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Fitzgerald Health Education Associates, Inc.

Resource 14-1: Stuart and Lieberman’s “15-minute-” method of primary care counseling

Applying the BATHE model is helpful in framing the problem and forming a therapeutic relationship and directing intervention. Developed by Stuart and Lieberman, this model provides a guide for gathering information while helping the patient reflect on the issues at hand. The components of the model are as follows. . BATHE o B- Background . How are things at home? At work? Has anything changed? Good or bad? Anything you wish would change? o A- Affect, anxiety . How do you feel about home life? Work? School? Life in general? o T- Trouble . What worries you the most? How stressed are you about this problem? o H- Handling . How are you handling the problems in your life? How much support do you get at home/ work? Who gives you support in dealing with problems? o E- Empathy . "That sounds difficult." . You might want to add soap to the BATHE. o S- Support . Normalize problems, but do not minimize. . "Many people struggle with the same (similar) problem." . "What supports/ resources can you use to help deal with this?"  Some providers may use select self-disclosure for this. Self-disclosure usually works best in crises that are common and not of unusually tragic proportions, such as timely death, job change, etc.

85 Flagship Drive VM  978  794  8366 email  [email protected] North Andover, MA 01845-6154 FAX  978  794  2455 Internet  http://www.fhea.com  Page 2

o O- Objectivity . your reactions to the story. Maintain your professional composure without acting stone-like, but be mindful of "recoiling" gestures. . Help client with objectivity.  “What is the worst thing that can happen?”  “How likely is that?”  “Then what would happen?” o A- Acceptance . Coach the client to personal acceptance.  "That is an understandable way to feel."  "I think you have done well considering the stress.”  "I wonder if you are not being too hard on yourself." o Acknowledge client priorities. . "It sounds like family is more important to you than your work." o Acknowledge readiness/ difficulty in making change. . “Change is hard and sometimes very scary." . “It sounds to me like you are (not) ready to make a change." o P- focus . Assist client in focusing on the present, without minimizing concerns of the and . . “How could you cope better?” . “What could you do differently?” . What to do after you have gathered this information o Negotiate a problem-focused contract for behavioral change. . Repeat after me," I promise not to harm myself or anyone else in any way between now and my next visit with ." o Homework assignment with "I" messages. . "I would like more help with the children." . “I feel really unimportant to you when ." . "I feel angry when ." . How do you keep this to 15 minutes? o Focus the client, using open and close-ended questions. Tell client how much you have, particularly with revisit. . “We have (fill in the blank) minutes to chat. What would you like to focus on?” . If client cannot focus, ask, "If one problem in your life could just disappear, what would you choose?" Source- Stuart, M., Lieberman, J. (2002) The 15-minute hour: Practical therapeutic intervention in primary care (3d. ed.). Philadelphia: W.B. Saunders, Inc.

85 Flagship Drive VM  978  794  8366 email  [email protected] North Andover, MA 01845-6154 FAX  978  794  2455 Internet  http://www.fhea.com ©Fitzgerald Health Education Associates, Inc.