You respond with: “Another possible topic just occurred to me as we were reviewing your list. It’s something we haven’t discussed yet but I noticed that Dr. Chin indicated on your referral form that you smoke a pack of cigarettes per day. So I’m wondering about this. Is it accurate and if so, how do you feel about your smoking?”
Analise responds:
“Ya, unfortunately it’s accurate but I did manage to cut down to half a pack, around the time I was first diagnosed. After two weeks of torturing myself, I gave up trying. It was just too hard. I think part of my stress around coming to this appointment today was because the last thing I need is another lecture about how bad my smoking is. I know smoking is bad for me and I know I have to quit. I wish I could quit but right now just isn’t a good time."
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You have established good rapport with Analise which enabled her to introduce a new topic (smoking) in a way that she experienced as respectful and supportive of her autonomy. As a result of your sensitive and thoughtful approach, Analise openly discusses her smoking and shares some of her feelings about this issue. Notice that her response contains a mix of both sustain talk and change talk, revealing that she feels ambivalent about her smoking.
What do you say next to keep the conversation moving forward? Select the best response:
I get that things are stressful for you right now but honestly, there will never be a perfect time to quit. Yes quitting is hard but so is going through the last decade of your life dragging an oxygen tank around. Do you really think continuing to smoke for 1 or 2 or 5 more years will make anything better?
You’re still smoking and you know it’s a bad for your health but you don’t see the point in adding smoking to our list because it’s not a realistic goal right now.
So you haven’t quit smoking yet, but you know you should. I’m certainly not going to lecture you about it but I will strongly advise you to add this to the list.
It sounds like you’ve really been wrestling with this issue. On one hand, quitting feels like an impossible goal right now and at the same time it’s an important goal and one that’s on your wish list.
