ABSTRACT
Illness or accidents exacerbate chronic conditions, and sickness is often triggered by psychosocial stress; therefore, this chapter reinforces the importance of routinely applying BATHE. Patients’ stories must be heard and reflected back with empathy before their limits are challenged. A therapeutic contract is a commitment to work with the patient for a specific period of time. The finite number of sessions suggests that the problem is solvable. Patients are assigned homework and report during regular visits. Even in difficult situations, there are options. Patients learn to consider the consequences of different choices, apply “tincture of time,” or decide not to decide. Incremental steps are effective in promoting change and enhancing competence. Small wins combat patients’ sense of being overwhelmed. Patients generally feel guilty about the past and anxious about the future, so focusing them in the present and engaged in active problem solving are therapeutic. A three-step approach to problem solving involves asking what the patient is feeling, what the patient wants, and what the patient can do to maximize the likelihood of getting that result. Expressing confidence in the patient’s ability to handle things makes the patient feel supported and able to function in a healthier mode.
