Repeat After Me

I was just listening to the Slate Political Gabfest, The “I Expect Loyalty”Edition Live from Denver, Colorado, this evening. One of the guests was Colorado Governor John Hickenlooper, who was at one point in the conversation talking about dealing with people who get very upset for various reasons. He was using the example of getting upset when visiting a restaurant. His take on this, and his espoused method of dealing with it, was to look directly at the person, listen to what they have to say, and then repeat exactly that back to them, multiple times, over and over again. His reasoning was that when the person heard what they were saying reflected back to them many times over, they would fairly quickly come back to their usual, more calm ways of processing things on a more rational basis.

I have had similar experiences in the past, most recently a few weeks ago when I was working my emergency department  telepsychiatry job. I was asked to see a young male who had threatened suicide, who was thought to be very depressed, and who was quite agitated and hostile with the staff who were trying to help him. I introduced myself, we talked, and then we got to the point in the interview when I wanted to get an idea from him what he thought would help him regain control, get better, and be allowed to leave the ED.

Almost immediately he got quite angry and hostile, drew nearer the screen, glared at me with unblinking eyes, and began to shout how he did not want to take any medications, using a few choice words just to make sure I understood his seriousness. I countered with medications that might be better tolerated, that he might get some benefit from, my usual drill. He became more and more hostile, fuming at me and getting more red-faced by the minute.

Then, the “Hickenlooper Principle” hit me. I understood what I should by all rights have picked up on many minutes earlier.

“So, I hear you now, loud and clear. You don’t want to take any medicine.”

“No! No! I don’t want to take any g–d—-d medication!”

“I can hear that now, You really don’t want to take any antidepressants or any other medication.”

“Damn right I don’t. I was stuck in prison for three years and they pumped me full of that crap and I had no choice and I don’t want to take no f—–g medicine!”

“So, I hear you. No medicine. No medicine, okay. ”

Like magic, he visibly relaxed. He sat back from his close encounter with the monitor and camera and cocked his head just the slightest bit at me, like he was hearing a far away, high pitched whine that no one else could hear.

I waited thirty more seconds.

“So, no medication then. Good. Now, what do you think might help you get better enough that you could get out of here and go home?”

A completely different conversation ensued.

I think Governor Hickenlooper is right. Sometime, simply stating and restating what an angry or hostile or upset or frightened person says to you is enough to defuse the situation, just enough so that something more productive can be said.

Have you ever been in one of these confrontational situations?

Might you handle it differently the next time?

 

 

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6 thoughts on “Repeat After Me

  1. Oh boy, could I ever benefit at work from that technique! I must somehow get that in my muscle memory. Great blog. Thank you!

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  2. Good post! Yep, I used that approach in psychiatry. Many patients hate the side effects of medicine. Once you agree with them, they can be approached with other ways for treatment to get in control. Sometimes, after calming down they’ll listen to the benefits of a new medication that other patients have found helpful. Have a peaceful weekend! 🌺🎶 Christine

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