The Drama Triangle and the Five Agreements – Helping Maintain Professional Detachment in the

Consultation

Dr Andrew Tresidder MBBS MRCGP

Relationships – the Solihull Triangle

• A model for achieving effective communication and change

• Containment• Reciprocity• Behavioural management• 1 Safety, trust and rapport• 2 A dialogue• 3 Support to change

Anatomy of a complaint

• Story – Andrew, new patient, prescription request ‘just a quick one, doc, I know you’re running late…’

• Observed by medical student

• Why was he unhappy?

Complaints

• Usually about facts (or misconceptions) – which may be major, or minor

• Always about feelings

The Seat of Power

• Every profession is a conspiracy against the layman, said George Bernard Shaw in ‘The Doctor’s Dilemma’

The Consultation

Two people approach a consultation, both independent adults.

However, the expert knowledge lies with the professional.

The layman (the patient), through ignorance or fear/anxiety, may give away his power of autonomy.

This power must be handed back at the end, to ensure a tidy ending

‘Stuff’ in the Consultation

• Three dynamics• 1 the patient’s stuff• 2 joint stuff• 3 my stuff

• My stuff is my responsibility• Responsibility = ability to choose our response

Transactional Analysis

• Parent Parent

• Adult Adult

• Child Child

The Drama Triangle

• 3 roles – 1 Child and two Parents

• The Child can give away their power - to a parent, and can play Victim, playing the script “If you help me / save me / protect me, I will give you my power”.

• The Parent takes the power and becomes Rescuer “If you give me your power, I will protect and help you”

The Drama Triangle

• • Victim•

• Rescuer Persecutor

The Drama TriangleSometimes hidden agreements

• Doctor as Parent – Patient as Child – I will take care of you and use my skill to help you

• If…….

• You agree to approve of me and give me respect (Doctor as Child needing patient as parent –many of us doctors are Little Pleasers)

The Drama Triangle

• Win –win?• Win – lose?• Lose – win?• Lose – lose?

Exercise

• In pairs, please study the scenarios

• One person play physician role, the other the patient role

• Five minutes to ‘consult’

• Then we will discuss

Resolving the Drama Triangle

• Be authentic – be true to yourself• To Thine Own Self Be True (Shakespeare)

• “Try to treat others as you would wish to be treated yourself”- the number one rule at Her Majesty’s Prison Guy’s Marsh, Dorset, UK

• Try to keep to the Four Agreements

The Five Agreements

• Be Impeccable with Your Word

• Take Nothing Personally

• Make No Assumptions

• Always Do Your Best

• Be Sceptical – but Learn to Listen

The Drama Triangle

• References• Karpman, S. (1968). Fairy tales and script drama analysis.

Transactional Analysis Bulletin, 7(26), 39-43 http://karpmandramatriangle.com/dt_article_only.html,

• Edwards, Gill. Conscious Medicine, Piatkus 2010, pp130-133• The Four Agreements, Don Miguel Ruiz, Amber-Allen

Publishing• The Five Agreements, same author• Games People Play, Eric Berne, 1964 Thankyou for your participation!