id text label dimension 117_24 Okay. other communication behavior 117_26 Sure. other communication behavior 117_28 That's interesting isn't it? You-- 'cause you kind of mentioned it there, like, you know, on one side of the coin, um, it helps calm the nerves to get yourself get out there and- reflection communication behavior 117_30 -talk to guys at the same time, on the other side it's not working you're finding. And i-i-it results in hangovers or? reflection communication behavior 117_32 Okay, and so I guess, you know, what would you like to do given the circumstances? question communication behavior 117_34 Yeah. other communication behavior 117_36 Okay. other communication behavior 117_38 Okay. other communication behavior 117_40 Okay, okay, so, uh, sounds like you really want to stop drinking, particularly during the weekdays? reflection communication behavior 117_42 Right, because you're noticing it's having a negative impact on what you're eating. reflection communication behavior 117_44 No, I get it. Yeah. I mean, you know, it sounds like it's, it is helpful to a degree for you when you go out because it makes you feel a little bit more calm to talk to-to guys is that right? reflection communication behavior 117_46 Yeah. other communication behavior 117_48 Yeah. other communication behavior 117_50 Sure. other communication behavior 117_52 "Yeah, yeah. So, you've got, you know, some benefits there then, you know. The social element, hanging with friends and-and going out together is something which is-is quite enjoyable. So, it's not a case of removing it completely but it’s a case of, ""Okay, I’m noticing this is impacting on me more than what I’d like to."" Yeah. Yeah, okay." reflection communication behavior 117_54 Has there been times in the past where you’ve tried to cut back on drinking? question communication behavior 117_56 Oh, this is the first time anything like this has come up? question communication behavior 117_58 Yes, yes. other communication behavior 117_60 Okay, yeah. Well, it’s great that you’re able to identify, you know, what’s going on at the moment and you've-- not only know that, you almost picked up on a bit of a pattern too you're in- other communication behavior 117_62 -as to why you’re-you're drinking. In terms of looking at cutting back on-on drinking, you know, on a scale of 0 to 100 and 100, uh, meaning it’s tremendously important for you and 0 not important at all. How important is it for you to cut back on the drinking? question communication behavior 117_64 Okay, yeah yeah sure, you're already taking a huge step forward in many ways by coming along to-to start talking about it. other communication behavior 117_66 Um, I guess 80 is quite high, what makes you say an 80 over say 50? question communication behavior 117_68 Okay. other communication behavior 117_70 "Okay, yes, so you’ve got this real sense of, ""I've gotta do something.""" reflection communication behavior 117_72 That’s what it seems like. reflection communication behavior 117_74 So, at the moment, it's been a case of the last six months, this is a pattern that you’ve been noticing more and more, um, a sign that it has had negative impacts on your lifestyle which you’re not happy with and you are in you're in a position where, you know what? I wanna do something about it. reflection communication behavior 117_76 Okay, I mean what do you think that next step is? therapist_input communication behavior 117_78 Yeah. other communication behavior 117_80 Okay. other communication behavior 117_82 Okay. other communication behavior 117_83 -so it just doesn’t go crazy. other communication behavior 117_84 Okay, okay, so you’re thinking about perhaps looking at trying to keep weekdays free of alcohol? Was that what you were saying? therapist_input communication behavior 117_86 Okay, how does that sound like a first step goal for you? therapist_input communication behavior 117_88 Okay. other communication behavior 117_90 Okay, you sound really mad about it to-to turn it around. reflection communication behavior 117_92 Okay, oh, that-that's excellent, okay. other communication behavior 119_0 Thanks for coming in. Tell me what's been happening since we last spoke. question communication behavior 119_2 Wow, that's so great. other communication behavior 119_4 You sound disappointed. reflection communication behavior 119_6 It's gonna keep happening that you have to turn down opportunities. reflection communication behavior 119_8 Mm-hmm, okay. Well, tell me, um, on a scale from one to 10, how important is it for you to get a job? question communication behavior 119_10 Yeah. You're-you're-you're it. reflection communication behavior 119_12 You have to provide for your children. reflection communication behavior 119_14 Um, and tell me on a scale from one to 10, how confident are you that you could get a job? question communication behavior 119_16 So, it sounds like, you know, the childcare issue has been getting in the way, and so finding something that would work for you would be really helpful. reflection communication behavior 119_18 And then also it sounds like you're kinda feeling not so great about your resume and your experience. reflection communication behavior 119_20 Okay. What is it that you- what is it that you want? question communication behavior 119_22 Yeah. Yeah. So, if you had- if you had consistent work, it would change your life in a lot of ways. reflection communication behavior 119_24 Mm-hmm. It would provide the income that you need and you wouldn't worry so much. reflection communication behavior 119_26 Right. So every day you know where you're going. reflection communication behavior 119_28 Okay. And you know, what's- what's happening for the- for the day, for the week. reflection communication behavior 119_30 Yeah. other communication behavior 119_32 Right. Yeah. Because you're- you're the kind of parent that wants to make sure your kids are doing well. reflection communication behavior 119_34 Yeah. Um, so tell me, what would it take to get you to like a five in confidence, to feel a little bit more confident about getting work? question communication behavior 119_36 Okay, Yeah. other communication behavior 119_38 Mm-hmm. other communication behavior 119_40 Yeah. Because you definitely need to go to an interview in order to get the job. reflection communication behavior 119_42 So having taken care of that part, having some reliable childcare would definitely help. reflection communication behavior 119_44 What else would get you to a five? question communication behavior 119_46 Okay. other communication behavior 119_48 Mm-hmm, mm-hmm. other communication behavior 119_50 Okay. other communication behavior 119_52 Yeah, so if you had something on your resume that was around education training, maybe a certificate of some kind of a field that you're interested in, that you would feel proud of yourself. reflection communication behavior 119_54 Mm-hmm. Okay. What-- do you have any ideas as to what fields you might be interested in getting some more education, more training? question communication behavior 119_56 Like what's going to be fastest. reflection communication behavior 119_58 Okay, and so if- if you were, it sounds like if you were going to do something you'd wanna to do something really quickly like a short- a short certificate. reflection communication behavior 119_60 Yeah, sort of like a short-term or transition into something else. reflection communication behavior 119_62 But that would be steady and pays well? reflection communication behavior 119_64 Okay, and allow you to afford everything you need to afford. reflection communication behavior 119_66 Okay, so specifically getting some computer skills will help? reflection communication behavior 119_68 The technology. reflection communication behavior 119_70 Mm-hmm. Okay. So whatever and so far it sounds like getting a job is really important right now and you really need the money and you really need to take care of your children and it sounds like you have some ideas as to how you could get to these interviews for one, and then once you're there at the interview, feeling more confident about your skills, um, getting some child-- reliable child care certainly sounds very important. reflection communication behavior 119_72 Um, as well as maybe doing some sort of certificate or getting some classes and training in computers? question communication behavior 119_74 Okay. other communication behavior 119_76 So what would you like to do next, you think? question communication behavior 119_78 Okay, okay. other communication behavior 119_80 That's a priority. reflection communication behavior 119_82 Yeah. other communication behavior 119_84 Yeah. other communication behavior 120_0 Well, I'm glad we figured that out and I think you'll feel better over the next few days. other communication behavior 120_2 Well, since I have you here and we still have a few minutes left, I'd like to bring up another topic. I noticed that your blood pressure and your weight have been climbing a bit over the past few years. We haven't really had time to talk about this much before and I may be able to offer some useful strategies. Would it be okay if we discussed weight and health for a few minutes? question communication behavior 120_4 I know how you feel. Managing weight can be frustrating. Maybe we can just start trying to figure it out together and I'll be here to help you through the challenges. reflection communication behavior 120_6 Yeah, that's certainly understandable. We both know that there's a lot that plays into weight management, but there's no need to figure it all out today, especially since things are so busy for you right now. Maybe we could put our heads together and think about something small that fits reasonably into your life and then we can take further steps when you're ready. therapist_input communication behavior 120_8 Well, let's see. One of the things that's involved in managing weight and health is being active. Physical activity benefits the whole body. It's healthy for our joints, our stress levels, and especially for weight management. Perhaps we could talk about some ways of adding activity that fit into your life. therapist_input communication behavior 120_10 Well, I understand that. I don't have an hour to go to the gym every day either, but one of the great things about physical activity is that any amount in any type of activity can be very helpful. For example, let's think about some activities that you enjoy doing. therapist_input communication behavior 120_12 Me too. Walking is great exercise. therapist_input communication behavior 120_14 Actually, even just a few minutes of walking is really healthy and worthwhile, and then when you have time to do even more, that's great. Walking is also great because you can do it anywhere, it doesn't need to be at the gym. therapist_input communication behavior 120_16 That sounds great. other communication behavior 120_18 Well, dancing is a great exercise, especially because it's fun. therapist_input communication behavior 120_20 Oh, that's great to hear that your family is so supportive. And I bet there's a dance class somewhere around where you live or maybe even a dance fitness class at the gym. reflection communication behavior 120_22 Would you like to do some research on this and give it a shot? therapist_input communication behavior 120_24 Well, small steps can go a long way. So, even things like taking the stairs instead of the elevator every once in a while or parking just a bit further from the door when you go to a store can be ways to increase movement in your day. therapist_input communication behavior 120_26 How about we start there and let's plan to follow up in a few weeks so we can see how it's going and then maybe talk about some other strategies that might help. therapist_input communication behavior 120_28 Not necessarily. What we eat is certainly important for weight and health, but just like we did today, we can talk about some small steps that can fit into your life, and especially ones that you feel good about. therapist_input communication behavior 120_30 That's great. I'll see you soon other communication behavior 121_0 Uh, welcome. And, uh— other communication behavior 121_2 I'd say my name is Mark and I work here at Green Prescriptions. And- therapist_input communication behavior 121_4 I know a little bit about you from the referral letter from the doctor. reflection communication behavior 121_6 From your GP, yeah. reflection communication behavior 121_8 But before we get to anything, I'll probably want to just ask you a little bit about what's led you to come here today and get a bit of an idea about what's been going on for you. other communication behavior 121_10 Mm. other communication behavior 121_12 And what did he have to say? question communication behavior 121_14 mm. other communication behavior 121_16 Right. other communication behavior 121_18 Mm. other communication behavior 121_20 Right, so he kinda gave you a directive? reflection communication behavior 121_22 Mm. other communication behavior 121_24 So it kind of came a bit of a surprise, you feeling okay. reflection communication behavior 121_26 "You go for this checkup with the doctor. And he says, ""You've got Type II diabetes.""" reflection communication behavior 121_28 Mm. Came out of the blue for you? reflection communication behavior 121_30 Mm. other communication behavior 121_32 And you said you kind of don't fit that kinda Type II diabetes look. That you kinda have had this idea- reflection communication behavior 121_34 -you've been-been overweight with it. reflection communication behavior 121_36 Mm. other communication behavior 121_38 Mm. other communication behavior 121_40 Mm. other communication behavior 121_42 Mm. other communication behavior 121_44 Hmm. So it doesn't quite fit in your head, Type II diabetes and- reflection communication behavior 121_46 -your lifestyle? question communication behavior 121_48 Comes as a big surprise. And what was your reaction when he told you that at the time? question communication behavior 121_50 Mm. other communication behavior 121_52 Mm, mm. other communication behavior 121_54 Yeah, yeah. other communication behavior 121_56 He's got a lot to do. reflection communication behavior 121_58 Mm. other communication behavior 121_60 Right. other communication behavior 121_62 Mm. other communication behavior 121_64 So how are you feel in your head- question communication behavior 121_66 -and what the tests say kind of like don't join up. reflection communication behavior 121_68 Mm. other communication behavior 121_70 Hmm. other communication behavior 121_72 Hmm-hmm. other communication behavior 121_74 Hmm. other communication behavior 121_76 Yeah. What's the problem? Mm. reflection communication behavior 121_78 And how did this happen is probably kind of what you're also thinking. Well, how did this--? reflection communication behavior 121_80 Mm. other communication behavior 121_82 Okay. other communication behavior 121_84 Yeah. other communication behavior 121_86 Mm. other communication behavior 121_88 So he mentioned, it might be a family thing. And so you- reflection communication behavior 121_90 -maybe got from your parents or something of the sort. reflection communication behavior 121_92 Mm. other communication behavior 121_94 Mm. other communication behavior 121_96 Right. other communication behavior 121_98 Mm-hmm. other communication behavior 121_100 Yeah. other communication behavior 121_102 Mm. other communication behavior 121_104 Right. other communication behavior 121_106 So he fits the picture- reflection communication behavior 121_108 -when you think about what he-he-- Yeah, he's stereotypical. reflection communication behavior 121_110 A little bit bigger, perhaps doesn't look after himself that well, and he fits that foot reflection communication behavior 121_112 Yeah. other communication behavior 121_114 Mm. So you got this knowledge as a witness there's some family history of diabetes in the past? reflection communication behavior 121_116 Doctor mentioned that as being a factor. reflection communication behavior 121_118 That's certainly true. Yes. We know that people who've had parents or have been in the past, there is a hereditary factor or genetic factor in-involved. therapist_input communication behavior 121_120 Mm. other communication behavior 121_122 Correct. Yeah. therapist_input communication behavior 121_124 But it's not inevitable. therapist_input communication behavior 121_126 Because its genes or the-the-the-the hereditary factor is not the only factor that causes it or is involved in it happening to you. So there's other factors that come into play. therapist_input communication behavior 121_128 Well, you've-you've mentioned some of the things you know, and one of those is hereditary factors. You mentioned that the doctor mentioned that. And what else do you know or have you heard? You say you haven't had a lot of time to do the research. What else? Other things you've. question communication behavior 121_130 Yeah. other communication behavior 121_132 That makes a bit of sense. other communication behavior 121_134 Yeah. other communication behavior 121_136 Yeah. other communication behavior 121_138 They managed with it. reflection communication behavior 121_140 Okay. I don't know if it'd be helpful for you if you'd like to know a little bit more about some of the factors involved in time Type II diabetes. other communication behavior 121_142 If that would help. other communication behavior 121_144 Well, I'll perhaps share with you what I know from working with other people and some of the things I've experienced in working with people. other communication behavior 121_146 And see what you make of it. See if it fits a little bit more with where you're at. We know that there is a strong family factor or hereditary factor, so that's one aspect. So also it tends to happen a little bit later in life, rather than something you might get when you're a teenager, this type of diabetes. So-so it's a later onset. It takes a bit of time for it to develop maybe. And the main reason I think, um, the main aspect of it is that it, have you heard about insulin. therapist_input communication behavior 121_148 So that's a hormone or a chemical, it allows you to utilize sugar in your body. therapist_input communication behavior 121_150 All right. And Type II diabetes typically people have a resistance or a resistance to insulin in their cells, in their fat cells or their muscle cells or liver cells. They can't use insulin. And so sugar builds up in your system. therapist_input communication behavior 121_152 You need insulin in your cells, individual cells in muscle or in fat or wherever to, um, use up excess sugar or to utilize sugar. therapist_input communication behavior 121_154 That's right. other communication behavior 121_156 Kind of, as your. other communication behavior 121_158 Yap. other communication behavior 121_160 Yeah. other communication behavior 121_162 That's a good way to think. other communication behavior 121_164 Exactly. And what's happening in Type II diabetes is your-your fat cells and liver cells and muscle cells are resistant to insulin. It's almost like they're saying we can't use that. therapist_input communication behavior 121_166 And if-- Well, there's