more and it's a sign that you're not rushing in with judgment, which they will be looking for because they're very afraid of that. So use that silence. And then the third thing is reflect back what they've shared with you. Whatever the concern, whatever the worry, whatever the confusion, whatever the question, whatever the uncertainty might be, reflect it back to them. This is really, really powerful for amiables because they really want to feel that connection. They feel that connection when they know you understand them. Non judgmentally and reflective listening is a very powerful way to do that, especially a complex reflection such as, for example, finishing the paragraph. Finishing the paragraph is where they may share something. You reflect back what they've said and you make a guess about what the next sentence might have been because it shows you understand them, not just the words they've said, but actually what's going on. At a deeper level. You can use things like tactical empathy and labeling that we've talked about before as well. Very, very powerful tools to show that you understand their experience. So if you can do that. So if you can not trust the first or second. Yes, ask three times to get the real truth of it. Be silent for a moment, don't jump in to correct it. And then when you have reflect back what you've heard in a non judgmental tone, that will go a huge way to calm you down. The aim, when they see, oh, I can share this problem, I can share this question, I can share this concern. Chris listened to me. He took the time to understand me and he showed me how well he's listened by showing me what he's heard. Oh, and look, he's not annoyed. Big reassurance for them. They calm down, they don't have to worry about avoiding the conflict. Their style needs getting met because they feel the connection with you again. And most importantly, they don't feel like they need to go back into the backup behavior and the people pleasing so you can have an honest conversation, one that leads to them feeling like they can trust you even more and you've got the reality, you've got the honest answer there. Do that with these patients, I promise you, not only will you get better results with them, but practice will get less frustrating as well. Since I started doing this, suddenly they make sense to me. I'm not going home frustrated. These patients who are misleading me or being dishonest, I'm just realizing how I can better meet their needs. Now, if that's useful and you'd like to learn more, I've got very cool announcement coming in a couple of days. I'm going to leave it right there, but keep an eye out for Thursday's email. I'm going to share something brand new that I'm offering for the first time that I think you're really, really going to enjoy. So keep an eye out for that. I'll see you soon for that one. Take care of.