A Question of Trust
Why do some clients hold back the info we need to help them?
For many years I took for granted that the personal information I was asking of clients was a lot to hand over to someone they’d never met before. While most of us have had to undress for medical doctors or nurses for physical examinations, the poking and prodding they do can be easier for some patients than revealing their fears.
Historically, I’ve had very good success getting the information I need to help my clients. As a clinical nutritionist, about 99% of the information I gather from clients is obtained from a combo of their initial intake forms and the conversations we have face-to-face. I can count on just a few fingers the individuals who initially denied me what I needed to know. Here are two of them.
Helene refused to complete my health questionnaire in full. At the time I was using a lengthy but detailed form called the Nutri-Body Questionnaire, which was about 18 pages. The reason it was so lengthy was that many of the questions were repetitive as they were asked in the context of different health concerns and nutrient deficiencies. For example, the client was asked to rate their ‘fatigue’ according to frequency and severity using a number system, between 0 and 3. Most of the symptoms were physical (“bleeding gums”, “migraine headaches”, “constipation”, “diarrhea”, etc.), but some related to emotions. The client would also rate themselves on this scale for “anger”, “anxiety”, “depression”, etc.
Helene was one of the first few clients who I asked to complete the Nutri-Body. When Helene handed it back to me at our first session, I was surprised to find that many sections were left completely blank. Now, Helene was an elderly lady. I thought perhaps she had overlooked sections or paused with the intention to return and complete them, but she had simply forgotten. So when I questioned Helene, her answer surprised me. “Many of the questions I find very personal”, she explained, an edge to her voice.
Immediately I assumed she meant that reporting the quality of her bowel movements was uncomfortable for her. I reassured her that I was very comfortable with this information as it provided insights into her health. However, it wasn’t that at all, she said. She was talking about the questions that related to emotions. How interesting, I thought. Here’s an example of a person who doesn’t see the relationship between how she feels emotionally and how she feels physically.
Recognizing I wasn’t a psychotherapist, Helene did not expect me to link the two together. Yet this is one of the tenets of holistic nutrition practice: recognizing the connections between body, mind and spirit. Understanding that this door was “locked”, I did not push Helene to share her emotions with me at this early stage, and I had no choice but to focus on her physical symptoms and her diet. She was relatively compliant, but her health goals were vague and we didn’t get the results we could have had she been more forthcoming about her emotional burden, whatever that was.
Sometimes when a client withholds information it’s due to an undisclosed fear.
Bertrand was a man in his late sixties who’d recently had a stroke. The stroke had left him partially paralyzed for a month or so. As he regained feeling in that side of his body, he explained, he had developed chronic nerve pain that made daily life very taxing for him. He had also developed constipation, which added to his woes.
After a detailed 10 minute verbal health history given voluntarily by Bertrand, he stopped talking and asked me if I could help him. At this point, I asked him if he had had a chance to complete the initial intake forms, because he hadn’t given me any yet. Bertrand said something like, ‘but I just told you everything you need to know. Besides, how do I know I can trust you with my health information?”
This was a first for me. I sensed there was something Bertrand did not want to become public knowledge. But I was not the public; I was a health practitioner. I questioned Bertrand gently about what was stopping him from trusting me with his written health information. And guess what? He said, “Listen; I have narcotics in my home that I take for my pain management. I can’t have someone breaking into my house looking for them!”
I spent the next few minutes reassuring Bertrand and his wife of the confidential nature of my client work and how I took privacy very seriously. My computer had a password to access any files. My physical filing cabinet had a lock to which I only had the key. I’d never had a ‘security breach’ yet, and I endeavored to keep it that way.
Bertrand and his wife and I sat in silence for the next few seconds. It felt like minutes! I waited patiently in suspense. One of two things will happen next, I thought. Bertrand would tell me he was leaving and not coming back, or that he was leaving to fill out the forms and would reschedule. But what did happen next surprised me.
Finally, Bertrand turned to his wife, and ordered, “Give her the forms”. Dutifully, his wife reached into her bag and produced a set of fully completed intake forms! With relief, I thanked the couple profusely and said that now we could begin.
What had happened in those seconds to help Bertrand make this decision? Did he suddenly realize I was nice (unlikely, after just a few minutes)? Trustworthy (after a description of my office privacy measures)? I don’t think it was either of these things. It was something simpler:
I think Bertrand decided he really needed my help.
From that point on, Bertrand was co-operative and compliant with the recommendations I made. We even got his bowels moving more often with an increase in fiber, water and magnesium supplementation.
Nothing inspires more trust than getting results with the advice given. But clients need to understand we don’t have x-ray vision or ESP when it comes to their health. Without the information and co-operation we request of them, practitioners can’t give them personalized advice.