Behavior change: Is empathy enough for Physical Therapists to help?

Of course, empathy is an essential component when working with patients.

Clients and patients come to physical therapists, and in many cases, during times of heightened or peak stress and hopelessness. As a coach and clinician, you will have to harness your ability to understand and share the feelings of the person in front of you.

Can you count how many patients you’ve worked with that don’t exercise at all? How many of them have said, “I know I need to exercise more, but I just can’t seem to find the time.”

This is when the alarm bells should be ringing.

But, is that enough to help motivate somebody to change their life for the better?

Have you been in a situation where a patient or client expresses a desire to eat better, sleep better, or exercise more? How do you handle that?

Can you count how many patients you’ve worked with that don’t exercise at all? How many of them have said, “I know I need to exercise more, but I just can’t seem to find the time.” 

This is when the alarm bells should be ringing. I believe that every clinician and physical therapist should be able to hear this and deploy some form of behavior change coaching. 

In the book, Switch: How to Change Things When Change is Hard, Chip & Dan Heath discuss how the conventional wisdom in psychology is that the brain has two independent systems at work at all times. 

The Elephant & Elephant Rider

There’s the emotional side and the rational side. The first half, the emotional side, is instinctive and feels pain/pleasure. The rational side is reflective and conscious. This side deliberates, analyzes, and looks into the future. 

This is an important concept to understand in the context of behavior change especially because these two sides of the brain are often like two stags fighting. There's a constant tension between these two when it comes to change. 

Chip and Dan Heath describe human behavior and cognition as being like "a person," the one in control with logic and reason, on top of "an elephant," a massive, strong, powerful, and primal emotional brain. 

The authors also describe, "the path" where the elephant walks as the environment which constrains the elephant's actions - often without the elephant realizing it.

The person riding the elephant wants to stay on this path. 

Picture a massive emotional elephant that doesn't always listen or do what the rider asks. When the rider and elephant are at odds, the elephant will rarely stay on the path. 

The path is the environment that shapes perspectives and behavior. This environment includes social, cultural, intellectual, and physical.

If you can shape the path or change the environment, you can change behavior almost seamlessly. 

A straightforward example, let's say Joe can't stop mindlessly eating the peanut M&Ms that are on a hallway table in his home. He passes by this table in the hallway to and from the kitchen. I realize now this is quite literally a path example. His two choices are to take an alternate route, or he can move the peanut M&Ms bowl. Notice I didn't say remove the container altogether. You don't need to change the path completely. Sometimes altering the path slightly will be enough to make an impact. Joe moved the peanut M&Ms to a table in the dining room, where he spends considerably less time. 

So, merely having empathy and understanding someone's feelings is not enough to shape the path. 

A change to the environment doesn't require much investment from the rider and zero effort from the elephant. Thus decision fatigue and the bulldozing emotional elephant will walk down the path.