a number of-- We're not entirely sure, there's a lot of research still going on as to how this happens and how that could be modified. But what we do know is that, um, one of the key things in managing it is to try and modify or modulate, control the amount of sugar that are in your system. therapist_input communication behavior 121_168 Yeah. So there's a couple of things that we know that people with Type II diabetes have to look after and have to think about if they want to control the amount of sugar that's in their system, which is the main issue that's causing some of the health problems that people have with Type II diabetes. Too much sugar, and if it's not able to be utilized in the blood cell, in the fat cells, or liver cells, and the muscle cells stays in your bloodstream. And that can cause problems with your circulation. So too high blood sugar and too low a blood sugar can be a problem. So sugar is the main concern in Type II- Type II diabetes.And you mentioned earlier on, a couple of things that the doctor-- You've mentioned some signs that he was kind of a little bit concerned about. Well, what things did you notice over the-over the last month or so? therapist_input communication behavior 121_170 Yeah. other communication behavior 121_172 Yeah. other communication behavior 121_174 Yeah. other communication behavior 121_176 Yeah. other communication behavior 121_178 A slightly more sedate lifestyle. reflection communication behavior 121_180 Yeah. other communication behavior 121_182 Yeah. other communication behavior 121_184 Yeah. It should feel like there's something really wrong with you. other communication behavior 121_186 What's-how have you been feeling over the last month? So, you say you're very busy you're doing a lot of work. question communication behavior 121_188 Yeah. other communication behavior 121_190 Mh-hmm. other communication behavior 121_192 Okay. other communication behavior 121_194 So a little bit sort of energy is not quite there sometimes? The vitality. reflection communication behavior 121_196 Yeah, Mh-hmm. other communication behavior 121_198 Yeah. other communication behavior 121_200 Mh-hmm. other communication behavior 121_202 You haven't noticed it. So it's a progressive, you know, you've just seen this, as-as you got older, things have slowed down. You know those activities you used to do, but that's kind of like what happens. reflection communication behavior 121_204 Mh-hmm. other communication behavior 121_206 Yeah. other communication behavior 121_208 Okay. other communication behavior 121_210 Hmm, a bit of a mystery there. reflection communication behavior 121_212 Really? So what I'm hearing is there's actually a lot of aspects in your life which are really good. reflection communication behavior 121_214 From your perspective, things are going well? reflection communication behavior 121_216 Yeah. It doesn't fit. reflection communication behavior 121_218 Mh-hmm. other communication behavior 121_220 Right. other communication behavior 121_222 Yeah. When you get uh, a headache. reflection communication behavior 121_224 Yeah. other communication behavior 121_226 So the idea of having to test-test your blood sugar and take medications is kinda like off-- reflection communication behavior 121_228 And you know that's a bit too- other communication behavior 121_230 Too much. reflection communication behavior 121_232 Yeah. Okay. other communication behavior 121_234 And you're here today and that's probably something in you you've thought well I'll follow this through, you know I'll-I'll come along and see what-see what they've got to say. And I'm just wondering for this session, for the time we have today, there's a number of things we could talk about. You mentioned a couple of things about your lifestyle and, um, medication is one thing you've been told by the doctor you might need to do that. And a number of things that we could talk about today. Which-which area would you think would be useful for you to focus on? question communication behavior 121_236 Hmm. other communication behavior 121_238 Okay. other communication behavior 121_240 Mh-hmm. other communication behavior 121_242 So then, since you've been on your own since you've separated, divorced and you've noticed that the things you eat and how you eat has changed. reflection communication behavior 121_244 Hmm. other communication behavior 121_246 Yeah, yeah. other communication behavior 121_250 Hmm. Yeah, yeah. other communication behavior 121_252 Yeah. And your-- part of your wife used to do a lot of that for you? reflection communication behavior 121_254 Yeah. other communication behavior 121_256 And so she would kinda look after what you ate and healthy things that you had, spread in front of you and off you go. reflection communication behavior 121_258 Mm-hmm. And now you have to think about what you might eat and sometimes you don't eat the best. reflection communication behavior 121_260 Okay. other communication behavior 121_262 Hmm. other communication behavior 121_264 Yeah. other communication behavior 121_266 Yeah. reflection communication behavior 121_268 Very appealing, isn't it? reflection communication behavior 121_270 Mm-hmm, Mm-hmm. other communication behavior 121_272 Yeah they look pretty good on the plate, don't they? reflection communication behavior 121_274 Yeah. other communication behavior 121_276 They're food choices in what you eat and what's in your diet it's not what-something you actually you've actually been aware of or had to think about in the past. reflection communication behavior 121_278 So one thing that you noticed is diet and the eating patterns and- reflection communication behavior 121_280 -when you eat. That's one aspect. What other aspects do you think you've-- you would be--? question communication behavior 121_282 Right. other communication behavior 121_284 You kinda juggle those two things and kinda-- reflection communication behavior 121_286 You still run and have a cigarette? reflection communication behavior 121_288 Hmm. Hmm. Yeah, part of the culture. reflection communication behavior 121_290 Yeah. other communication behavior 121_292 Yeah. other communication behavior 121_294 Hmm. other communication behavior 121_296 But over the years, you've actually reduced your smoking or you've stopped altogether or at times? reflection communication behavior 121_298 Hmm. other communication behavior 121_300 Okay, so you meant to reduce. reflection communication behavior 121_302 You were noticing that it's having an impact on your breathing and health wasn't so good. reflection communication behavior 121_304 When you related that to your smoking, so you managed to reduce your smoking. reflection communication behavior 121_306 So you've made our decision to do that? reflection communication behavior 121_308 Hmm. other communication behavior 121_310 Yeah, and it's hard to get to stop something you enjoy, isn't it? reflection communication behavior 121_312 Hmm. other communication behavior 121_314 Yeah. other communication behavior 121_316 Hmm. other communication behavior 121_318 But they go together so well. And sugar in the coffee? question communication behavior 121_322 Hmm. other communication behavior 121_324 "You're drinking more coffee. So what I've heard you say so far is, if I can just start right back from the beginning and you used to come in and sais, ""I went to the doctor."" You went for-- it sounds like you went for just a checkup." reflection communication behavior 121_326 MIT. reflection communication behavior 121_328 Got to check out, why not? reflection communication behavior 121_330 Hmm. other communication behavior 121_332 Yeah. other communication behavior 121_334 So everything else looked pretty good? reflection communication behavior 121_336 Cholesterol good, your weight is good. reflection communication behavior 121_338 Um, you are smoking, but you've managed to reduce that. reflection communication behavior 121_340 And anything else, you know, you go ticking down the list. The tire is good, oil good. reflection communication behavior 121_342 So we're looking good. reflection communication behavior 121_344 And ah, hang on. reflection communication behavior 121_346 Yeah, there's something wrong with the, uh, with this bit. reflection communication behavior 121_348 And it doesn't quite fit with how you see your own lifestyle. reflection communication behavior 121_350 Because you've-- it sounds like what you've been doing, you've made some conscious effort to be aware of some of those things you might think are important. reflection communication behavior 121_352 Mm. other communication behavior 121_354 Yeah. other communication behavior 121_356 So like a domino effect, and they'll all be just sitting- reflection communication behavior 121_358 Mm-hm. other communication behavior 121_360 A bit broad kind of like you've gotta change everything. reflection communication behavior 121_362 Yeah. And your thought was, yeah, right, I hear that, but actually, I don't want to make all these big changes in my life. reflection communication behavior 121_364 Feel like you need to. Yeah. reflection communication behavior 121_366 Mm. other communication behavior 121_368 The test, is the test, and experience, yeah. therapist_input communication behavior 121_370 I don't know. I think it's up to you where we start, and that's the question I've got in my mind. You've mentioned a couple of things that you've already made some effort, or been conscious of. You've mentioned the diet, you've mentioned your smoking, those are two quite important aspects that we often talk about here in how people work. reflection communication behavior 121_372 It can have an impact, yes. So smoking, um, affects your blood system, so it hardens the arteries, um, and over time, it can have a significant impact on the healing of wounds. So people with Type II diabetes, often, if they get a cut, or a bruise, or something, it takes a long time to heal. Smoking reduces the amount of oxygen in your system, so that can further, you know, limit the time it takes your body to heal. therapist_input communication behavior 121_374 So we know that smoking and Type II diabetes together- therapist_input communication behavior 121_376 -isn't a good combination. therapist_input communication behavior 121_378 Well, the question is, I suppose, that I have for you is, where would you think, for you, would be a good place to start? If you were gonna make any changes, even small changes at the beginning, rather than just thinking, oh, I got to change everything, which it sounds like you're not prepared to, you know, do a whole lifestyle change, and I don't think that's what we're talking about here. Where would you feel most comfortable to start if you were gonna make any changes at all? question communication behavior 121_380 Yeah. Hmm, that might be a start. therapist_input communication behavior 121_382 Hm. What we also find is that people make these little changes, small changes, and that starts to kind of well, it makes them- therapist_input communication behavior 121_384 -rollover, the domino effect starts to happen, and they start looking at other aspects. reflection communication behavior 121_386 "So rather than thinking, ""oh, my God, I have to change all these things. I've gotta stop smoking, I've gotta exercise more, I've gotta, you know, start eating more fruit and vegetables,"" you might start with these small changes, and then-" reflection communication behavior 121_388 Um, I-I'm reluctant to give a prescription for that because I think it's really up to you. And I think it depends on how things go, as to how much you need to do. therapist_input communication behavior 121_390 You mentioned earlier on, the doctors talking about you monitoring your blood sugar. reflection communication behavior 121_392 So on how-- It depends on how-how that goes. Let's say, if you started doing that and you do some more exercise, you start to have longer blacks, rather than short blacks with lots of sugar. And you get down the sugar and you find your blood sugar starts to come down, then we're heading in the right direction. reflection communication behavior 121_394 So it's really, I suppose, up to how things go for you, and you get that feedback. And if that's going in the right direction, you carry on doing and do some more of that. reflection communication behavior 121_396 I think where we start is where you feel comfortable starting. other communication behavior 121_398 Apples for breakfast. therapist_input communication behavior 121_400 So what I'm hearing you're kind of saying is, that there's-- You're now starting to think of some very useful little starting points. reflection communication behavior 121_402 Not huge changes, but some little things you could do. reflection communication behavior 121_404 And it's kind of dawning on you there may be some possibilities here for making some changes. Let me ask you this. Um, let's say you put some of these things in place and you start to make some of these small changes. reflection communication behavior 121_406 Um, where do you see that taking you in the next set of three, four, five years? You know, where do you want to be in three to four years' time? What would be your ideal picture? question communication behavior 121_408 No. other communication behavior 121_410 Yeah? You like the social aspect? reflection communication behavior 121_412 No, no, I get that. I get that. other communication behavior 121_414 So part of that whole keeping fit and exercise stuff is actually the social side of it, isn't it? reflection communication behavior 121_416 Yeah. other communication behavior 121_418 Haven't quite that- other communication behavior 121_420 And the coffee helps a little bit because it perks you up? reflection communication behavior 121_422 And the sugar in it helps too. reflection communication behavior 121_424 So what I'm hearing is that your life, your work, your routines are-- Sometimes you're driving or you've got to keep awake, get up in the morning sometimes and you haven't quite got that buzz or the energy. You need a shot, and then throughout the day you might need just more shots to keep that energy up. reflection communication behavior 121_426 Yeah. other communication behavior 121_428 And an activity which has got a starting to finish and it's something you do for a slot. therapist_input communication behavior 121_430 And then there's maybe some social aspects to it as well. reflection communication behavior 121_432 You can see some benefits and some enjoyment that. reflection communication behavior 121_434 That sounds like a great plan. reflection communication behavior 121_436 Yeah, sounds like a good idea. other communication behavior 121_438 I think anything you do, it has to be something you've decided. You know, just start where you want to start. You've mentioned some really good ideas about possibly getting a little bit more exercise into your life, doing something like squash or something of that nature. You've mentioned some really good ideas about reducing the amount of sugar you-you-you're-you're intaking during the day, and coffee is a good place to start. Having an apple for breakfast, I think you mentioned that, a bit of fruit. reflection communication behavior 121_440 Those are some really good ideas and good starting points. So thinking about it like that, what-- Where are you now? What's your-- What-what-- Where-where is your thinking now? question communication behavior 121_442 What's to lose? What's to gain? question communication behavior 121_444 It does make sense, yeah. other communication behavior 121_446 So when you look at it, there's probably more to gain from making these changes than there is to lose. reflection communication behavior 121_448 Right. other communication behavior 121_450 Yeah. other communication behavior 121_452 So you've got to work these things on your mind. You know, the-- And workout where's the place to start. reflection communication behavior 121_454 Yeah. other communication behavior 121_456 You've been stuck? reflection communication behavior 121_458 Yeah? other communication behavior 121_460 Indeed, yeah. other communication behavior 121_462 So rather than-- other communication behavior 121_464 Carrying on. reflection communication behavior 121_466 So it's been a bit of a-a bit of a shock, but now you kinda reflect on it. reflection communication behavior 121_468 Maybe this is the- other communication behavior 121_470 "-bit of a shake that I needed, you know, just sort of remind me. I might feel okay. I might-- From my perspective, your perspective, you're thinking, ""Well, what's the problem? Everything's fine.""" reflection communication behavior 121_472 "But now you seem to be thinking looking and thinking, ""Maybe things weren't, or aren't, as good as I thought they were.""" reflection communication behavior 121_474 Things could be better? reflection communication behavior 121_476 Yeah, I sense that. I sense that in you that you're-- reflection communication behavior 121_478 Quite invigorated with the idea of-- reflection communication behavior 121_480 Making some of these changes. Yeah. reflection communication behavior 121_482 You're up for the challenge? reflection communication behavior 121_484 So think about when you were-- This-this is an interesting question to see what you think. You were- you were a coach. You-- Maybe you'll be a coach again. reflection communication behavior 121_486 "What would you say if you were talking to yourself, if you like, you know, if you were the coach saying, ""Right--""" question communication behavior 121_488 Yeah, what-what would you be saying? question communication behavior 121_490 Yeah. other communication behavior 121_492 Yeah. other communication behavior 121_494 And, I suppose, our own personalized a little bit like that, there's lots of different aspects that need to be tweaked. therapist_input communication behavior 121_496 Modified and looked at, to get the best out of ourselves, to get the best out of the opportunities we have. therapist_input communication behavior 121_498 Yeah, yeah. other communication behavior 121_500 "Some good things I'm- some things I'm good at and there are some other aspects we think, ""Well--""" reflection communication behavior 121_502 It's not about giving up your personality or- reflection communication behavior 121_504 -changing who you are fundamentally. reflection communication behavior 121_506 It's just tweaking things. Just fine-tuning a few areas and being a bit more aw-aware of one aspect of your life a bit more, like the food choices or whatever. Well, Mike, I-I've really enjoyed listening to your perspective, and your story a little bit, and it's helped me a lot to get an idea about where you're coming from, and a little bit about who you are, and what's happened in your past. And-and we've also talked a bit about what's going to happen next. And you've come up with some great ideas. What I hear you saying is that, you know, before all this, before you met the GP, things are going fine.Well, as you would of-- As, you know, as you'd seen it, you were just doing your thing, and getting on working, and being busy, and being successful, and then suddenly this diagnosis, this doctor tells you that you've got a problem. reflection