Fitzgerald Health Education Associates, Inc. Resource 14-1: Stuart and Lieberman’s “15-minute-hour” 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 . Watch 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- Present focus . Assist client in focusing on the present, without minimizing concerns of the past and future. “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 time 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. .