Effective communication with Neuro-linguistic Programming

Last month, as part of the VDP’s day release programme, I attended a two-day seminar on NLP (Neuro-linguistic Programming) given by Dr Brid Hendron.

Being somewhat familiar with the area from my psychology days, I was very interested to find out what NLP could do for me and my patients.

NLP first emerged in the 1970s from the works of John Grinder, an assistant professor of linguistics, and Richard Bandler, a psychology student at the University of California. They believed that by identifying excellence, one could analyse it, model it and use it. Their initial work studied three outstanding communicators, Fritz Perls, the founder of Gestalt Therapy, Virginia Satir, the founder of family therapy, and Milton Erikson, a psychiatrist and hypnotherapist.

The framework for NLP comes from the awareness that our processes are sensory-based and that we use linguistics (language) to order thought and behaviour and to communicate with others.

To communicate effectively with patients it is necessary to establish a rapport with them. When any two people in conversation with each other are in rapport, body language and voice tonality flow together, they match each other’s postures, gestures and eye movements; in essence, they mirror each other.

Studies have shown that the presence of rapport between practitioners and patients treats illness, enhances compliance and satisfaction, and prevents malpractice litigation. NLP provides a framework for dental practitioners to establish a rapport with their patients based on three steps:

1. Matching

2. Pacing

3. Leading.

Matching a person’s body language with sensitivity and respect helps to construct a bridge between the dentist and the patient’s view of the world. By matching a patient’s body language it may enable you to experience what your patient is experiencing. Once rapport is established, by pacing and leading it is possible to change a patient’s behaviour.

As human beings we all have the ability to think but what we sometimes fail to remember is that we don’t all think in the same manner or pattern, and this can lead to difficulty in communication. In NLP these patterns are termed representational systems; they are the ways in which we take in, store and code information through our sensory systems. We use our sensory systems to perceive the world and then we internally rearrange the world to our own individual requirements. Primary representational systems in western cultures are: auditory, visual and kinaesthetic.

Once rapport has been established, by effectively listening to patients, it is possible to identify their preferred representational system so that when responding to you patients will frequently use phrases such as ‘Oh, I see’ or ‘I hear what you’re saying’.

The term kinaesthesia includes tactile sensations such as touch, temperature, moisture, internal feelings of remembered emotions and sensations, inner feeling of balance, body awareness and proprioception. Kinaesthetic patients account for approximately 40% of all patients. There are those who will feel warm or cold in the surgery, will be sensitive to your feelings and may comment upon how you look tired or pale, but are unlikely to comment upon the visuals of your surgery. They will be hypersensitive to pain and may return again and again as a filling still feels too high or a denture feels too rough. They are also unlikely to be overly concerned with aesthetics.

Patients whose preferred representational system is visual will notice almost everything that is within their sight and will comment upon a refurbishment of the surgery (or lack of it!). Aesthetics will be foremost for such patients and they will ask for a mirror to see their teeth after a scale and polish! They are quite easy to distract and will be avid fans of the IO camera – seeing is believing. They will, however, have difficulty following verbal instructions and will prefer to read thing for themselves, hence written post-op instruction after extractions, for example, is very beneficial as they get distracted with too much verbal information.

Auditory patients comprise about 20% of the patient base and can be subdivided into auditory digital and auditory tonal. Auditory tonal patients very often arrive at your surgery as a result of a recommendation of a friend. They will hear EVERYTHING that is said. When they are receiving information from you they tend to repeat it out loud. Such patients dislike the sound of the drill and like having background music. Auditory digital patients can often appear quite rude and aloof, and when asked what seems to be the bother they may respond by saying, ‘Well you’re the dentist, you tell me’! They will generally give a poor history as they tend to think about how they feel, rather than just feel it. They can be quite oblivious to their own physical discomfort and may often request that you don’t use local anaesthesia.

What is written here only scratches the surface of the areas covered on the course, but I feel it provides a valuable insight into the minds of our patients as to what they are experiencing while they are in our surgery sitting in a dental chair. It has also taught me not to take great offence when a patient asks me for a mirror after I have spent 20 minutes scaling and polishing their teeth! But, most importantly, it has enabled me to focus on the patient, on that person as a whole and not just their mouth, while realising that building a rapport with each patient is just as important in their treatment, if not more so, than doing a textbook DO composite!

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