A Wish List for goal directions

I’ve been posting about goal-setting, and mentioned the Wish List approach – today I can do the Big Reveal!

Thanks to my colleagues at PMC (who shall remain nameless!) I have attached a copy of the ways-i-want-my-life-to-change-wish-list that people can use at the very beginning of a programme to help identify the areas they want to influence by developing pain management coping skills.  It can be used instead of the menu I showed yesterday, or it can be used alongside it.

There are quite a lot of areas that people would like to change or learn about with regard to chronic pain, and this list isn’t designed to be exhaustive. It’s also not especially specific in terms of making measureable goals based on research into goal-setting that we’ve discussed a few days ago.

What it does do is give you, as the clinician, a really good idea of the sorts of needs the person has already identified. In terms of motivation or readiness for change, it can indicate areas that the person is already ‘contemplating’, or is even perhaps in ‘preparation’ for change. Prochaska and DiClemente’s model (oh yes, I’ve talked about this a LOT!) and work around this model clearly supports the finding that people need to be in the right space to even start to consider making changes.

If the person is never asked to consider an area that could change, though, it’s fairly difficult for them to actually decide that they would like it to be different, so part of our role is to help open up the possibility for change – and you can see this in the ‘Wish List’.

I use this Wish List at the very beginning of the programme, asking people to tick all the areas they would like to see changes in. Then after a week or so, I ask them to indicate their three most important ‘wishes’. Then we can start working on importance and confidence: why these areas are important (providing the person with the opportunity to reflect on how important it is to them, and uncovering personally-relevant values to support their change process), and how confident they are to achieve them. Once we’ve identified their level of confidence, it’s part of my work to help the person build the confidence to start taking steps towards achieving the changes they want to see in their lives.

To me, pain management is not simply about developing a set of new coping strategies that can be employed while the person continues on in their life. It’s much more about reconceptualising who they are: to move from a person who has become quite experienced at being a patient, and following other people’s requests or directions, into someone who has their own life to live, their own direction to follow and is becoming a person again.

This is why I feel quite frustrated with many self-help books, even for chronic pain, that are chock-full of new ways to cope, but leave the integration of these coping skills to the person.  Integrating new skills is critical for the skills to actually be used. If you’ve ever been to a workshop and come away with a whole set of new ideas – only two weeks later find yourself doing just what you’ve always done, you’ll know exactly what I mean!

In industrial and organisational psychology, a lot of research has been undertaken into ‘transfer of training’ – and things like ongoing support in different contexts, refresher courses, memory prompts, support from ‘important people’ (eg line managers in a factory) are all known to be both effective and almost essential before training can be implemented in a workplace. (For some good information on transfer of training, this site provides some good resources).

Now, start to think of how we as health providers, support transfer of skills developed in a clinic: how many of us get the support of the ‘important people’ in the person’s life to help them use the new skills? How often do we consider the network of relationships that are a part of an individual’s context? How could we help that person make the links between what we show them and what they can readily use in their own environment?

This is really important as far as developing pain management skills in the workplace goes. Without specific support to help someone use their skills, in the context of work where all the cues for old behaviour exist, it’s going to be very difficult for them to recall and do something different. Especially when they are perhaps not entirely convinced that this new way of working is helpful.

So while pain management itself is not about ‘personality makeover’, it is all about reconceptualising the person-as-patient into the-person-as-person. Without that essential ‘new belief’ the person will likely return to old habits.

Your challenge for today? What about taking some time to think about one method you could use to support someone to recall a skill that you are helping them develop? How could you transfer what they are starting to learn with you into their home or work situation – hey, even into their car!

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