1. 2006 STFM Families & Health 1 First, the Content: The BATHE technique  is a brief counseling procedure  tailored for use in primary care  useful for … eliciting emotional information comforting the patient empowering the patient Lieberman JA, Stuart MR. The BATHE method: incorporating counseling and psychotherapy into the everyday management of patients. Primary Care Companion Journal of Clinical Psychiatry 1(2): 35-38, 1999 Stuart MR, Lieberman JA. The 15-minute Hour: Applied Psychotherapy for the Primary Care Physician, Second Edition. Praeger, 1993.

2. 2006 STFM Families & Health 2 The BATHE Technique B ackground “What’s going on in your life?” A ffect “How do you feel about that?” T rouble “What troubles you the most?” H andling “How are you handling that?” E mpathy “That must be very difficult for you”

3. 2006 STFM Families & Health 3 Comparison: Musculo-Skeletal History B ackground “What happened?” A ffect “How has it affected you?” or “Where does it hurt?” T rouble “With one finger, point to the place that hurts the most.” H andling “What have you done to treat it?” E mpathy “Poor baby.”

4. 2006 STFM Families & Health 4 BATHE Is Useful For… Promotion Discovering the reason for visit Understanding the context of a patient’s illness Providing structure for a home/ hospital visit Prevention Connecting physical and emotional symptoms Exploring compliance issues Intervention Comforting a distressed patient Handling unexpected psychosocial revelations Diagnosis & Treatment Screening for anxiety, depression, or life stress Providing a structure for a counseling visit

5. 2006 STFM Families & Health 5 Do Not Use BATHE When… Patient is in severe pain or life-threatening circumstance Patient is resistant, suspicious, or hostile. Patient is psychotic or borderline To intervene with suicidal patients, victims of violence, or substance abusers  In these circumstances, BATHE can be used, but should be followed with further exploration & action

6. 2006 STFM Families & Health 6 BATHE: Instructions for Use: Use only the 4 questions Shift quickly away from details of events (“B”) to feelings about the situation. (“A” & “T”) Do not interpret or analyze patient’s responses. Resist giving advice. Remember, the goal is not to fix the problem, but to provide support & clarification. BATHE should take about 1 minute