communication behavior 121_508 It comes along to me and talk today a bit about how you felt about that. Initially, it can be quite a bit of a-bit of a shock. It didn't quite fit with how you saw things. reflection communication behavior 121_510 And as we've been talking, I'm hearing you're saying that maybe if you look back to where you were before you went to the doctor, things weren't quite that right, maybe. Things weren't as good as you thought they were. reflection communication behavior 121_512 Yeah. other communication behavior 121_514 And what I also hear you saying, it's possibly the-- It's now possibly more possible, in your mind, that you could make some of these changes, rather than bring broad-brush, you know, huge changes to your lifestyles. It's not about changing who you are, it's not changing huge facets of your life, but maybe small steps that need to be taken. reflection communication behavior 121_516 What you're kind of thinking about what those might. reflection communication behavior 121_518 Mm. other communication behavior 121_520 Yeah. other communication behavior 121_522 Nobody there too. reflection communication behavior 121_524 Yeah. other communication behavior 121_526 Mhm. other communication behavior 121_528 So now it's time- reflection communication behavior 121_530 -to think about looking after yourself a bit more. reflection communication behavior 121_532 Why not? reflection communication behavior 121_534 Yeah. So, we've run out of time but I also want to ask you a final question, where to from here, what's next? question communication behavior 121_536 You'll start with that? reflection communication behavior 121_538 Yeah. other communication behavior 121_540 The gym. reflection communication behavior 121_542 Yeah. other communication behavior 121_544 Yeah. other communication behavior 121_546 Yeah. other communication behavior 121_548 Yeah. other communication behavior 121_550 Yeah. other communication behavior 121_552 And you also mentioned you'll perhaps go and- back and see the doctor and just give him a bit of an update as to- reflection communication behavior 121_554 Yeah. other communication behavior 121_556 Mhm. other communication behavior 121_558 Yep. other communication behavior 121_560 It's fine. other communication behavior 121_562 Sure. other communication behavior 121_564 Mhm. other communication behavior 121_566 You are gonna make a start? reflection communication behavior 121_568 It is. Well, just to help you, because there's probably a lot of other questions you might have, other questions that might come up after this session. other communication behavior 121_570 -before we go, I'd like to just-just give you a lot of- some information that might help-help you. therapist_input communication behavior 121_572 Not too much, just some stuff that might just give you a little bit of background information on- therapist_input communication behavior 121_574 -some of the things that have- other communication behavior 121_576 -around type- around Type II diabetes and some,- other communication behavior 121_578 [unintelligible 00:36:53] some of that. other communication behavior 121_580 Um, and I'd like to us- for us to meet again, so to catch up with you and make an appointment before you leave. Just to see how things are going and- therapist_input communication behavior 121_582 -see what sort of little changes you've managed to make. I'd be really [unintelligible 00:37:07]- reflection communication behavior 121_584 It's really up to you. Probably a little bit sooner would be good. therapist_input communication behavior 121_586 That'd be great. other communication behavior 121_588 How does that sound? question communication behavior 121_590 Because you don't know the timeline? question communication behavior 121_592 Mhm. other communication behavior 121_594 Yeah. other communication behavior 121_596 Excellent, excellent. Thanks, Mike. [croostalk] other communication behavior 122_1 Mm-hmm. other communication behavior 122_3 Got it. other communication behavior 122_5 Uh-huh. other communication behavior 122_7 Mm-hmm. other communication behavior 122_9 Mm-hmm. other communication behavior 122_11 Yeah. So-so you've got this new group of friends and-and, um, you-you actually kind of like where you're at with things right now. And your mom was going through your stuff and found your stash, and it's just turned into a, you know, all of this. reflection communication behavior 122_13 Yeah. reflection communication behavior 122_15 Yeah. reflection communication behavior 122_17 And, uh, sounds like you're-you're pretty upset with your mom for-for doing that? reflection communication behavior 122_19 Yeah. reflection communication behavior 122_21 Right. It's like your private place and, you know, it's-- that's-- it's your stuff. reflection communication behavior 122_23 Yeah. So why should she go through yours? reflection communication behavior 122_25 Yeah. Yeah other communication behavior 124_0 Okay. So what ideas do you have, Natalie for, um, getting started in adding more physical activity? question communication behavior 124_3 Great. It sounds like there are a lot of activities that you do like- reflection communication behavior 124_5 -and I'm hearing a theme of climate control, [chuckles] being important to you and you've already been researching gyms. reflection communication behavior 124_7 Tell me more about that. question communication behavior 124_9 Right. Okay. So you're looking for some-something that's reasonably priced- reflection communication behavior 124_11 -and that you don't have to sign a contract and you're right. It's hard to tell what the cost is just from looking on the website. reflection communication behavior 124_13 And I completely agree [laughs]about wanting to avoid the sales pitch- reflection communication behavior 124_15 -um, element of it. What seems like a logical next step based on-- You've kind of already gotten the ball rolling. What feels like a logical next step? question communication behavior 124_17 Okay. So maybe visiting a gym and then also choosing a non-gym activity to sort of get started when the weather's permitting. reflection communication behavior 124_19 I have one, um, idea that is jumping into my mind as you're talking. Is it okay if I share that? question communication behavior 124_21 I'm wondering about the price of the YMCA compared to other gyms. Uh, is that one that you have an interest in or have looked at already? therapist_input communication behavior 124_23 Yes. And honestly, I don't either. [chuckles] I just suspect that it might be slightly cheaper than some of the more private gyms. other communication behavior 124_25 So something to look into if you're interested. reflection communication behavior 124_27 And they-- I would suspect they'd be less sales pitch-oriented than a private gym. So it might be a safe place to explore first- therapist_input communication behavior 124_29 -and to build some confidence in that conversation. reflection communication behavior 124_31 Okay. Great. So, um, in addition to exploring the gym possibility, what sounds like a logical next step for a non-gym activity to get started, some small goal that feels doable, um, and you have control over because it doesn't require the perfect weather- question communication behavior 124_33 -or the perfect gym? reflection communication behavior 124_35 Okay. So exploring some yoga classes. Is-is doing yoga in your living room appealing to you at all? question communication behavior 124_37 That's great. It's important to know this about yourself, what works, and what doesn't work, and what you feel motivated to do. So, it sounds like we sort of have two small goals right now. One is to maybe visit the YMCA and-and find out how much that costs- reflection communication behavior 124_39 -and the other goal being maybe just a walk, um, one time between now and the next time I see you. Um, and I say one time, you can, of course, go more than that, but just with snow in the forecast, it might be reasonable to start with a small goal like that and go for one nice day between now and a few weeks from now when I get to see you again. How do those two goals sound? reflection communication behavior 124_41 Okay. So you'd like to kind of get motivated with- with the use of an app and that might help you get started. reflection communication behavior 124_43 Okay, fantastic. So, on a scale from 0 to 10, 10 being really confident, I can research a gym and go for one walk, and zero being not at all confident, how are you feeling about these two small goals? question communication behavior 124_45 Okay. other communication behavior 124_47 Wonderful. Are there any other barriers that would be helpful to sort of talk through? question communication behavior 124_49 Okay. So being creative with your indoor space is a-is a solution you've come up with yourself for - f there just aren't any good days, nice days outside. reflection communication behavior 124_51 Great. Well, you came in today feeling pretty discouraged about your energy levels and your mood and, um, feeling lousy about your body in general. And, uh, today we've talked about a small-small step to get started and you're hoping to experience some mood boost and some energy as you get rolling here. Um, how are you feeling about today's session? reflection communication behavior 124_53 Great. Well, I look forward to checking in with you, and thanks so much for coming in. other communication behavior 125_1 So, what you're saying is you've had a rough night? reflection communication behavior 125_3 So, she needed to eat every three hours last night and that was really frustrating for you? reflection communication behavior 125_5 Hmm. So, based on what your mom told you, you were expecting Lilly at this point to be sleeping through the night? reflection communication behavior 127_0 So, where you said you'd like to start, Sal, is talking about your asthma and specifically about your dog and how one is affecting the other. reflection communication behavior 127_2 Hmm. So, what- can you let me know or-or what do you know about your asthma and the things that affected or might make it worse? question communication behavior 127_4 Mm-hmm. other communication behavior 127_6 Hmm. other communication behavior 127_8 Right. other communication behavior 127_10 Okay. And that your pet has never been mentioned as a concern? question communication behavior 127_12 Hmm. Yeah. And I-I can see that you've already worked hard to make some changes. You've almost quit smoking. reflection communication behavior 127_14 You're just down to your last couple of cigarettes- reflection communication behavior 127_16 -and you're not even smoking those in the house. reflection communication behavior 127_18 So, your house is totally smoke-free. reflection communication behavior 127_20 Yeah, okay. And you have also thought about cutting back on alcohol. reflection communication behavior 127_22 -and-and I think you mentioned done-done a little bit towards that. reflection communication behavior 127_24 Okay, okay. other communication behavior 127_26 So now almost like that's not good enough, like now you have to, now it's the dog and now- reflection communication behavior 127_28 -what's next. Right. Okay. So, I mean, there is certainly a lot of evidence that pets in the home and the dander from their fur can make asthma worse. therapist_input communication behavior 127_30 -but I wonder what are your experiences with Oscar, you know, when he's in the house or-or maybe sleeping near you or you're around him, what happens with your asthma symptoms? question communication behavior 127_32 Okay. other communication behavior 127_34 Hmm. So, it doesn't make total sense to you that-that it's all Oscar's fault and that- reflection communication behavior 127_36 That's that the only solution. other communication behavior 127_38 I guess I also wonder whether, regardless of-of if your asthma symptoms are connected to Oscar, that may be part of you feels like it's worth it because he's been- reflection communication behavior 127_40 -such a big part of your life for so long. reflection communication behavior 127_42 Hmm. Yeah. And-and in the end, you know, whatever you- whatever you do, about Oscar, about your asthma, about all the other things that we talked about on that agenda-setting worksheet, I mean, you are in the driver's seat solid. It really is your choice. other communication behavior 127_44 Mm-hmm. other communication behavior 127_46 There's a lot of decisions and a lot of change with your wife, with the new baby. reflection communication behavior 127_48 And now thinking about, looking after your health and wanting to be healthy for your wife and your baby. reflection communication behavior 127_50 Mm-hmm, so what-what would need to happen or how would you know, when you- when or if you ever did have to make a decision about whether to keep Oscar with you or not? question communication behavior 127_52 Mm-hmm. other communication behavior 127_54 Yeah and I get the feeling that it's something that you wanna think about that this is a really big decision- reflection communication behavior 127_56 -and it's not one that you're gonna make in a hurry. reflection communication behavior 127_58 Mm-hmm. other communication behavior 128_1 Yeah. He wasn't too happy with the exam, was he Hailey? question communication behavior 128_3 Um, well the good news is that the exam's over and I don't think Jake has pneumonia. What I actually think he has is a cold. So there are some things you could do to manage his symptoms. Would you be interested in knowing? question communication behavior 128_5 What I would recommend is that you avoid over-the-counter cold remedies, keep him away from any friends or family who may have the flu, keep him well hydrated, um, avoid excessive dust, and avoid smoking. And at least that last one's easy because you are an ex-smoker now. therapist_input communication behavior 128_7 Oh, fun. other communication behavior 128_9 All right, Well, first I'd just like to commend you for your honesty and that's really helpful information that you shared with me. Thank you for letting me know that you're smoking again and-and, um, I also appreciate the fact you're taking so many measures to protect your son from secondhand smoke. Can I give you some advice on how you could protect him, even the- even further? question communication behavior 128_11 So, my sense is that you're smoking and you're minimizing hi-his exposure by not smoking in the same room and smoking near windows. Is that- therapist_input communication behavior 128_13 -correct? question communication behavior 128_15 So what I would recommend then, is to move your smoking outside completely. As a smoker, the ideal situation for a smoker in the house is if their home can be made smoke-free and the smoking is moved entirely outside, especially while he's experiencing this cold. therapist_input communication behavior 128_17 Okay, so, what I'm hearing you say is that, it sounds like a feasible short-term plan, not ideal and not comfortable because what you really enjoy is that cigarette with a glass of wine, kicking back up on the sofa and chilling out perhaps while you're watching TV. And to maintain that long-term outside smoking outside in Canadian winters where it's cold and snowy, not realistic. reflection communication behavior 128_19 So, on the one hand I'm hearing smoking and drinking at night as a way to chill out but at the same time the next day, you're not feeling so great. reflection communication behavior 128_21 Would it be helpful to give you some information on low risk drinking guidelines? question communication behavior 128_23 Okay. Well, Hailey, what they suggest is that women don't have more than one to two standard drinks a day or a total of nine standard drinks in a week. How does that fit for you? therapist_input communication behavior 128_25 So, it sounds like you'd be open to reducing as a way to still enjoy the wine but perhaps alleviate the way you feel in the morning, some of the hangover effects that sounds like you're experiencing. reflection communication behavior 128_27 Okay. So, you're gonna try to reduce the drinking, not sure about the smoking, what the plan is but I think we did agree upon earlier that you would move it outside, at least while he's sick? question communication behavior 128_29 That's okay. All right and, um, I guess we'll see you next week for Jake's six-month checkup. Is there anything else we could talk about that might be helpful? question communication behavior 128_31 Sure, of course, Hailey a-and again I really appreciate your openness and honesty about letting me know what's going on with, you know, the stress levels and coping and drinking. I just had a thought that there's also a good mom's group, we run out of our center. So if you'd like a referral to that or some information, I'd be happy to give you and while you think about it, if you want to, um, talk about this further with one of my colleagues, I'd be happy to make you an appointment. therapist_input communication behavior 128_33 Thanks, Hailey. We'll see you next week. other communication behavior 129_1 Huh, you feel like you dodged the bullet. reflection communication behavior 129_3 It feels like it was like two days was a year? question communication behavior 129_5 Ah. other communication behavior 129_7 Okay. other communication behavior 129_9 Okay. other communication behavior 129_11 So what would have happened if you found out that you were pregnant? question communication behavior 129_13 Okay. That's a big step and that's not the direction you want to go in right now. reflection communication behavior 129_15 Would you be open to kind of exploring the idea of birth control and family planning? question communication behavior 129_17 Now, it's a discussion you don't really wanna have. reflection communication behavior 129_19 At the same time, you have some concerns about the possibility of getting pregnant. reflection communication behavior 129_21 "So you found some ways to prevent pregnancy up until-- well, maybe, um, you've been pretty fortunate, and then there is also some times where you feel like, ""Oh, no. What if I didn't dodge the bullet?""" reflection communication behavior 129_23 Mm-hmm. other communication behavior 129_25 Okay. So, you've been able to kind of avoid any kind of consequences, and right now, you're not feeling that talking about birth control is something on your-your list. reflection communication behavior 129_27 Sure. I totally appreciate that, and it's your decision, Olivia. You know yourself best and what fits for you. If you ever feel like you like to open up the idea of conversation about family planning or birth control, I'd love to talk to you about that another time. therapist_input communication behavior 129_29 Okay. other communication behavior 129_31 Okay. I respect that. Thanks though for coming in to see me today. other communication behavior 129_33 And I'm glad that this appointment was a positive one for you. other communication behavior 129_35 You're welcome. other communication behavior 132_0 Hello, again, Mr. Green. It's really nice to see you again. If you remember last week, we looked at your results here and you've got impaired glucose tolerance and you were a bit