The “Why” Behind the Hesitancy

“. . .the Yule log and Christmas candle were regularly burnt, and the mistletoe, with its white berries, hung up, to the imminent peril of all the pretty housemaids.”

Washington Irving
“Christmas Eve” from Old Christmas

The “Why” Behind the Hesitancy

TISA Description of the Problem: During the course of an initial assessment, we will often encounter moments in which a client feels hesitant to share information. With a little afterthought it can be seen that many psychological issues and concerns may prompt these hesitancies. In the following excellent clinical interviewing tip, Martha Rhoades, M. D. describes a method of ensuring that these hesitancies may not become clinical gremlins in the future.

Tip: After I have successfully uncovered sensitive material such as suicide, I find that it is useful to try to gain a better understanding of the patient’s hesitancies in case they may arise again in future sessions or even in the same interview itself. I might have some immediate assumptions as to the root of the hesitancies, but these may be wrong, for each person remains unique. Better to know the real person than my assumption of who he or she might be. In this regard, at some point I may say something along the following lines:

“When we were talking earlier about some of your suicidal thoughts, I noticed you seemed a little hesitant to share some of them. That is totally normal. Many times people have things that feel private and are tough to share, but it really helps me to help you if we can share openly. I genuinely want to know what some of your concerns about sharing your thoughts on suicide are, because I don’t want anything to get in the way of our being able to talk openly about any suicidal thoughts or anything for that matter in the future. What did you think might happen if you shared too much about your suicidal thoughts?”

TISA Follow-up: This is a practical clinical interviewing tip that can be of use frequently. It is not limited to inquiries on suicide. It can follow discussions on domestic violence, substance abuse, financial concerns or anything that may prove to be sensitive or taboo material. A gentle retrospective exploration of the patient’s hesitancies on sharing material, that is normally kept private, often can be nicely addressed at the end of the interview during the closing phase. As professionals we become so used to exploring sensitive and private material upon first meeting an individual, that it is easy to forget that such sharing is unusual in normal day to day functioning and can feel quite odd to clients, for, in reality, it is breaking social norms.

Tip provided by:

Martha Rhoades, M.D
Billings Clinic Behavioral Health
Adult Psychiatry