Daniel Finkelman on Dentistry and Psychology
Daniel Finkelman (DMD, B.Sc. Psychology) was born 42 years ago in Israel, studied dentistry and psychology in Jerusalem and then moved to The Netherlands. He is currently the dentist and owner of The Hague Dental Care and recently launched the website TreatYourDentalFear.com, which was inspired by his experience on the DFC forum over the last 10 years. Our DFC volunteer Nikoleta Gehrmann travelled to The Hague to interview him.
Nikoleta Gehrmann: You have a dentistry degree but also a BSc in psychology. How come you decided to spend two more years studying psychology when you were already a dentist?
Daniel Finkelman: I always wanted to study psychology, from an early age on. Plus, I needed a break from dentistry. Between my third and fourth year in dental school I took a year’s break from teeth and went to study psychology. During that year, I came across Cognitive Behavioural Therapy and I said to myself “Wow, we can use that for anxiety”.
Even though I thought in the beginning that CBT can be a good solution for dental anxiety, these days I no longer believe that. There are some bits and pieces of CBT that can be used, but not the protocol as a whole. Later on, I came across other approaches and methods in psychology such as motivational interviewing, positive psychology, narrative psychology, mindfulness and others.
I remember very well one lecture with a very senior professor, during which this professor of psychology asked a simple question: “Why does psychology work?” There are all kinds of psychological theories and approaches, sometimes they even contradict one another, but still it looks as if they all more or less work. The answer apparently is that it is not about the therapy, but it is all about the therapist. As long as the therapist is knowledgeable, skilful and committed to the patient, therapy can take place. The important principle is to touch the problem in a safe and skilful way.
NG: What do you mean by touching the problem?
DF: I see myself as a coach, not a psychologist, who helps dental phobic patients go through dental experiences. My job is to lessen their anxiety throughout the appointment, mainly when facing something they are extremely afraid of, for example injections or the drill. My goal is that right after the difficult procedure, the patients will say to themselves that it might have been challenging at first but still went well.
NG: Because otherwise there’s no learning effect for the patient?
DF: Yeah, it’s learning effect, it’s also a self-belief effect and it’s also opening up to the possibility that dental treatment can be different. It’s also trusting that specific dentist. It is so important in many ways. There is a challenge and they manage it.
NG: When did you decide to work with nervous patients and why?
DF: In student years, right from the beginning, I had some very positive experiences as a student where I managed very fearful patients, that gave me the motivation to explore more. On a personal level I think I’m very empathetic to someone in distress. I also felt like I never wanted to do only teeth, there was something bigger. Plus people usually find my voice calming.
NG: That’s right, you really do have a very calming, soothing voice, this must be very useful during treatment.
DF: Voice is a very good tool for the dentist during treatment. It’s not only the calmness, there are other things a dentist can do with his voice. For example, people are sensitive to changes in voice so you can start, not a high volume, but a bit more tense and slowly come down, for example when giving the injection and I count till ten or sometimes from ten to one. I start with a little bit more of an affirmative voice and then soften down. It’s not the volume, but the tone. It’s a suggestion and I think it works well, especially with kids.
NG: What is the difference between dealing with nervous adults and nervous children?
DF: You can’t reason with children. CBT is considered effective with specific phobias which are not really realistic. You know, most airplanes land well, so through reasoning you can counter the fear with logical thinking. However, CBT is less effective when it comes to dental phobia because in most cases the fear is realistic, there is a chance that you may feel discomfort during treatment. With an adult you can still use logic to counter the fear. With kids it is even more difficult.
NG: If you have a kid and you show them the tool and they take it and then try it on a nail, isn’t this CBT?
DF: Tell-Show-Do? Sometimes I do, sometimes I don’t. Tell-Show-Do or any gradual exposure is not always needed. The real thing is to put the sharp instrument touching the hard enamel and then ask how does it feel and whether it is OK or not, that’s where therapy starts. The gradual exposure is only one means of getting to the real deal.
NG: Tell me about how you first came across Dental Fear Central?
DF: My wife introduced me to it. When I met my wife, she knew I wanted to go into a video project for fearful people, that was eight years ago. And she really encouraged me. It took me a long time to find what I wanted to say in a video but once I saw DFC I said this is it, this is what I need.
NG: You were around a lot and then had a longer break.
DF: Yeah, I never left, DFC is something that I am committed to but if my private life doesn’t allow me, I take a break and come back later. It is very important for me not to burn out. I do try to be fully attentive to each thread and then if I don’t have the capacity for that, I simply stop. It’s also, you know, a very nice place for me to get acquainted with many fearful patients. I learned a lot, for example: there is an assumption that dental fear is an acquired kind of phobia, nobody is born with fear of the dentist. I don’t believe this is always the case, mainly because of what I read in the DCF forum.
NG: How do you determine whether someone is nervous or not if they do not disclose it to you? What are the signs you watch for?
DF: I don’t determine. I market myself as a specialist for dental anxiety so I am committed to every patient. I am always gentle with all my patients. I also give the person a chance to feel comfortable to be themselves.
NG: What do you think is the biggest challenge for a dentist when it comes to treating nervous patients?
DF: I think that the biggest problem not only in dentistry but in the entire medical world is that these days everything is protocolised, legally protective and business oriented, of course in the name of efficiency and seemingly professionalism. As a result you get this distance between the patient and the caregiver.
When most dentists treat fearful patients, they tend to follow a certain protocol. It is faster and more definitive. Most dentists cannot invest the time and effort in getting to know the patient and together find a way to counter the fear. Having said that, I know plenty dentists who gladly do.
NG: What do you think are some of the mistakes that nervous patients make when trying to tackle their fear?
DF: Avoidance is the number one problem. After years of not going to the dentist they have a specific notion about the dentist and they are less open to a new experience. When patients say that they are afraid of a painful injection, I always ask them to give me a chance and pay attention to what they really feel and not to what they think might come – they might be pleasantly surprised…
NG: Dentistry involves a lot of routine and nervous patients can all seem the same sometimes, as they have similar stories. How do you make sure to stay sensitive and awake and treat every nervous patient with the fresh attention they deserve?
DF: For me the biggest challenge is a physical one. I need to be fit in order to contain the patient’s difficulty. Then there is also the ego thing: you need to remind yourself to be modest and open to the individual patient. I am also very much against tagging patients. When you label someone, you narrow them down and you miss the person.
NG: Aren’t you curious sometimes about what is happening in the minds of your patients?
DF: It’s a black box to me. You never know what is happening in the other’s mind. That’s what keeps us human.
Date of Publication: 27 December 2018