worried about type two diabetes, your blood pressure and your cholesterol are up a bit too. So today, we're meeting up to talk through some of the things that you could do for yourself that might improve the situation. And as you know, there's all sorts of things can affect your health. So can we just have a bit of a general chat, but how are you getting on? reflection communication behavior 132_2 Actually, I'm not going to do that because you're the boss. It's up to you what you want to do with you about your own health. therapist_input communication behavior 132_4 You don't seem too happy about that. reflection communication behavior 132_6 Well, there's a lot of things you can do yourself that will improve the situation as well. So what we can do today is wee up some of those things, smoking, diet, exercise, weight, loss, all those kinds of things. So we're just gonna start and see how you feel as we go. therapist_input communication behavior 132_8 Well, it's very much up to you, you're the boss of your own life. Where would you like to start? question communication behavior 132_10 Well, I could give you my opinion. Um, and I can give you lots of information, but I think you know the score pretty well. And I think you'd know what I would say. therapist_input communication behavior 132_12 Absolutely. Spot on. So stopping smoking would have a huge impact, that would have a big impact very early on. Losing weight would also have a big impact because that would help with your blood pressure, your cholesterol, and also lower your diabetes risk. So what-what'd you think about those things? Uh, question communication behavior 132_14 It’s really tough. It's hard to know where to start, isn't it? reflection communication behavior 132_16 How important is it for you then to lose weight? question communication behavior 132_18 So can it be in there for your-your family's important to you? question communication behavior 132_20 Yeah. So w-where do you think you can start with that? question communication behavior 132_22 What's kind of the first thing you might think about doing? question communication behavior 132_24 Yeah. That would be a really good place to start, mm-hmm. reflection communication behavior 132_26 So I think it should be really supportive of that then. reflection communication behavior 132_28 So what would you do to make sure you didn't get hungry at work? question communication behavior 132_30 Yeah. Well, a big bowl of vegetable soup. You could probably count that as one or maybe even two of your five a day. So it'd be a really good place to start. Anything else you could think about doing? reflection communication behavior 132_32 Well, that's good. That's probably benefited you already. And the other thing you might not be aware of is that salt intake is linked to loss of calcium from our bones, which makes the bones more fragile. So reducing your salt intake will really help with that too. therapist_input communication behavior 132_34 So well, maybe you can help her as well and that would be good. Well, I think you've got off to a really great start, Mr. Green. You're very well aware of what you-you need to do, and you've obviously thought about it and got some good plans in place. So you're going to reduce your-your alcohol intake, you've already started by reducing your salt intake. Um, perhaps when we meet up next time we could talk a little bit about smoking and exercise as well, when you're ready for that. So how do you feel now? reflection communication behavior 132_36 That's great. So should we meet up at the same time next week then? question communication behavior 132_38 That’s great. All the very best then. other communication behavior 133_0 Thanks for coming in today. I guess you've, uh, sat in that seat with lots of people like me in the past. question communication behavior 133_2 Yeah. And you have some ideas about that and some experiences about that. So today I wanna- be good for us to talk about that and, um, I'm really interested to know what you've been thinking about in terms of what you may wanna change in your life 'cause we're gonna be working together for a while here. question communication behavior 133_4 What you've been thinking about, um, over the last little while about getting your life back on track. 'Cause I noticed you've— question communication behavior 133_6 Yeah. other communication behavior 133_8 Sure. So what I'm picking up is-is that-that-that's a life that you know a lot about. reflection communication behavior 133_10 And you can make lots of money and set yourself up well. What's the other side, because I guess when I talk to guys like yourself who have done time, often they're thinking about actually, mm, maybe life can be with different. So I'm wondering where-where you're at with the kind of thinking about— question communication behavior 133_12 Okay. other communication behavior 133_14 Sure. So life on the outside is pretty different than the kind of- reflection communication behavior 133_16 -the expectation of life on the inside something? question communication behavior 133_18 Yeah? question communication behavior 133_20 So tell me how you've been managing. 'Cause I don't know if you'd been back dealing? How have you been managing to-to-to— question communication behavior 133_22 Okay. other communication behavior 133_24 Yeah? other communication behavior 133_26 Uh, tell me- question communication behavior 133_28 It's there and-and-and you've a lot of contacts? question communication behavior 133_30 You've been in the system, so lots of context. So this isn't a new challenge for you. reflection communication behavior 133_32 So what stopped you over the last-- How long have you been out now? question communication behavior 133_34 Yeah. other communication behavior 133_36 Three weeks, isn't it? question communication behavior 133_38 So what's been there? What's it about that you haven't done in three weeks one day? question communication behavior 133_40 22 days you've actually made a decision not to-to pick up your old life and continue on. reflection communication behavior 133_42 Okay. other communication behavior 133_44 Right. So the one hand you've-you-you could sit yourself up and-and take the risk, but on the other hand, you know, that actually it might not last? reflection communication behavior 133_46 Never lasts. Mm. You seem like a bit of a crossroads to me. reflection communication behavior 133_48 Mm. But there've been times when those crossroads would be more sort of focused than other times. reflection communication behavior 133_50 Yeah. And it sounds like maybe like- reflection communication behavior 133_52 Yeah. other communication behavior 133_54 Yeah. other communication behavior 133_56 Okay. Okay. So— other communication behavior 133_58 No. Well, I've-I've got lots of ideas, but I'm really interested to hearing your ideas kind of first though because you know, and there might be some things that we can work on. other communication behavior 133_60 But I guess what I'm really interested in is-is you've made a commitment 22 days, drug-free. Haven't gone back into that lifestyle. What-what's keeping you, 'cause you're at the crossroads, you kind of just pause there at the moment. I'm not sure about this other bit over here. What keeping you in that place? question communication behavior 133_62 Yeah? question communication behavior 133_64 Tell me about Fiona? question communication behavior 133_66 Okay. other communication behavior 133_68 Okay. So you've been with Fiona for how long? question communication behavior 133_70 12 years. Okay. So she's stood by you then for the time, [crosstalk] but this time she said, it happens again I'm out of here? reflection communication behavior 133_72 Okay. And it sounds like you're listening to that black and white line. reflection communication behavior 133_74 Yeah, yeah. other communication behavior 133_76 Yeah. other communication behavior 133_78 Okay. So something's changed in your relationship between you, yeah? question communication behavior 133_80 Okay. So what's Fiona want you from you? question communication behavior 133_82 She wants him. So which him does she want, Daryl? question communication behavior 133_84 Does she want the- did she want the-the him that she fell in love with and saw great things in? question communication behavior 133_86 Or does she want the-the-the-the him that's- that keeps on getting into trouble? question communication behavior 133_88 Okay. other communication behavior 133_90 So what's it gonna take to reclaim this Daryl that she fell in love with? question communication behavior 133_92 Sure, yeah. other communication behavior 133_94 "All right. Well, let's-let's just play with this idea a little bit, Daryl. So what did Fiona fall in love with? What were the qualities of Daryl that she said, ""This is him""?" question communication behavior 133_96 I know. other communication behavior 133_98 Sure. Everyone will age, but that will happen on time. reflection communication behavior 133_100 Um, but that's okay. So-so it's she fell in love with this, the sense of fun, the sense of Daryl, and things have changed, but she's still with you? reflection communication behavior 133_102 Yeah? other communication behavior 133_104 Yeah. And you're still with her? question communication behavior 133_106 Yeah. So catch me up with the conversations you've had with Fiona about this crossroads you're at. You know, these 22 days, you haven't gone back, you've coming out and you're not back? You could pick up this dealing quite easily and probably some workout here tomorrow and get back into it. question communication behavior 133_108 Okay. All right. So-so back together, things are starting to get tense at home, and your relationship a little bit? reflection communication behavior 133_110 Yeah. Don't put words in your mouth. I'm sure if that is— reflection communication behavior 133_112 Oh, yeah? Yeah? other communication behavior 133_114 Second, I'd like to talk, Daryl, about this all- whole idea, that's this crossroads idea, yep? So on the one hand here, you've got this 12 year history of being in the other system and done some time and being away from Fiona, but you're now back, sitting back together, and you've got some choice about where to go. So, in that 'where to go', what ideas have you been thinking about in terms of where this-this Daryl, non-dealing [crosstalk] guy— question communication behavior 133_116 Okay. Yep. So a part of you knows you need to go something different, but the direction doesn't seem to be that clear at the moment? other communication behavior 133_118 It [unintelligible 00:09:33] picking up? question communication behavior 133_120 No idea. Okay. So I'm wondering, you've been in the system a while. You're now 34, is it right from the pick-up? question communication behavior 133_122 "Yeah. So, you know, often at 34, guys start to think about being with a girl in their life and what's important. And-and you would have also been part- not as a guy, so they've actually made some shifts and changes and thought, ""Time to move on""." reflection communication behavior 133_124 And now you've got— other communication behavior 133_126 Not many? question communication behavior 133_128 But some. question communication behavior 133_130 One? question communication behavior 133_132 Yeah. other communication behavior 133_134 Yeah? question communication behavior 133_136 Tell me something about that. question communication behavior 133_138 Okay. other communication behavior 133_140 He did it? reflection communication behavior 133_142 Yeah. other communication behavior 133_144 Cool. So how interested would you be to find out more information about how he did it? 'Cause I'm thinking about this is someone who you know, you've done time with, got a relationship. question communication behavior 133_146 No, I'm not suggesting you-- No, not about being a drug counselor, but about he made that transition from-from being involved in crime- therapist_input communication behavior 133_148 -to a transition about being in a different place. other communication behavior 133_150 Okay, no 12-step higher power idea? question communication behavior 133_152 So that might work for him, but what might work for you? question communication behavior 133_154 Sure. other communication behavior 133_156 Okay, so part of being here with me, and the work we might do, will be to find- try and find- search for that- therapist_input communication behavior 133_158 -thing. Whatever it is. other communication behavior 133_160 Well, it's a search, isn't it? reflection communication behavior 133_162 No. other communication behavior 133_164 Yep, it is a big ask. So what qualities would you need to have to-to go there? question communication behavior 133_166 Guts? Yeah? other communication behavior 133_168 I think it is. other communication behavior 133_170 Yeah? So you're the sort of guy, Daryl, with guts? reflection communication behavior 133_172 Yeah. other communication behavior 133_174 Not yet? question communication behavior 133_176 Yeah? other communication behavior 133_178 Yet you're sitting here with me today- reflection communication behavior 133_180 -and-and-and you're talking about stuff. reflection communication behavior 133_182 Well, you're sitting here, and you're talking with me- reflection communication behavior 133_184 -about stuff that's-that's quite deep- reflection communication behavior 133_186 -in a way. Um, that takes guts. That takes courage. reflection communication behavior 133_188 In my view, it does. other communication behavior 133_190 'Cause you could've come in here and said- other communication behavior 133_192 "-""Look, Ken, you know, I'll come in, report in, I'm outta here.""" other communication behavior 133_194 You could've done that, but you're not. So I'm wondering what's different? 'Cause you may have done that in the past, I don't know, Daryl, with other people like me, but-but sounds like something's different this time. reflection communication behavior 133_196 Yeah? other communication behavior 133_198 Yeah. other communication behavior 133_200 Sure. other communication behavior 133_202 I kind of see a sense of sadness there when you have to kind of think about this. reflection communication behavior 133_204 Yeah. other communication behavior 133_206 Okay. So I'm interested in this idea, let's, uh-- Opportunities come and go all the time. reflection communication behavior 133_208 They do. other communication behavior 133_210 Well you said before you had an opportunity to pick up and start dealing again. reflection communication behavior 133_212 And-and so-so-so there's opportunities- there's opportunities in one world, and I'm wondering about what might make it hard to see opportunities in a different world? question communication behavior 133_214 Sure, sure. You're in the system- reflection communication behavior 133_216 -you're not in the system. Pick up that, where is it gonna take you? question communication behavior 133_218 Yeah, what-what's gonna happen if you start dealing again? question communication behavior 133_220 Yeah. other communication behavior 133_222 Okay, okay. other communication behavior 133_224 So-So again, I'm-I'm wondering about this other world, and you're saying it doesn't look to attractive at the moment. reflection communication behavior 133_226 You can't se it? question communication behavior 133_228 Yeah? other communication behavior 133_230 Yeah? You just described to me how it looked like a minute ago. reflection communication behavior 133_232 Minimum wage- reflection communication behavior 133_234 -night shift, petrol station. reflection communication behavior 133_236 Yeah? other communication behavior 133_238 Yeah? It is really hard. therapist_input communication behavior 133_240 Sure. other communication behavior 133_242 Sure. We talked about courage before and you've got the guts to be talking with me about this stuff today, and I'm wondering if you actually do have some courage to think about these ideas. I'm not saying that pumping gas at minimum wage is where you wanna go, but-but the guts to actually start steeping into this other world. I wonder if you do have, I'm-I'm-I'm just not sure. reflection communication behavior 133_244 Maybe. You're not convinced at the moment, I understand that and, um— other communication behavior 133_246 Sure. Well, it's hard to me to convince you- therapist_input communication behavior 133_248 -'cause this is your life and this is your story, and you-you've got to walk your life and I can't walk your life for you. I only walk my. And so, but I can walk with you on this life to try and think about-- 'Cause I-I-- You know, I-I've no interest in actually you falling over and going back into-into a lifestyle a crime 'cause I know where it'll take you. And I'm hearing that with your relationship, where it's going to take your relationship too, [unintelligible 00:16:39] got the bottom line drawn pretty clearly. reflection communication behavior 133_250 So it seems like what's gonna push in this direction, just tip that balance a little bit to give this other world of go? Because it is new, it's different. It means doing stuff, a lot of stuff actually that-that's kind of mundane. question communication behavior 133_252 It's kind of cool? question communication behavior 133_254 Not part of on the wire? reflection communication behavior 133_256 No? question communication behavior 133_258 You don't. And who's sitting on the porch with you? question communication behavior 133_260 Mm-hmm. other communication behavior 133_262 Cool. So I'm picking up this world actually has the freedom to you to be your own man? reflection communication behavior 133_264 Maybe? question communication behavior 133_266 Yeah? other communication behavior 133_268 Yeah. other communication behavior 133_270 Yeah it is. It is. other communication behavior 133_272 Absolutely massive. And, uh-- So, is there a challenge you're up to, to start creating some-some-some of that sort of world for Fiona? 'Cause I'm hearing that— question communication behavior 133_274 Sure. So what I'm hearing is, you're not convinced at the moment. reflection communication behavior 133_276 "No. So what would convince you to-to make that shift? 