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Last week, I discussed why information does not typically lead to transformation. and how the over-emphasis on content knowledge.

I alluded to our over-emphasis on content knowledge over relational knowledge.

So why can’t we just focus more on improving the way we relate, communicate and converse?

One of the reasons I suspect is because, deeply embedded in the way we were trained to think, we have inadvertently become “explainaholics.”[1]

In an interview with hosted by economist, Tyler Cowen, surgeon and writer Atul Gawande talked about his pitfall that we share. Tyler asked him, The famous late 19th-century doctor, William Osler once said: ‘Look wise, say nothing, and grunt. Speech was given to conceal thought.’ True or false?”

 “False, but there’s a grain of truth. One of the things that I learned in writing my last book, Being Mortal, was talking to palliative care clinicians and geriatricians and others who really have a different kind of approach to practice. Examining the way I practice, what they would say I do is talk too much, and as one put it, ‘Your problem, Atul, is that you’re an explainaholic.'”


Gawande elaborates:

“Our model of what a clinician does is that they are Dr. Informative. They give you data about what condition you have, data about the options. Here are the option A, option B, option C. Risks, benefits, pros, cons, and now what would you like to do? It’s a conversation where we do 95 percent of the talking, and then the patient does 5 percent.
What they point out is that they, the clinicians of the future, really need to be oriented in a counselor mode, where they are not just telling you what the options are, but also eliciting from you very clearly what your goals are, and then making a recommendation about what most matches your goals. What are your priorities for your quality of life as well as quantity of life? People have priorities besides mere survival.

When we don’t ask and don’t know how to ask what those priorities are, the treatment is often mismatched with those priorities, and that’s where you get suffering, and that’s where you get lots of hot air from doctors, and you have total misalignment. When you are able to elicit those goals and then align the care with it, you have massively better outcomes, both for quantity and quality of life.”

Gawande could have easily be talking about our field of psychotherapy and not medicine.

Curing Explanaholism

There is a process of undoing that I believe we need to undertake. Clinical supervisors and therapists need to do less “talking about,” “case formulation” and “theorizing,” and do more of systematically monitoring the improvement of clients’ wellbeing, “analysing the game,” and comprehending the impact of our therapeutic efforts.

We need to hold our therapeutic persuasions lightly, and listen first to our client’s worldview and beliefs. When we do, we are then able to listen to the person into speech.

The poet David Whyte has an apt way of putting it, “There is a conversation nature of reality.” When we move closer towards cultivating better conversations, we are able to move beyond explanations, and pass the threshold into the possibilities of shaping a new experience.

2 Responses

  1. Wonderful piece Daryl. It resonates with so Manu cases I have at the moment!

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