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ss nucleus - autumn 1997,  Doctor as counsellor

Doctor as counsellor

This article is a resume of a seminar given at a recent CMF Student Conference. The seminar was run three times with over 100 students attending in all. Of those attending the seminar, only five indicated that they had any training in counselling or communication skills within their professional setting. It would appear that most Doctors learn counselling and communication skills 'on the job'. The purpose of this article is not only to review counselling and communication as a Doctor, but also its relevance in communicating and reflecting the love of Jesus Christ within a professional setting.


Communication can be seen as conveying facts or information, but genuine communication is always seen in the light of a relationship. Good communication in a Doctor-Patient relationship requires trust, acceptance and understanding.

The tone of voice and the body language expressed within this relationship may communicate a lot more than the words themselves. Many writers have indicated that the body language itself is over 50% of communicating and this is why it is important to meet somebody if you want to find out what is going on, to see their facial expressions. Whilst some accomplished speakers can give false impressions through body language and tone of voice, for the majority of people it is totally involuntary. Professionals who want to treat their clients properly need to know what they are saying and what they feel, which involves developing both listening and observational skills.

Types of listening skills

  • Reflective. This involves listening to what the patient has said and reflecting it back to them in their own words. This shows that you have understood what they have said and if you haven't, they quickly correct you.
  • Listening for Feelings. If you are to treat the whole person, feelings are as important as facts. It is therefore important to train your ear to' hear ' the feelings behind the facts volunteered.
  • Listening for Words. Many people do not listen well and are tuning in to other thoughts and distractions in the room. Proper listening requires focused attention on the person's face, correct posture and the showing of interest. This shows an attitude of caring which is, sadly, disappearing from medicine.
  • Body Language. The position of your hands around your face, how people sit in a chair, fidgeting etc., show a lot about a person at first glance. One can often detect whether a person is lying, whether they are uncomfortable or threatened or are showing large amounts of anxiety and depression by some limited knowledge of body language and so this aspect of communication is important on both sides of the Doctor-Patient relationship.

Definition of counselling

All Doctors are counsellors at one level or another. Counselling involves encouraging, exalting and enlightening and to be a good counsellor a doctor needs all three of these skills. Encouragement is probably the hardest skill and ranges from being a good listener, showing empathy and esteeming each individual as unique and of equal value in the sight of God. It requires having faith and optimism, even in the midst of difficult circumstances, and seeing beyond the person to the disease. Exalting comes easily to most Doctors, telling patients what they should do and how they should behave.

Enlightenment involves explaining to patients exactly what is going on- their diagnosis, treatment and informing of choices and options.

When I trained in medicine in 1970 to 1975, the clear teaching of many professionals was not to focus on people but their problems. Physical problems went to the Doctor/Specialist, emotional problems went to the Psychiatrist and spiritual problems went to the Priest or Vicar. Whilst this gave clear boundaries and security to the Doctor this artificial division was often very unsatisfactory to the patient. A number of articles have been published over the past 10 years viewing the importance of both patient's and Doctor's beliefs and personalities in the healing process and the interactions between a person's spiritual emotional and physical well-being. Many of the alternative forms of Medicine have made use of this holistic approach to good effect.

The biblical view of man is that of a whole person, the soul, spirit and body which are all closely inter-related. A disease in the spirit can, therefore, affect physical well-being and vice versa. This was particularly true in the life and ministry of Jesus and is present in Hebrew thoughts expressed in the Bible. However, one has to be careful in directly linking cause and effect, as seen in Jesus' reply to his disciples when they questioned him about the origin of the sin in the blind boy ( John 9: 1-3). When God created man and woman, he created them in His image and each aspect of a person - body, soul and spirit are important to him. This fact will help us to understand a patient more fully as we counsel them.

The soul involves our thinking, will and emotions. Our emotions are never seen in a vacuum but are always a result of an external event and resultant thoughts as this is processed through our individual beliefs and value systems. The event does not matter as much as its meaning to an individual. Negative words or events can have a positive reaction in some people but be totally devastating to others, depending upon their inner beliefs and values. A refusal to speak to somebody because you are so busy may be seen as a personal rejection to someone who has suffered with rejection for all of their life whereas it may be interpreted positively by a person who finds value in performance.

The Spirit of Man is that part which makes people different to animals and that which reflects God. God gave man spiritual abilities and spiritual needs which are; the need for security, self-worth and significance. These spiritual abilities and needs were seen in Jesus and were totally fulfilled in His relationship with the Father.

False gods

A key to counselling is to recognize that many people do not have their spiritual needs met in a relationship with God but in other religions, possessions, jobs, hobbies or relationships etc. When a person's spiritual needs are met in these things there is a general sense of well-being until the security is removed, leading to anxiety and depression. For example, a person may experience severe depression and anxiety when their job is lost or they are unable to fulfil their job role, and when their sole security, self-worth and significance was rooted there. An example of this was a gentleman who came to see me feeling very depressed and he did not know why; he had a very happy marriage, he had children, a nice house, a good car and he had just been promoted at work. He could not find out why he was becoming more and more depressed. Remembering that change can often be a trigger for anxiety or depression, I asked him what had happened. He told me that he used to work on the shop floor as a Production Engineer. His production was so good that his boss and supervisors were very pleased with him; he got a lot of reward for doing good jobs, a lot of encouragement and a lot of positive feedback. He had done so well that they promoted him to being Supervisor over 20 people. Subsequently he did not produce to his usual standard, and found himself bribing his friends with gifts, staying late to catch up on their work and, of course, if production was not met, instead of praise he received criticism. Because his value was so much in his doing and because he no longer received the input and satisfaction from his doing, he became depressed. The Christian solution to this is to try and find value and worth in God, not in your doing. This particular gentleman returned to working as an ordinary factory Production Engineer and his problems resolved.

When a person becomes a Christian, the Bible teaches us that the Holy Spirit comes and dwells in that person ( Ephesians 2:22). Their spiritual needs for security, love, value and purpose are now met in God. Their security is founded in the knowledge of God as their loving, Heavenly Father who cares for his children ( Psalm 23 is a good example), their self-worth comes from knowing that God's love is unconditional for them ( as demonstrated by the sacrifice of his Son on the cross), and their significance is founded on knowing that God has a perfect plan for their life, ( Psalm 139:16). However, if parents have not done a good job, they often have a different set of beliefs and values which were laid down in the past. The role of a Christian Counsellor is to enable their new spiritual values and beliefs to become part of their soul life. Anxiety and depression can, therefore, be a tool which caring professionals can use to point out a person's need for God in their life and as a possible solution to their problems. This can be an effective method of communicating spiritual things to others. When patients present with unmet needs, it is a wonderful opportunity for all Christian Doctors to share how needs can be met in God. For a Christian Doctor to be a good counsellor who is able to listen, empathize and advise in a professional context, knowledge and skills are required in order to care for the whole person physically, emotionally and spiritually. It is vital that we learn to adopt the skills of counselling and communication to help us show the love of Christ and the wholeness which can only be found in him.

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