'Cause I hear a lot of kind of-- And in this hard, like, y-you've done time and then once you've got a record, the employers- you know, we know, I know that. That's-that's not easy. You can't just wonder into a job, a high-paying job and go, ""Pick me, pick me, pick me."" I know that." question communication behavior 133_278 You know that. other communication behavior 133_280 So, um-- And-and maybe it's about small steps and first steps. therapist_input communication behavior 133_282 Well, you trying to get a job, maybe and get into some routine. other communication behavior 133_284 Okay. other communication behavior 133_286 "Yeah. I'm confused though at the moment because you're saying, ""Yeah, I could make in a night what you make in a week,"" but you've haven't. 22-22 days-" reflection communication behavior 133_288 -and you haven't done that. So-so tell me what that's about. question communication behavior 133_290 So you told yourself you wouldn't, so you're once you- you're the sort of guy that once you make a decision you're gonna go, you're staunch with that decision? question communication behavior 133_292 Oh, it's a decision whether it's right or wrong-- It's not gonna be- reflection communication behavior 133_294 Yeah, you're that kinda guy okay, so once you make a decision. So you made a decision that you're not gonna- you're not gonna go back to dealing? reflection communication behavior 133_296 Yet. question communication behavior 133_298 You're keeping the door open- reflection communication behavior 133_300 -at the moment, is what I'm picking up. reflection communication behavior 133_302 Yeah, okay, so that will be a call you-you've got to make. other communication behavior 133_304 I'm-I'm not gonna- I'm not gonna make that call. You'll make that call, but there's a consequence of making that call, and there's big consequences more time probably and Fiona not being around. On the other hand, what I'm picking up is a call to-to do some- do some stuff that may not be racy and exciting and in the big dollars, but me being with Fiona and engaging in this transition into a-a different life. reflection communication behavior 133_306 Yeah. other communication behavior 133_308 No. other communication behavior 133_310 But we're talking about it. other communication behavior 133_312 So how much time have you been talking about this- question communication behavior 133_314 -position? question communication behavior 133_316 Okay-okay, so the fact we're even having a conversation about it, it's kind of interesting? reflection communication behavior 133_318 Yeah, so I wanna summarize, Daryl, what-what I picked up so far and then just so I make sure I'm really listening to you well 'cause it's important, isn't it? 'Cause, you know, it's important you're listened to- question communication behavior 133_320 -by people me. So what I'm picking up is-is-is that if you've-you've got this long 12-year history, you can make some big money or you can dealing, doing crime, that stuff, I'm-I'm picking up that Fiona's set the bottom line, is if you go back in that lifestyle, she's out of here, yet she stayed here for 13, 12, 13 years? reflection communication behavior 133_322 Nearly 13 years, so and-and so-so she stuck with you, and I'm pick up that's important to you, um, and-and-and yet you talk about it, it just seems easy, this bit over here, this whole lifestyle. reflection communication behavior 133_324 This other lifestyle over here though when we talk about, actually thinking about, you know, doing stuff, doing the stuff that-that everybody else generally does, [unintelligible 00:22:30] will gets on doing, it doesn't have that same kinda seem to excitement, and it doesn't seem to be a-a starting point for you over here. reflection communication behavior 133_326 Oh, it does? reflection communication behavior 133_328 Right, okay. other communication behavior 133_330 Okay, you're over that one, okay. So, let's start to think about what might be the first step. therapist_input communication behavior 133_332 Yeah, with while going in, I think you got a high steep. reflection communication behavior 133_334 Yeah, a steep, you see before you had a mate who turned his back on offending. reflection communication behavior 133_336 And for him this 12-- You wondered that the 12-step stuff working for him. reflection communication behavior 133_338 Yeah, maybe that, I'm wondering the conve- the conversation with him that might be around actually how did he do it, and how did he stay without slipping back across the line, 'cause like-like get this crossroads you've got the path and go the other path and go here, so I'm wondering about conversation with him, what would it take to have that conversation? question communication behavior 133_340 Ringing him? question communication behavior 133_342 Yeah. You seem a little surprised, I'm-I'm [crosstalk] wondering about, surprising face. reflection communication behavior 133_344 So possibility to call? other communication behavior 133_346 Yeah there's possible. other communication behavior 133_348 Yeah, okay, and Fiona's been pretty staunch. reflection communication behavior 133_350 Is someone who actually who has some pretty clear ideas about where she wants you as a couple to go- reflection communication behavior 133_352 -I get a sense. other communication behavior 133_354 Yeah. other communication behavior 133_356 Yeah, but I'm picking up though behind that doing what you're told, she's got some hopes. reflection communication behavior 133_358 So what will it take for you to start thinking about some of her hopes and sharing some of her hopes? question communication behavior 133_360 Yeah? other communication behavior 133_362 You said before you're sort of guy that once you make a decision you're pretty staunch with that decision. reflection communication behavior 133_364 So if you made a decision to go there, it might be a scary as shit but again it seems that, uh, it could work if see it look, this is important, this relationship's important, let me go for— reflection communication behavior 133_366 Sure. other communication behavior 133_368 Yeah. That's-that's what I'm thinking- I'm thinking actually. Here's someone that actually has made a different decision then, uh, it sounds like that's the pathway that starts over here and I'm wondering. I wonder whether you might have wisdom about what it's like to t-to tread that path. reflection communication behavior 133_370 So you know there's a part of you going, I was thinking in this place that's hard work. reflection communication behavior 133_372 And this is a pretty lonely road to-to walk by yourself. I'm wondering who else might be around you that might actually walk with you? question communication behavior 133_374 Yeah. other communication behavior 133_376 You know maybe they'll walk that road with you too. other communication behavior 133_378 There's a couple of people. other communication behavior 133_380 If you want to do that. It gotta be your call. therapist_input communication behavior 9_0 So now that we've discussed a little bit of your medical history and- and taking your vitals, I'd like to ask you a few more questions. The- therapist_input communication behavior 9_2 -the rise in your blood pressure is concerning to me, so I'd like to gather a bit more information about your lifestyle. therapist_input communication behavior 9_4 Okay. Have you had any major stressful events recently or any change in your work situation? question communication behavior 9_6 Yeah, that's certainly true. I'd also like to ask about some health habits that can contribute to high blood pressure. other communication behavior 9_8 Okay, do you smoke at all? question communication behavior 9_10 Okay, great. Um, do you drink alcohol, including beer or wine? question communication behavior 9_12 Okay. Well, I'm concerned about the amount that you're drinking currently. It sounds like you're having about 15 to 20 drinks per week, and that's definitely more than what we would recommend and could certainly be contributing to your high blood pressure. therapist_input communication behavior 9_14 Well, according to your chart, your blood pressure has gone up since July, and you said that you've been drinking more recently, so do you see the connection there? therapist_input communication behavior 9_16 Alcohol can have some dangerous effects on your body. So along with contributing to high blood pressure, it can have a big impact on your liver, which you need to keep in mind. So your liver has several different roles in your body. First, it helps process excess fatty acids before they get distributed to the rest of your body. It also helps process alcohol and other drugs. So when you have an excess of alcohol, your liver can't work as efficiently and the fatty acids build up, and over time, your liver won't be able to work as well. therapist_input communication behavior 9_18 Okay. And how about the use of other drugs like cocaine, heroin, marijuana? question communication behavior 9_20 Okay. Have you ever used any prescription medications that weren't prescribed for you or in a way that wasn't prescribed? question communication behavior 9_22 Okay, excellent. Well, it sounds to me like the increase in your drinking could certainly be contributing to your high blood pressure. I think decreasing the number of drinks that you have when you go out and maybe decreasing the number of times that you go to the bar each week could be the best thing that you can do for your health. therapist_input communication behavior 9_24 Okay. And then we'll set up an appointment for about a month from now. We'll recheck your blood pressure and see how you're doing with all this, sound okay? therapist_input communication behavior 9_26 Okay. other communication behavior 10_0 Hi. You are [unintelligible 00:00:02]? question communication behavior 10_2 Okay. Um, what brings you in? question communication behavior 10_4 Mm-hmm. I see- I see that your A1C or your blood glucose is very high. therapist_input communication behavior 10_6 Mm-hmm. Well, you do need to take your medicine. We, uh, will need to start dieting, uh, you know, lose some weight, change-change your eating habits, exercise, uh, to get your diabetes under control, because your doctor is right, it is very serious. therapist_input communication behavior 10_8 So, it sure can. therapist_input communication behavior 10_10 So, uh, you know, we-we need to start looking at doing all those different things to get your diabetes under control 'cause your-your number is very high. therapist_input communication behavior 15_0 Can I help you? question communication behavior 15_2 So you want nicotine replacement, but you don't wanna quit smoking? reflection communication behavior 15_4 We don't really recommend that. The idea is you would use the nicotine replacement to actually quit, so then you wouldn't be smoking at work, but you also wouldn't be smoking the rest of the time either. therapist_input communication behavior 15_6 Okay. Well, smoking really is really bad for you, you know. It causes things like lung cancer, emphysema, heart disease- therapist_input communication behavior 15_8 -oral diseases. therapist_input communication behavior 15_10 Well, to be honest with you, you mentioned the patch. I can't recommend a patch to you if you're gonna continue smoking. That can actually be pretty dangerous for you. In order to advise you about this at all, I need you to tell me a little bit more about your smoking history and how much you're smoking now. therapist_input communication behavior 15_12 Okay. Well, we actually consider 20 cigarettes a day to be a significant amount, and in fact, I would then recommend to you that you would start on the highest dose of nicotine replacement. therapist_input communication behavior 15_14 Well, there are some products that you could use to take away some of your cravings, and probably the gum would be the best option for you. It's not something you would continue to use continuously throughout the day, however, but gum is something you use just when you have a craving. therapist_input communication behavior 15_16 Well, we have that here, but again, the-the idea would be for you to actually quit smoking. therapist_input communication behavior 15_18 Well, aside from the gum, you could try the nicotine lozenge, that would be another option for you. Again, that's not something you'd wanna use continuously throughout the day. The nicotine patch is the best for continuous nicotine replacement, but again, that's not something you can use while you're continuing to smoke. therapist_input communication behavior 15_20 Okay. other communication behavior 17_0 Okay, so I'm just gonna ask you a couple of more background questions. therapist_input communication behavior 17_2 Do you use any tobacco products, or smoke cigarettes? question communication behavior 17_4 Okay. How about in the last year? question communication behavior 17_6 Okay. And how often do you have a drink containing alcohol? question communication behavior 17_8 Okay. So it sounds like you're drinking about four times a week, anywhere between three and eight drinks on a given day. So, maybe around 20 drinks a week? question communication behavior 17_10 Okay. Do you use any street drugs like any marijuana, cocaine, heroin? question communication behavior 17_12 Do you, um, do you ever use any prescription medicines that were not prescribed for you, or ever use your own prescriptions in a way on which they were not prescribed? question communication behavior 17_14 Okay. So, you know, as we said before, you're drinking-- it sounds like you're drinking about 20 drinks a week, over the course of a few days. And I did want to point out to you that the recommended limit for women is actually no more than seven drinks a week, and no more than three on a given day. therapist_input communication behavior 17_16 So you're doing more than that right now. And when you drink more than this amount, it puts you at risk for a number of things, okay? Things like greater risk of injury, damage to different parts of your body, um, just a bunch of different problems. And, uh-- so I'm going to recommend that you cut down- cut down that amount to the recommended limit. Again, that's no more than seven drinks a week and no more than three on a given day. Do you think you could do that? Would that be a good goal for you? therapist_input communication behavior 17_18 Yeah, I know that making changes isn't always easy. But when you drink more than what's recommended, it creates problems. You know, you said you hurt your ankle when you came out of the bar this time. reflection communication behavior 17_20 Yeah. Well, it's possible you strained your ankle as a result of the alcohol. You know, it can actually affect your balance and stability. So, really, you know, for where you are right now, you're drinking a good amount more than what's recommended. And, you know, I want you to be healthy. And I don't want to see you coming back in here for something else. So I'm really gonna recommend that you try to cut down to that amount. So, do you think you could do that, cut down to no more than three drinks on a given day? therapist_input communication behavior 17_22 So, it sounds like, you know, the amount you drink is pretty normal- reflection communication behavior 17_24 -amongst the people you typically drink with. But these limits are-- they're actually recommended for all adults. And studies have shown that when you drink more than this, it creates a bunch of problems like we talked about. So, you know, why do you think you drink the amount you drink? therapist_input communication behavior 17_26 Well, I think you can still have fun within these amounts. So that's what I'm gonna recommend. Um, I think this is a really good goal, and hopefully, we won't see any more injuries. Okay? So why don't you try that? therapist_input communication behavior 17_28 All right. Thank you so much. other communication behavior 27_0 I understand that your asthma symptoms have been just really out of control. So, we need to look at some of the ways that you can get healthy and not be back here again. therapist_input communication behavior 27_2 Yeah. other communication behavior 27_4 Well, you sound a bit surprised by that. But I'm sure that you've seen some of the material that-that the clinic gave you about asthma symptoms and managing your asthma, and pets are a really big source of problems in that respect. therapist_input communication behavior 27_6 Mm-hmm. other communication behavior 27_8 Well, uh, wait a second, Sal, what do you mean you-you- ha- If you-- As in-- You know to be informed about-- I'm just really taken aback by that because I understand from your chart that you have a young baby- other communication behavior 27_10 -a new baby. other communication behavior 27_12 -and you are very concerned about your health, you wanna be there for your baby and that you've already taken some steps, you've-you've almost quit smoking- reflection communication behavior 27_14 -which is fantastic. So, the next step is to really deal with the dog, deal with the pet. I know it's- so- It's gonna be hard to do that. But there are always people who will adopt animals. I'm sure that you have friends or family members. therapist_input communication behavior 27_16 It's you that I'm worried about, Sal. It's you that I'm worried about, okay? The-the symptoms are worse. You've had two or three major asthma attacks. And-and do you appreciate how-- This is, uh, a risk to your life that there are some-some adults with severe asthma who actually can die as a result of their symptoms? It-it truly is something to take very, very seriously. I can't emphasize that enough. therapist_input communication behavior 27_18 Sal, what, uh, do you understand that what happened 6 years ago or 10 years ago, your asthma is progressively getting worse. You know very well that the puffers, the strength of the medication is getting higher and higher, and there's only so much that can be done with medication alone. You know this. therapist_input communication behavior 27_20 Sal, you're almost on the strongest one. And if Oscar is that important to you, then do you put Oscar higher than your baby, than your wife? Like, uh, that makes no sense to me. Do you understand how important this is? therapist_input communication behavior 27_22 Uh, okay, well other communication behavior 32_0 In summary, the Minnesota State, Mankato security report states that you were stopped on Stadium Road last Friday, cited for driving under the influence, and then you were transported to detox. Plus, you're only 21 years old. Is the report accurate? therapist_input communication behavior 32_2 Okay. Behavior like this could get you suspended, doesn't that concern you? therapist_input communication behavior 32_4 What were you thinking when you got into your car after having six beers, you could have caused an accident and killed somebody. question communication behavior 32_6 You need to take responsibility for your actions. If you keep partying like this, your problems will only get worse. You're likely to face costly legal citations, poor grades, health problems. Getting kicked out of school and disappointing your parents. You don't want that to happen, do you? therapist_input communication behavior 32_8 Your behavior is not what Minnesota State University expects of its students. If you wanna be a student here, you'll need to show that you're able to follow our rules. Do you think you can do that, otherwise, you'll be suspended? therapist_input communication behavior 32_10 Okay. Well, your sanction is you'll be placed on university disciplinary probation and you'll have to attend an alcohol education seminar that'll cost you $150. Also, disciplinary action is progressive and cumulative, meaning that any further violations will result in suspension for one semester or longer. therapist_input communication behavior 44_0 Hey, hi, Andrea. Thanks for coming in today. So I don't know how much you've been told about why you're here, but basically, it's my job just to meet with all the students. I usually meet with you once or twice a semester. And I'm going to be talking to you kind of about your life and your goals and some behaviors that you might engage in and just the sorts of things like that. reflection communication behavior 