|INTERVIEWING TIP OF THE MONTH
# 101 July 2008
Helping Patients Who Have AIDS Cope With Demoralization
TISA Description of the Problem: As we continue moving through the year 2008, we have a very special series of "Tips of the Month." In 2007 our TISA website was honored by having the following article, "My Favorite Tips from the Interviewing Tip of the Month Archive" published in the Psychiatric Clinics of North America (Shea, SC: Psychiatric Clinics of North America, June 2007,Vol 30:#2, 219-225). The tips in this article all appeared on this website. During the first eight months of 2008 they will now be re-posted with some additional comments - exactly as they appeared in the journal. Congratulations to all of the contributors whose tips were chosen as the very best! Let us now look at our seventh tip from the article.
For patients who have AIDS every day presents a multitude of difficult situations, all of which can lead to demoralization and/or depression. One demoralizing topic that does not always receive the attention it deserves is the huge psychological hurdle of having to take 14 or 15 pills three or four times a day. It is not an exaggeration to say that some of these pills are the size of "horse pills". Many of these patients must, literally, gag them down. In addition, the pills come to symbolize for some AIDS patients not that they are beating their disease but serve as reminders that they are "diseased".
Along these lines, the following tip, by Edward Hamaty, D.O., was offered to me in a recent workshop on improving medication interest. Let's see how Dr. Hamaty puts it all together with a population - AIDS patients - that he has specialized in helping.
Tip: As the pills become more and more problematic, patients begin to anticipate the unpleasantness of the upcoming pill taking. In essence, they begin to "play a tape" that sounds something like, "Oh God, not this again" or "I can't take this anymore". I have found that by working with the patient to come up with a concrete affirmation to say to themselves as they take their medications, this "tape" can be re-recorded into something much more comforting and inspiring.
For example, let us say the patient has a powerful desire to continue to live to be there for his or her grandchild, the patient may repeat the following affirmation, "This is for my grandchild."
Or let us assume that a patient gains a sense of satisfaction that he or she is battling back the AIDS virus, then the following simple affirmation may function almost like a personal act of releasing defiance, "Take that!"
Each aphorism must be generated by the patient and have unique meaning to the patient. For instance, if the patient is suffering from intractable pain, as he or she takes his pain medication the patient may say, directed towards the pain, "Not today you won't."
TISA Follow-up: These are great tips from Dr. Hamaty, and the range of affirmations is only limited by the imaginations and unique qualities of each patient. In essence, the range is essentially limitless.
I am finding these techniques to be very effective with certain patients dealing with psychiatric disorders. For instance, many of my younger patients with OCD find it re-affirming to say something like the following: "This one is for you OCD, I'm gonna kick your butt today." Such affirmations externalize the disease so that the patient does not view himself or herself as the problem while focusing the patient on his or her ability to control the OCD symptoms, frequently using CBT techniques as well.
Tip provided by:
Edward Hamaty, DO
Pulmonologist, General Hospitalist
Voorhees, New Jersey