1. The Drama Triangle and the Five Agreements – Helping Maintain Professional Detachment in the Consultation Dr Andrew Tresidder MBBS MRCGP

2. Relationships – the Solihull Triangle A model for achieving effective communication and change Containment Reciprocity Behavioural management 1 Safety, trust and rapport 2 A dialogue 3 Support to change

3. Anatomy of a complaint Story – Andrew, new patient, prescription request ‘just a quick one, doc, I know you’re running late…’ Observed by medical student Why was he unhappy?

4. Complaints Usually about facts (or misconceptions) – which may be major, or minor Always about feelings

5. The Seat of Power Every profession is a conspiracy against the layman, said George Bernard Shaw in ‘The Doctor’s Dilemma’

6. The Consultation Two people approach a consultation, both independent adults. However, the expert knowledge lies with the professional. The layman (the patient), through ignorance or fear/anxiety, may give away his power of autonomy. This power must be handed back at the end, to ensure a tidy ending

7. ‘Stuff’ in the Consultation Three dynamics 1 the patient’s stuff 2 joint stuff 3 my stuff My stuff is my responsibility Responsibility = ability to choose our response

8. Transactional Analysis Parent Parent Adult Adult Child Child

9. The Drama Triangle 3 roles – 1 Child and two Parents The Child can give away their power - to a parent, and can play Victim, playing the script “If you help me / save me / protect me, I will give you my power”. The Parent takes the power and becomes Rescuer “If you give me your power, I will protect and help you”

10. The Drama Triangle Victim Rescuer Persecutor

11. The Drama Triangle Sometimes hidden agreements Doctor as Parent – Patient as Child – I will take care of you and use my skill to help you If……. You agree to approve of me and give me respect (Doctor as Child needing patient as parent –many of us doctors are Little Pleasers)

12. The Drama Triangle Win –win? Win – lose? Lose – win? Lose – lose?

13. Exercise In pairs, please study the scenarios One person play physician role, the other the patient role Five minutes to ‘consult’ Then we will discuss

14. Resolving the Drama Triangle Be authentic – be true to yourself To Thine Own Self Be True (Shakespeare) “Try to treat others as you would wish to be treated yourself”- the number one rule at Her Majesty’s Prison Guy’s Marsh, Dorset, UK Try to keep to the Four Agreements

15. The Five Agreements Be Impeccable with Your Word Take Nothing Personally Make No Assumptions Always Do Your Best Be Sceptical – but Learn to Listen

16. The Drama Triangle References Karpman, S. (1968). Fairy tales and script drama analysis. Transactional Analysis Bulletin, 7(26), 39-43 http://karpmandramatriangle.com/dt_article_only.html, http://karpmandramatriangle.com/dt_article_only.html Edwards, Gill. Conscious Medicine, Piatkus 2010, pp130-133 The Four Agreements, Don Miguel Ruiz, Amber-Allen Publishing The Five Agreements, same author Games People Play, Eric Berne, 1964 Thankyou for your participation!