44_2 So why don't you start by telling me a little bit about yourself? question communication behavior 44_4 Oh. other communication behavior 44_6 Okay. other communication behavior 44_8 Okay. How long ago did you start playing saxophone? question communication behavior 44_10 Wow. That's a long time. What other instruments? question communication behavior 44_12 No kidding. other communication behavior 44_14 That's awesome. And you play tenor sax? question communication behavior 44_16 Wow. And how long have you been in marching band? question communication behavior 44_18 Okay. Couple of years. Great. And how do you like Marching Band? question communication behavior 44_20 What are your favorite parts about it? question communication behavior 44_22 Oh, okay. other communication behavior 44_24 Uh-huh. other communication behavior 44_26 Okay. other communication behavior 44_28 Cool. And do you have a lot of friends who are in band with you or- question communication behavior 44_30 -friends outside of band or? question communication behavior 44_32 Okay. other communication behavior 44_34 Great. And then, um, tell me a little bit about your family? question communication behavior 44_36 Oh, wow. other communication behavior 44_38 Okay. What kind of dog do you have? question communication behavior 44_40 Oh, nice. other communication behavior 44_42 Charlie. other communication behavior 44_44 Oh, cute. Have you had him a long time? question communication behavior 44_46 Oh gosh. Yeah. Okay. Very cool. And what are your plans for after high school? question communication behavior 44_48 Wow. other communication behavior 44_50 You've got big dreams. other communication behavior 44_52 Cool. All right. Have you started thinking about schools or majors? I guess you're thinking about psychology as a major. question communication behavior 44_54 Right. other communication behavior 44_56 All right. And how about your grades? question communication behavior 44_58 Okay. Good. Very good. All right. Well, what are the kinds of things do you do for fun on weekends? question communication behavior 44_60 Mm-hmm. other communication behavior 44_62 Mm-hmm. When you're hanging out, is there ever alcohol? question communication behavior 44_64 Uh-huh So how often do you think you drink alcohol? question communication behavior 44_66 Oh, so you're drinking a lot? question communication behavior 44_68 Okay. And how much are you drinking on the days that you're-- on the days that you drink? question communication behavior 44_70 Mm-hmm. other communication behavior 44_72 Mm-hmm. other communication behavior 44_74 Got it. So you've-you've had some pretty heavy drinking. What-what do you think is the most you've ever had? question communication behavior 44_76 Yeah. other communication behavior 44_78 Okay, so you don't even know. question communication behavior 44_80 Okay. So, and then your friends drink too? question communication behavior 44_82 Okay. And how much do they typically drink? question communication behavior 44_84 Okay, so it's one cup, but it's not-not one drink. other communication behavior 44_86 It has a lot of alcohol in it. other communication behavior 44_88 Okay. Um, so gosh, you're-you're actually really drinking quite a lot. Um, you know, your level of drinking puts you in what we call a high-risk group. therapist_input communication behavior 44_90 So, is that surprising to you? question communication behavior 44_92 Yeah. Um, so we call it high-risk because it means that there's actually quite a bit of chances that you're gonna have some bad consequences from drinking like that. So, you know, things like, um, having car accidents, or other accidents, or getting in fights, or, you know, sexual assault, or health problems, or developing alcoholism. Have you thought about those things? question communication behavior 44_94 Uh-huh. other communication behavior 44_96 Uh-huh. other communication behavior 44_98 Okay. So it's, um, so it's good, because you're not drinking and driving, but you're still really drinking a lot. Um, and yeah. Okay. So, let's-let's talk a little bit about that, how you might be able to make some changes. Because I think you really need to- need to stop drinking like this. other communication behavior 44_100 So, um, do you think you could quit drinking or? question communication behavior 44_102 Uh-huh. other communication behavior 44_104 Uh-huh. other communication behavior 44_106 Okay. So, does that mean you're gonna stop drinking? reflection communication behavior 44_108 Uh-huh. other communication behavior 44_110 Okay. Um, you don't sound very much like you think that's gonna work. reflection communication behavior 44_112 Mm-hmm. other communication behavior 44_114 Okay. So, how are you gonna quit drinking without your friends thinking you look stupid? question communication behavior 44_116 Okay. Um, so I mean, do you think they're really good friends of yours if they're gonna give you such a hard time? question communication behavior 44_118 Uh-huh. other communication behavior 44_120 It sounds like you might be better off without them though. They’re- reflection communication behavior 44_122 - maybe not very good friends. reflection communication behavior 44_124 Mm-hmm. So, um, so I think we should set a goal that you're gonna stop drinking. therapist_input communication behavior 44_126 And, um, I think you should probably stop as soon as possible, like this weekend. therapist_input communication behavior 44_128 Um, so the way this normally works is, you know, we set you a goal, and then I'll have you come back and we'll talk about it again in a couple of weeks and make sure that you actually stopped. Um, and so what do you think about that? therapist_input communication behavior 44_130 Okay. So- other communication behavior 44_132 Okay, great. So, the plan is gonna be that you're gonna quit and, um, the friends that you have that you don't think are supportive, you're just gonna, I guess, not hang out with anymore. other communication behavior 44_134 Okay. And then, um, you know, like, are your friends in band drinking? question communication behavior 44_136 Uh-huh. other communication behavior 44_138 Okay. So, that might be good, is really just to focus more on band. Um, because you know, the other big concern I have for you is if you wanna go to medical school, you're not ever gonna get into medical school if you're drinking like this. other communication behavior 44_140 You know, like college is gonna be really hard. And especially with all those pre-med classes, you're not gonna be able to handle it drinking this much. You know, have you thought about that? question communication behavior 44_142 Yeah. Okay. So, setting this goal then of quitting drinking is gonna be really helpful for you. And um, it sounds like i-it shouldn't be that tough really, um, especially because you can just stop hanging out with- therapist_input communication behavior 44_144 -the people who drink a lot, um, since you have some other friends. Um, yeah. So, do you have any questions for me or? question communication behavior 44_146 Mm-hmm. other communication behavior 44_148 "Well, you know, one good option would be to just review with them review with them all the bad things about alcohol. You can say, you know, ""I thought about it, and I realized it's gonna mess up my schoolwork. And you know, it's really a lot of risk for my health."" ""I don't want to become an alcoholic."" Um, you know, ""I don't want to get liver disease."", ""I don't want to end up driving drunk or getting into accidents-" therapist_input communication behavior 44_150 "-or getting in fights."" You know, one thing you could bring up is, ""I've heard a lot of stories about kids who you know, are at parties and they're drunk and acting stupid, and then people post stuff on Instagram.""" therapist_input communication behavior 44_152 And you know, that's it for their social life. It's like over. other communication behavior 44_154 So— other communication behavior 44_156 Mm-hmm. other communication behavior 44_158 Yeah. So I think just tell your friends you know, you realized there's always bad things about it and you don't want to do it anymore, so you're just not going to. therapist_input communication behavior 44_160 And then- other communication behavior 44_162 -you can tell them to stop too. You know, then that'd be really good. You'd being a good friend. other communication behavior 44_164 Yeah. Yeah. Exactly. All right. Any other questions or anything else I can help with? question communication behavior 44_166 Okay. So, like I said, I'll plan to meet with you again in a couple weeks. other communication behavior 44_168 And make sure that you actually quit drinking. other communication behavior 44_170 All right. other communication behavior 44_172 Great. other communication behavior 53_0 Hi, Laura. So, thanks for coming in. I'm not sure how much you know about why you're here or what we're supposed to talk about. So, basically, I'm going to be meeting with all the students in the school usually once or twice per semester. And we're going to talk about, you know, whatever's kind of going on in your life. I'll ask you some questions about, you know, your goals and what you like to do for fun and those sorts of things. And then we'll talk a little bit about, you know, different behaviors and-and stuff like that. And so, it's-it's pretty casual, pretty informal, just sort of a chance for me to get to know you if that's all right. question communication behavior 53_2 Okay. Why don't we start by just having you tell me a little bit about yourself? question communication behavior 53_4 Okay. And what do you like to do for fun? question communication behavior 53_6 Mm-hmm, and when you and your friends are hanging out, and what- what do you do? Do you go to football games, go to parties? question communication behavior 53_8 Okay. And what kind of hobbies do you have? question communication behavior 53_10 Oh, cool. What are your plans for after high school? question communication behavior 53_12 That's great. What do you think you'll study? question communication behavior 53_14 Oh, neat. other communication behavior 53_16 Yeah, that's great. That's a really good goal. other communication behavior 53_18 It's, uh, hard work to get into law school. Are you doing well in school? What kind of grades do you get? question communication behavior 53_20 Okay. What classes are you not getting A's and B's in? question communication behavior 53_22 Okay. And do you know where you're going to apply to college? question communication behavior 53_24 Okay. Cool. And, you know, what made you decide maybe law school or-or journalism? question communication behavior 53_26 Okay. Great. Sounds like you have, like I said, really good goals and you're working hard in school. Um, you said that when you're going out with your friends, you like to hang out and shop and stuff like that and also go to parties, so do you drink alcohol? question communication behavior 53_28 Okay. And how often do you think you drink? question communication behavior 53_30 Mm-hmm, so like once or twice a month you're having alcohol? reflection communication behavior 53_32 Okay, and so that's maybe like 20 times a year. question communication behavior 53_34 So that's actually kind of a lot of drinking then? reflection communication behavior 53_36 Okay. What do you think is the most you've ever had? question communication behavior 53_38 But you've been drunk before? question communication behavior 53_40 Okay. Um, so the most you've ever, ever had is two drinks in a day. reflection communication behavior 53_42 Okay. Interesting. So, do you know all the bad stuff about alcohol? question communication behavior 53_44 Okay. Um, so one of the things that, you know, is really important to talk to teenagers about is drinking and driving. So, um, you know, that's actually a really big problem. And even around here, we have kids die every year from getting in a drunk driving accident. So that's something that you really need to make sure you're not doing, all right? Have you ever done that? Have you ever gotten in the car- question communication behavior 53_46 Okay. Uh, how much do your friends drink? question communication behavior 53_48 Okay. What about at these parties you're going to, are there other kids there who are drinking a lot? question communication behavior 53_50 And do you hang out with them? question communication behavior 53_52 Mm-hmm, so, you know, even just hanging out around kids who are drinking a lot actually puts you at a lot more risk. Did you know that? question communication behavior 53_54 Yeah, so, there, I mean, a lot of the other dangers of drinking, like, um, not just car accidents, but you can have other accidents, you know, people, um, you know, will fall or, um, you know, break things or a lot of people actually end up breaking their bones and ending up in the emergency room because they've been drunk and falling down or, you know, as a girl, it's really important too that you're careful because you could be sexually assaulted. therapist_input communication behavior 53_56 You know, especially if you've been drinking, then, you know, you're at a lot more risk because a guy can take advantage of you. Did- have you thought about that? question communication behavior 53_58 Mm-hmm. other communication behavior 53_60 And then, um, you know, people get in fights more often when they've been drinking too. Um, also, you know, there have been a lot of kids, even at this school, who've gotten in trouble because they were drinking and someone took pictures with their cell phone and put it up on Facebook- therapist_input communication behavior 53_62 And then their parents find out or the school finds out and, you know, we have a no-tolerance policy here about drugs and alcohol, and really can get you into trouble, and it could put your whole college career in jeopardy. Have you thought about that? therapist_input communication behavior 53_64 But you're still drinking. other communication behavior 53_66 Uh-huh. So, I mean, do you think it's the thing to do if you wanna be an attorney? question communication behavior 53_68 Mm-hmm. other communication behavior 53_70 Mm-hmm. Okay. Hmm. So, I mean, I guess what we need to do then is kinda talk about some goals for how to be- other communication behavior 53_72 -safer. other communication behavior 53_74 Um, obviously, you shouldn't be drinking at all. Um, what do you think about that? question communication behavior 53_76 Mm-hmm. So, do you think you can quit? therapist_input communication behavior 53_78 Okay. So, I'm going to write down then that you've decided to quit. therapist_input communication behavior 53_80 And, um, that's gonna be your goal, and that's great, you know, that's really why we're here, is to talk about that and-and make sure that you come to that decision. Um, so, I guess, can you quit this weekend then? therapist_input communication behavior 53_82 Okay, and then what about your friends who are still drinking? question communication behavior 53_84 Okay, and-and what if they won't? question communication behavior 53_86 Yeah. Probably if your friends won't quit drinking, you should just find new friends. other communication behavior 53_88 'Cause, you know, the problem is if they're drinking, they're gonna pressure you into drinking and then you're gonna feel awkward and, you know, you're gonna be stuck and-and not know what to do and really you'd just be better off probably without them. If they're- if they're the kind of people who are gonna keep drinking- reflection communication behavior 53_90 -they're probably not a good influence. reflection communication behavior 53_92 Um, and then, then you'll be better set for college too because, you know, the issue is you're getting good grades now, but when you get to college, it's a lot harder and, you know, if you're needing really good grades to get into law school, which you will need, then you really can't be distracted by alcohol. other communication behavior 53_94 Okay, so, um, that's great 'cause it pretty much covers all the stuff that I think I needed to go over with you. Um, let's see. I guess we didn't talk about what would happen if your parents found out you were drinking. other communication behavior 53_96 Mm-hmm. other communication behavior 53_98 Okay, so, yeah, just another reason why you probably need to just quit then. Um, okay, yeah. I-- Okay, so, like I said, I'm gonna right down here that you've decided to quit and, um, uh, you know, I'm gonna be meeting with you again probably in the next semester sometime, so we can kinda check-in and-and make sure that, you know, that's still going well- therapist_input communication behavior 53_100 -and you're still not drinking and not hanging out with any people who are drinking. Um, is there anything else you'd like to talk about while you're here? therapist_input communication behavior 53_102 Okay. Um, any questions or anything- question communication behavior 53_104 -like that? question communication behavior 53_106 Okay. You're sure? Okay. All right. Um, well, that's probably it then. You can, uh, head back to class and-and thanks for coming in. other communication behavior 57_0 Mr. Johnson? question communication behavior 57_2 Uh, I'm here to talk to you about, uh, your cholesterol and the, um, medicine your doctor prescribed. other communication behavior 57_4 But well, it's my job too, uh, to-to help you understand how to use your medicine and, uh, give you information about getting the most benefits from it. other communication behavior 57_6 So your-your-your doctor told you that if your cholesterol remains elevated, you're at risk of stroke or heart attack? therapist_input communication behavior 57_8 Okay. Well, the-the side effect is something that's very, very rare, it's not really something you need to worry about, and the risk of stroke or heart attack is much worse. therapist_input communication behavior 57_10 Well, I-I-I understand that. Um, but like I said, it's very rare. If you feel some muscle weakness, you'll let your doctor know. It's not permanent, okay? Yeah, it won't get to the blood- it won't get to the point where it affects your job— therapist_input communication behavior 57_12 You- you really need to take it, and-and like I said, the-the muscle weakness is rare. If you feel muscle weakness, just let your doctor know. He can take you off or switch. It's not permanent. therapist_input communication behavior 57_14 It's-it's not permanent. other communication behavior 57_16 Okay? So a stroke or heart attack is much worse, so make sure you go ahead and pick up your medicine as you're on your way out and, uh, one-one every day to get your cholesterol down. therapist_input communication behavior 57_18 Okay. other communication behavior 59_0 So, what you told me earlier was that you've got into a car with someone you knew had smoked marijuana earlier. What were you thinking? therapist_input communication behavior 59_2 Science fair project or not, don't you know what happens when someone drives under the influence of marijuana or alcohol? It's bad. They can wreck the car, you can lose your life. I thought you were smart, you're taking AP classes, you wanna get into a Ivy League school. This is not the way you do that. therapist_input