Model of the Iatrosedative Interview
A simple four step model of the above strategy is:
1. Recognizing and acknowledging the problem
2. Exploring and identifying the problem
3. Explaining (your interpretation of) the problem
4. Offering a solution to the problem (commitment)
The following is a brief explanation of each of these steps:
1. Recognizing and acknowledging the problem:
To respond both non-verbally and verbally to the expression of fear, in a way as to communicate understanding and acceptance of the fear and the intent to explore the problem in order to help. The dentist may say, “I’m sorry, this must be difficult for you. Let’s look at this first because we can do something about it.” This is a crucial point – a sort of “moment of truth”.
Fearful patients are very perceptive and sensitive to a dentist’s behavior. If the doctor feels threatened by the fear either because he does not know how to deal with it or does not want to, he is apt to communicate the message [nonverbally]. This will either intensify the fear or terminate the relationship.
2. Exploring and identifying the problem:
To gather information through the use of questioning and facilitation skills in order to determine:
- The specific fear and its intensity
- The origin of the fear
- The behavior of the doctor(s) or authoritative figure(s) that may have been involved if traumatic conditioning had occurred. This usually is revealed with the origin.
Determining the specific fear and its origin enables the doctor to offer a specific solution and aids in formulating a plan of effective behavior. The goals of giving information are:
3. Explaining (your interpretation of) the problem:
To provide feedback of the information gathered in order to validate it and to explain:
- How the fear is learned. Some fears, although on a conscious level, are not apparent to the patient and require explanation and interpretation. An example will follow.
- The specific fear and associated fears of helplessness, dependency and the unknown leading to some discussion of control.
- Patients have the ability to unlearn the sense of danger and relearn a sense of safety.
- With supportive statements that other patients with similar problems have relearned.
4. Offering a solution to the problem (commitment):
To provide a commitment through explaining:
- How the doctor will perform the procedure that is feared.
- The kind of behavior the patient can expect from the doctor, for example:
- Offer of control so that the treatment will be stopped if the patient feels threatened.
- Being kept informed as to what to expect as treatment progresses (Preparatory communications)
- Keeping a two-way line of communication open in the event the patient needs to discuss feelings or emotions.