communication behavior 59_4 It's a big deal. You can't drink either. You're 16. The drinking age is 21. I think you know that. You could get into an auto crash. Uh, I just wanted you to hear this. I don't' tolerate it as a doctor drinking or driving with somebody who's under the influence, and if you do it again, I'm gonna tell your parents. therapist_input communication behavior 69_0 Hi, Dr. Martin. I heard you had a question for me. What did you want to talk about? question communication behavior 69_2 Yeah, I'm the pharmacist on duty. Citalopram, okay. It's an antidepressant and it comes in 10, 20, and 40-milligram strengths. It's excreted in the urine and it has a half-life of about 35 hours. For side effects, there are sexual side effects, heart side effects, and stomach side effects. therapist_input communication behavior 69_4 Oh, um, yeah, I think that should be fine. therapist_input communication behavior 69_6 All right, thanks. Call me anytime. other communication behavior 72_0 All right, Chris, so I need to talk to you because as you know, we have a zero-tolerance policy for drugs and alcohol at this school. And as-as athletic director, it's my job to check in with our student-athletes and make sure everyone's adhering to that rule. And I've been hearing some chatter from some of the other kids about a party this weekend, and from what I hear, where you were there and, you know, I can't confirm or deny anything. So I'm not at the point where I can give you consequences, but I did want to talk to you about whether or not you're drinking and how, you know, you really can't be doing this as a member of one of our teams. therapist_input communication behavior 72_2 Mm-hmm. other communication behavior 72_4 Yeah, you know, I get it. Like, we've all been there. Okay. You know, I was in high school ones too, you know, I drank too. I get it. There's not a ton to do in this town a-and kids drink, but, you know, promise we have these rules- therapist_input communication behavior 72_6 -and you're on a team, you have to stick by the rules. therapist_input communication behavior 72_8 Yeah. Chris, come on. You're getting peer pressure? therapist_input communication behavior 72_10 Yeah, but you're one of the leaders. therapist_input communication behavior 72_12 Yeah. Well, maybe you can start leading as a non-drinker then. therapist_input communication behavior 72_14 You're a star player, who's going to pick on you? question communication behavior 72_16 All right. Well, yeah. So the issue again is I can't be hearing reports about you drinking. I can't be hearing that you're at parties and you can't be seeing pictures on Facebook. You know, there-there are rules at this school and in my job, I have to enforce them. So, you know, like I said, I get it, you know- therapist_input communication behavior 72_18 -I'm not saying I know what it's like. I-I get that you want to have fun in your teenage years. I get that. But, you know, you are a star player, we want to keep you on the team. You know, we got to figure out a way to get through this. therapist_input communication behavior 72_20 What do you mean? question communication behavior 72_22 All right. Yeah. I mean, we got to have a deal here if you're going to be on the team. Okay? therapist_input communication behavior 72_24 All right. You promise? other communication behavior 72_26 All right. Shake. question communication behavior 72_28 All right. I'll see you later. other communication behavior 72_30 All right. other communication behavior 74_0 Hi, Emily. How are you? question communication behavior 74_2 I'm good. Um, wow, what's changed? What do we have here? question communication behavior 74_4 Emily, why? Why did you get your lip pierced? question communication behavior 74_6 You're- other communication behavior 74_8 -gorgeous. Your teeth are lovely. You do not need a piercing. therapist_input communication behavior 74_10 Do you know what- question communication behavior 74_12 -those oral piercings can do to your teeth? question communication behavior 74_14 Well, yes, except that, you know what's gonna happen. See how-- Do you feel how when you're moving your lips-- Smile for me. Okay. So, do you see how when your muscles are moving, that piercing is rubbing against your gums- therapist_input communication behavior 90_0 So, Tommy, I wanted to talk to because I was on Facebook the other day and saw some pictures that are kind of concerning to me of you and some of your friends at a party, and, you know, you're such a good kid. Like, I don't know what you're doing drinking. It's going to ruin your life. therapist_input communication behavior 90_2 But, Tommy, there's so many consequences with drinking. You know, you're not even 21 yet, you could get arrested, you could, you know, have a drunk driving accident. You could, you know, mess up your schoolwork. You have such a bright future ahead of you. It just really, really concerns me. therapist_input communication behavior 90_4 There's really no such thing as not drinking too much. I mean, anything that's drinking when you're underage is drinking too much, you know. Like, think about it, think about all the things that can happen to you. therapist_input communication behavior 90_6 How much are you drinking? question communication behavior 90_8 Is it like every weekend? question communication behavior 90_10 Tommy, I'm just so concerned, you know, can't you think of anything better to do? question communication behavior 90_12 Yeah. Is-- are your friends the problem, like maybe you should just start hanging out with more kids in the youth group and not hang out with those kids that you were partying with? therapist_input communication behavior 90_14 Well, there's a lot of things that seem fun in the moment that we know aren't a good choice, right? That's some of the things we talk about all the time is making good choices for our life and-and really doing what's best for you. And I just, you know, I really think you should think about making a big change here. therapist_input communication behavior 90_16 I think you really need to quit. therapist_input communication behavior 90_18 I think you're wrong. You know, it really worries me. Anyway, um, I wish you would quit. If all you're going to do is cut down, that's better than nothing. You know, I appreciate you talking to me about this, but I'm gonna keep talking to you about it. It's really important. therapist_input communication behavior 90_20 Do you wanna wait for that happen? Do you wanna wait for a dramatic experience? question communication behavior 92_0 Hi, are you Julie Thompson? other communication behavior 92_2 Hi, I'm Bruce Berger, I work in the clinic. I know you're here to pick up a prescription today. reflection communication behavior 92_4 Um, I noticed, uh, we noticed some of your records that, uh, you've been coming in and getting Sarah's resc-rescue inhaler for her asthma quite frequently, and you haven't got a chronic inhaler for quite some time now. I also know she has been in the emergency room several times this year. Is-- can you tell me what's going on there? therapist_input communication behavior 92_6 Well, I-I need to tell you that the-the medicine that she's taking, the chronic inhaler, which is really essential to controlling her asthma does-- is not a steroid like you're thinking. It's-it's much safer, it's very safe, she-- and she needs to take it to get her asthma under control, and I also want to tell you that, uh, your smoking does affect her asthma, even if- even if it's outside, it gets on her clothes, and to be honest, I'd like to see you quit smoking for you anyway. But, uh, if you want to keep her out of the emergency room, she needs to use that chronic inhaler every day, and you need to watch your smoking. therapist_input communication behavior 92_8 Okay, I, you know, I-I don't want to argue with you about this. I-I know that if you-you know, and if you want to keep Sarah out of the emergency room, uh, I-I just wish you'd heed what I'm saying. She needs to use that chronic inhaler every day to get her- to get her asthma under control, and the smoke on your clothes and the smoking flares her asthma up. So she really needs to use that chronic inhaler, and you really need to think about quitting smoking. therapist_input communication behavior 92_10 Okay, well, I-I hope you really listen to what I'm telling you about her using that chronic inhaler, and I hope you consider quitting smoking. therapist_input communication behavior 92_12 Okay. other communication behavior 102_0 Hi, Liz. Well, thanks for meeting with me today. other communication behavior 102_2 So what's something that you'd like to change or, um, work towards? question communication behavior 102_4 And you've been talking about that a lot lately. So I really- reflection communication behavior 102_6 -feel like this is something that you need to do soon because, um, a lot of times, you're just a lot of talk. And then, there's no action. And if you really wanna see results, I think it's something that needs to be done. And, you know, stop being lazy about it and just do it. therapist_input communication behavior 102_8 Yeah. other communication behavior 102_10 And that sounds like a lot of excuses to me. So I feel like you had shared with me before that you do have a gym membership. So I think that's something that you just need to fit in your schedule. So for you to really see results that you want, my guess is you need to go about three to four times a week and really fit in that hour workout, um, on a daily basis. therapist_input communication behavior 102_12 Mm-hmm. other communication behavior 102_14 And it seems like if you really want to see the results you have to put the time in. And if it's gonna take you two hours, then it's gonna take you two hours. And, again, if you want the results that you want, you need to start, and you need to start now. therapist_input communication behavior 102_16 All right. Well, um, I look forward to talking to you tomorrow. And I'm hoping that you're gonna be able to tell me that you went to the gym. therapist_input communication behavior 102_18 Thanks. other communication behavior 106_0 Okay, so I wrote a prescription for an antibiotic for Aiden and that should help with the ear infection, but in looking through the chart, I mean, it seems like he's had six or seven of these just in the past year or so. other communication behavior 106_2 That's really a big problem. other communication behavior 106_4 Well, one of the primary risk factors for multiple ear infections in kids is actually smoke exposure. Are you smoking? question communication behavior 106_6 Well, the fact that he's having these ear infections is indicating to me that he is being exposed to smoke, and so, what can you tell me about that? other communication behavior 106_8 I really need you to quit smoking. Both for your health and for Aiden. Did you know s-smoking around your child is associated not only with ear infections, it could get to the point where you have to put tubes in his ears pretty shortly here. Also, things like vitamin C deficiency, cavities, like dental cavities, behavior problems, um, asthma, other upper respiratory infections. It's really putting him at a lot of risk. In addition to that, kids of smokers end up smoking themselves. Do you want him to grow up to be a smoker? therapist_input communication behavior 106_10 Well, now's the time to quit. It's really gotten to the point where you can't keep smoking. Not only for him, like I said, but also for you. You're putting yourself at risk for lung cancer, for emphysema, for oral cancers, for heart disease, for all kinds of things- other communication behavior 106_12 Well, there's all kinds of things you can use now. It's not as hard as it used to be. You can use nicotine replacement. There's patches, there's lozenges, there's gum, there's the inhaler, there's nasal spray. We can talk about medications. You can try Chantix, you can try Zyban, there's quit smoking groups you can go to, there's hotlines you can call. therapist_input communication behavior 106_14 There's no reason why you shouldn't be able to quit, this is really important. other communication behavior 106_16 Well, what can be more important to you than the health of your child? other communication behavior 106_18 I really need you to tell me that you're gonna quit smoking. This is really important. other communication behavior 106_20 Okay. Well, I think you really need to think about this seriously. Like I said, it's really putting yourself and your child in danger. other communication behavior 106_22 Okay. other communication behavior 115_0 Okay, so why don't you have a rinse, David. How are you feeling? question communication behavior 115_2 Good. Here, take a look, see what you think. And that feeling- other communication behavior 115_4 -and the color's okay? You know, there is quite a lot of staining so, um, I'm just wondering about, um, some concerns about smoking. question communication behavior 115_6 Possibly- other communication behavior 115_8 -coffee, tea. Yeah, you've heard this before, I'm sure. other communication behavior 115_10 Mm-hmm. So, you know, the smoking is going to be related not just to some of the other negative consequences. You know, physically, it affects dental caries, dental cavities- therapist_input communication behavior 115_12 -um, healing- other communication behavior 115_14 -in your mouth. other communication behavior 115_16 So-- other communication behavior 115_18 Yes, and I really want to be helpful. I really want to-- you know, my commitment is to your oral health, so um, there are lots of medications out there, David, that actually take away a lot of the cravings. They're-- they make quitting so much easier. therapist_input communication behavior 115_20 Mm-hmm. Yeah. other communication behavior 115_22 .No, it-- but David, it's not a waste. Research shows that people take on average about seven tries before they quit smoking, so think of it as you're one step closer to quitting, so-- therapist_input communication behavior 115_24 Well, I don't think I'm giving you a lecture, that's certainly not what I meant. I-- other communication behavior 115_26 Well, there's-there's a reason that [crosstalk] people are concerned. other communication behavior 115_28 No. But as I said, these medications-- so you've tried the medication, you've been willing once. therapist_input communication behavior 115_30 Then, can I write you a prescription for the medication? Can we talk about how you could use it? Because this is something that-that's very important. Not just for your overall physical health, for your oral health-- therapist_input communication behavior 115_32 Oh no, the smoking's going to cause you more problems than the-- than anything else. I can promise you that, David. therapist_input communication behavior 115_34 The side effects from the medications are nothing compared to what can happen from the smoking. therapist_input communication behavior 115_36 Like, that's the, I think, thing to really consider. other communication behavior 115_38 I'm-- okay, but you know-- other communication behavior 115_40 Okay. Well thanks for listening, and honestly, I- I am really worried about the smoking, so-- therapist_input communication behavior 115_42 I um-- other communication behavior 115_44 I'm here to help, okay? other communication behavior 115_46 So-- other communication behavior 118_0 Hi, come in. [door closes] Sit- sit yourself down. Uh, what can I do for you today? question communication behavior 118_2 Okay. other communication behavior 118_4 All right. Um, okay. Um, well let's, uh, let's just have a look shall we? See what's going on. You just wanna open your mouth for me. Say ah. therapist_input communication behavior 118_6 Okay. Right. Uh, to be honest, you know, looking there, it just looks like one of those viruses that are going around at the moment that are causing these sore throats. So, uh, I think that we should just perhaps go for a bit of paracetamol and, uh, some fluids and let nature sort it out. therapist_input communication behavior 118_8 Well, I mean, I'm sorry we're a bit late, but you know that's the general practice, isn't it? You know, sometimes these things happen. Um, but it doesn't alter the fact that you do just have a virus, uh, and they are very common. And the nice thing is that it will get better with paracetamol and fluids, and the paracetamol will help the pain. Um, with giving it to the kids, I'm afraid there's nothing we can do about that. It's unlikely they'll get it, but I can't guarantee it. therapist_input communication behavior 118_10 Uh, well- well, not really. Uh, you need to self-certify in your first seven days off sick so if you're going to take some time off, just take some paracetamol, lots of fluids, get a self-certified note, uh, in to your employer, and put sore throat there. therapist_input communication behavior 118_12 Uh, well, obviously that's a non-NHS thing so we have to charge you for that and our going rate for that is, uh, £12. therapist_input communication behavior 118_14 Oh, I'm sorry. But, you know, if you have just got a sore throat, then there's not much I can do about that. It's just, you know, something that we all get from time to time. Perhaps, what you really need to do is, uh, you know, just take some paracetamol and get some fluids. therapist_input communication behavior 118_16 Okay, that's pretty unlikely with sore throat. I think that's so, you know, a little bit of grand staging there. therapist_input communication behavior 118_18 Okay. other communication behavior 118_20 Bye. other communication behavior 123_0 Okay, I finished the exam. I have some good news and I have some not-so-good news. Looks like you don't have any cavities, so that's the good news. therapist_input communication behavior 123_2 However, I'm pretty concerned about something I'm noticing in your mouth. Actually, if you look up here, the roof of your mouth, I'm noticing a lot of irritation that's really consistent with tobacco use. And you had said on your form that you're not a tobacco user, so I'm just wondering what's going on. therapist_input communication behavior 123_4 Okay. Well, as I said, there's a lot of irritation, in particular, like I was mentioning, up here in the roof of your mouth, it's turned really definitely white-colored and there's little red spots. And you probably didn't notice because we don't spend a lot of time looking at the roof of our mouth, but you're really damaging this tissue in your mouth, which can really cause some severe problems in terms of your oral health. It's called nicotinic stomatitis. And this is something we don't see in any patients who don't use tobacco. So, maybe you're not smoking cigarettes, are you smoking a pipe or cigars? Or is there something else that could be contributing to this? Because I don't know what else might be causing it. question communication behavior 123_6 Mm-hmm. other communication behavior 123_8 Okay, so I think that's a pretty common misconception, because they're fruit-flavored, people think they're okay. Those are really bad for you. Did you know that? question communication behavior 123_10 Right. They're still cigars and they're still tobacco and so they still cause lung cancer, oral cancer, emphysema, all those same kinds of things that you would see with cigarette, so it's really important. therapist_input communication behavior 123_12 Uh-huh. Well, that's, I mean, at least you're not doing that, so that's good, but it's still causing a lot of problems. And as I said, I can see that the evidence in the roof of your mouth, you're causing some serious damage, and this needs to stop. Have you thought about quitting? question communication behavior 123_14 What do you mean? question communication behavior 123_16 So you're gonna quit then? question communication behavior 123_18 What do you mean, maybe? I just told you how bad it is for you. It's messing up your mouth, you're putting yourself at risk for all these other diseases. This is really important. You need to quit. therapist_input communication behavior 123_20 What's there to think about? [chuckles] You said it's not that something you do all that often, and there's all these negative side effects, there's all these risks that you're putting yourself in. therapist_input communication behavior 123_22 Okay, well, that's a good start, but cutting back isn't going to do it. If you actually quit the smoking, you can reverse all the damage you've done in your mouth, and you can stop yourself from- from being at risk for these other diseases. But as long as you're continuing to use these cigars you're really putting yourself in a lot of danger. therapist_input communication behavior 123_24 You're choosing to really damage your mouth and actually, it can cause problems with your teeth too. I don't know if you notice your teeth might be getting yellower than they were before. That's another side effect. There are a lot of really negative things that go along with any tobacco use, whether it's cigarettes, cigars, dip, chew, snuffs, snus, hookah, any of it. This is a really important decision that you're making and you said it's your choice, but you're really choosing to make yourself sick and potentially die. therapist_input communication behavior 123_26 Well, I appreciate you thinking about it. I hope you'll think about it really hard. You know, this is something that I'm gonna continue to ask you about because it's something that really needs to change. therapist_input communication behavior 126_0 Hello, Kaylie. It looks like you're here to pick up a prescription today. reflection communication behavior 126_2 Okay. It looks like cholesterol statin. Do you know how you're supposed to take the medication? question communication behavior 126_4 Well, you just take it once a day. Did he tell you what side effects to expect? question communication behavior 126_6 Well, some of the common ones are nausea, vomiting, headache. There are some severe ones like dermatomyositis, liver failure, lupus, rhabdomyolysis, hemorrhagic cerebral infarction. If you have any of those, just call your doctor. therapist_input communication behavior 126_8 It's for your dyslipidemia. Oh yeah, just one tablet a day. Do you have any questions for me? therapist_input communication behavior 126_10 All right. Great. Have a good day. other communication behavior 126_11 Hello, Kaylie. I see you're here to pick up a prescription today. other communication behavior 126_13 Oh, it looks like he called in cholesterol statin. Do you know how you're supposed to take this medication? question communication behavior 126_15 Okay. Well, you take this one once a day. Did he tell you what side effects to expect? question communication behavior 126_17 All right. Well, some of the common side effects are nausea, vomiting, headache. There are some severe side effects like dermatomyositis, liver failure, lupus, rhabdomyolysis, hemorrhagic, cerebral infarction. If you have any of those, you should call your doctor. other communication behavior 126_19 It's for your dyslipidemia. Oh, and you should take one every day. Do you have any questions for me? therapist_input communication behavior 126_21 All right. Great. Well, have a good afternoon. other communication behavior 126_22 Hello, Kaylie, I'm Lori, the pharmacist here at Bulldog Pharmacy. I see that you have a new prescription for cholesterol statin 20 called in by Dr. Ferris today. I wondered if you had a minute to talk to me. I just want to make sure that you know how best to take it, and if you have any questions. question communication behavior 126_24 Okay. What did the doctor tell you cholesterol statin is for? question communication behavior 126_26 He's right. This medicine is designed to help lower your cholesterol, and that means that it will help lower your risk of having a heart attack or a stroke. How did your doctor tell you to take this medicine? reflection communication behavior 126_28 Okay. Well, you're going to take one tablet of cholesterol statin 20 one time a day by mouth, and you can take that with or without food. When do you normally take your medications? therapist_input communication behavior 126_30 Okay. That's perfect because cholesterol statin works best if it's taken at night, though you can take it any time of the day. And you should take it every single day. It's important to keep that up. Where do you store your medications? therapist_input communication behavior 126_32 All right. Do you have any children in your home? question communication behavior 126_34 Okay. Well, then that sounds like a perfect location for you. Medicines keep best if they're stored away from light and heat and moisture. What did the doctor tell you to expect in terms of side effects? question communication behavior 126_36 All right. Well, this medication is pretty well tolerated, which means it doesn't have very many side effects. But you might experience some mild muscle aches and pains. If they seem really severe to you, then you should call Dr. Ferris and talk to him about that. Also this medicine can interact with a lot of other medications, and even over the counter things. So check with the doctor or myself before you start anything new. And lastly, grapefruit juice can interact with cholesterol statin 20. So if you use grapefruit juice every day, I probably would switch to a different juice while you're on this medication. therapist_input communication behavior 126_37 Just so I know we're on the same page, can you repeat back to me how you'll take this medicine? question communication behavior 126_39 Great, Kaylie. I know we went over a lot today. What other questions do you have for me? question communication behavior 126_41 Fantastic. All right. Well, here's your prescription. I even put it on auto fill for you so that it will be filled for you every- at the same time every month. And if you have any other questions later, our phone number is right here on the bottle, and you can call me at any time. Thanks so much. Have a great day. therapist_input communication behavior 126_42 Hello, Kaylie. I'm Lori, the pharmacist here at Bulldog Pharmacy. I see that you have a new medication to pick up today. Called in by Dr. Ferris for cholesterol statin 20. Do you have a minute to talk about it? I want to make sure that you know how best to take this medicine and to answer any questions that you might have. question communication behavior 126_44 All right. What did the doctor tell you cholesterol statin is for? question communication behavior 126_46 All right, and he's right. This medication will help lower your cholesterol, and it will help lower your risk of having a heart attack or a stroke. How did the doctor tell you to take this medicine? therapist_input communication behavior 126_48 All right. Well, you're going to take one tablet of cholesterol statin 20 one time a day by mouth, and you can take that with or without food. When do you usually take your medications? therapist_input communication behavior 126_50 That's perfect. This medication can be taken any time of the day, but it does work best if taken in the evening, and it's important to take it every day. therapist_input communication behavior 126_51 Where do you store your medications? question communication behavior 126_53 Do you have children in your house? question communication behavior 126_55 All right. So that sounds like a perfect place for you to store those. Medications are best when they're stored away from light, heat and moisture. reflection communication behavior 126_56 What did your doctor tell you to expect in terms of side effects? question communication behavior 126_58 All right. Well, this medication is usually well tolerated, which means that it doesn't have very many side effects, but you might experience some muscle aches or pains. If they seem really severe to you, then you should call Dr. Ferris and talk to him about that. Also, this medication can interact with over-the-counter medicines or even other medications. So before you start something new, you should check with either Dr. Ferris or myself. And lastly, this medication can interact with grapefruit juice. So while you're taking this medicine, I would avoid grapefruit juice. therapist_input communication behavior 126_59 Just so we know we're on the same page, can you repeat back to me how you are going to take this medicine? question communication behavior 126_61 That's great, Kaylie. I know we went over a lot today. What questions do you still have for me? question communication behavior 126_63 All right, good. Well, here's your prescription. I even put it on autofill for you so it'll be ready at the same time every month for you. And if you have any questions later, our phone number is right here on the bottle, and you can call me at any time. Thanks so much. Have a great day. therapist_input communication behavior 130_1 Yeah. Well, the good news is he doesn't have pneumonia. It's just an upper re-respiratory tract infection and a cold. So there's some things you can do to make- to help him get better. You can avoid excessive dust. You can keep him hydrated, avoid over-the-counter cold remedies. Keep him away from people who have flu or cold-like symptoms and avoid smoke. And the last one should be easy because you quit smoking during your pregnancy. therapist_input communication behavior 130_3 No, wait a minute. That has everything to do with what we're talking about. I can't believe at the end of this appointment, you're just slipping in the fact that you've resumed smoking again. That's very, very important information for me to know. And I'd like to spend some time talking about it now. therapist_input communication behavior 130_5 Come on, Hailey. You're here because you thought he had pneumonia. You're telling me that Jake can't breathe, you're concerned about his breathing. And then you just slip in the fact that you're smoking cigarettes and you think there's no relationship? Do I really need to review all the risks of smoking in front of your-your child or exposing him to secondhand smoke not to mention the risks that you're posing to yourself and your own health? question communication behavior 130_7 So it sounds like if you have alcohol, then smoking is very difficult to avoid and you know what you need to do. You need to go home and as your-your son's doctor, I need to tell you you need to go home and throw out those cigarettes. You need to quit. therapist_input communication behavior 130_9 And let's talk some more about wine. You keep throwing wine into the conversation. It sounds like it's become a significant part of your daily routine. How much are you drinking? question communication behavior 130_11 Well, no one said motherhood was going to be easy, Hailey. So let's talk about these drinks. Are we talking about the-the low-risk drinking guidelines, one to two standard drinks a night or are we talking about a mug of Margarita's? question communication behavior 130_13 What are you drinking? What's the quantity that you're drinking. question communication behavior 130_15 There's other ways to relax. There's yoga. There's deep breathing. You need to stop raising the roof and raise your kid. This is not okay. You're not just worrying about Hailey anymore. It's Hailey and Jake. You're a mom now. therapist_input communication behavior 130_17 I'm trying not to be hard on you, Hailey, but I've got to tell you as a position, it's a very big deal. Your drinking and your tobacco use are red flags for me and they need to stop immediately. So we've already talked about your plan for smoking. You're going home. You're throwing out your cigarettes. You're putting on the patches. What's the plan for the alcohol? therapist_input communication behavior 130_19 Sounds good. And if you need to relax, go for a walk, join a moms group, read a book. How about you come back in a week when we have Jake's six months checkup and you can let me know how that quit plan is going. therapist_input communication behavior 130_21 Thanks. other communication behavior 131_0 Good morning. It's really nice that you've come along to see me to talk about stopping smoking. other communication behavior 131_2 What have you got in mind, what do you want from us? question communication behavior 131_4 Absolutely, we're in the right place for that. other communication behavior 131_6 Okay. Well, just remind me again why it is you want to stop. question communication behavior 131_8 Oh, good, and so feeling under pressure here. reflection communication behavior 131_10 And so that-that can't feel a little uncomfortable being by yourself. So that sounds like one of the reasons you have to quit is it's a little getting smelly and it's getting embarrassing. reflection communication behavior 131_12 Any other reasons? question communication behavior 131_14 How much does it actually cost you a week? question communication behavior 131_16 £7 a week or a day? question communication behavior 131_18 So your pack a day— other communication behavior 131_20 £50 a week. reflection communication behavior 131_22 Even more mess, you see. other communication behavior 131_24 Okay. So we're talking about spending £50 a week- reflection communication behavior 131_26 -being one of the few left smoking in your crowd, and not liking the smell. That sounds like three reasons. reflection communication behavior 131_28 Do you think that's enough to make you say goodbye to cigarettes? question communication behavior 131_30 Great, okay. So have you got a date in mind when you'd like to stop smoking? question communication behavior 131_32 Generally, it works well if you find a time when you're not under a huge amount of other stresses and strains. therapist_input communication behavior 131_34 What are the main reasons why you actually smoke? What do you enjoy most about it? question communication behavior 131_36 Mm-hmm. other communication behavior 131_38 Okay. What do you think you'll miss most about it? question communication behavior 131_40 Mm-hmm, what sort of stresses? question communication behavior 131_42 Mm-hmm. question communication behavior 131_44 Yeah. And what is your favorite cigarette of the day? question communication behavior 131_46 Okay, so the end of the day- reflection communication behavior 131_48 -the thing that helps you just unwind, put an end to the work section and move into your own time. reflection communication behavior 131_50 Okay. So after you've had the quit date, what do you think you might do when it it's the first day at work and it's time to go home if you're not gonna have a cigarette? question communication behavior 131_52 Okay. other communication behavior 131_54 Have you managed to stop smoking in the past? question communication behavior 131_56 Okay. And what got you back? question communication behavior 131_58 So something just happened- reflection communication behavior 131_60 -so it took you back into it. All right. Let me just make sure I've understood what's going on here. You really want to stop smoking because you're kind of the last guy in your group still smoking, it costs a lot of money, and you don't really like the smell. reflection communication behavior 131_62 The main reason that you smoke is because, at the end of the day, it gives you a kind of relaxation, and if there's quite a little stress that's going on which you're using cigarettes to help you cope with. reflection communication behavior 131_64 What you'd like to do is stop and you'd like to sort of like choose a time to quit when it's going to be there's not as much stress around as possible. When do you think would be a good time for you to choose to be your quit date? reflection communication behavior 131_66 Okay. other communication behavior 131_68 So Monday morning after the party will be a good day, and that's next week. Okay. Now, one of the things that we do in the pharmacy is recommend that you use medication to help you. You know this increases your chance of success and it makes it more likely that can manage any cravings that come along. A lot of people like using nicotine replacement therapy which comes in a variety of formats like patches, gum, you've probably seen people using any of these products. And other options are tablets which you can get from the GP. therapist_input communication behavior 131_70 So, yeah, again-- Um, so have you something in mind that you might like to use to help you through managing the cravings? question communication behavior 131_72 Okay. So a patch is something you've already seen, and- reflection communication behavior 131_74 -and, again, I'll get some out and I'll show you what they look like. This course of medication lasts for 10 to 12 weeks. And we strongly recommend that people stay on the whole course of medication and that that gives you the best chance of success. Stopping smoking is not easy but it's possible and with the type of support that we offer here in the pharmacy, you absolutely make your chance of success four times greater than trying on your own, so, that's why it's really good that you've come to see me. Now, what you said is you really want to do it and that next week sounds like a good day for you to start because the party is over and done with. therapist_input communication behavior 131_76 You've got the time at the end of the day when you finish work, which might be the first time you've gone without a cigarette. So, what I'd like to recommend is that you use two products perhaps and I'm thinking of you're having a patch and then suggesting that you might use something that you can top up with. Often, a person who smokes knows exactly what it feels like when they're craving for a cigarette. What does it feel like to you, when you can't have a cigarette and you want one? therapist_input communication behavior 131_78 Okay. other communication behavior 131_80 And that's exactly one of the symptoms of nicotine withdrawal that I'm looking to stop happening to you. therapist_input communication behavior 131_82 So, I would strongly recommend that you have the patch. I'll talk to you about how to use that and that we have another product that I leave you to use as when any of those feelings of irritation are coming up, particularly in that first week. therapist_input communication behavior 131_84 So, you're happy with the date for [unintelligible 00:06:16]? question communication behavior 131_86 Okay and would you like to come back and see me again? question communication behavior 131_88 And what would you like me to do if you don't come back? question communication behavior 131_90 I'd be very happy to do that. therapist_input communication behavior