BATHE technique

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Introduction

A series of 4 questions followed by an empathic response.

B: Background: What is going on in your life?

A: Affect: How do you feel about that?

T: Trouble: What trouble you about that?

H: Handling: How are you handling that?

E: Empathy: That must be very difficult.

to answer the question 'Why is the patient her now?'
as a crude screening test for anxiety or depression
to establish personal rapport with patients
to help patients connect their physical symptoms with their emotions & life circumstances
to handle an unexpected psychosocial finding at the end of an interview
to explore a patients reaction to a diagnosis
to explore problems with compliance, requests for inappropriate referrals, & other difficult situations
to explore possible psychosocial precipitants of somatic complaints
as a structure for a brief counseling session or family interview

patients in severe pain
patients in life-threatening circumstances
resistance on the part of the patient expressed as hostility
insufficient in the case of:
- suicidal patients
- sexual abuse victims
- substance abusers
psychotic patients
patients with borderline personality Comments:
Attempt to say nothing but the BATHE questions
Do not allow patients to elaborate at length
Do not analyze or interpret the patient's responses
Avoid giving advice
When patients fail to answer the 'affect' question, but rather provide more background information, intervene by repeating 'Yes, but how do you feel about that?' until the patient responds to the question
When patients express positive feelings, do not assume there is nothing 'troubling' them; modify the 'T' question.
recognize it is not your job to fix the patient's problems, only to provide support & clarification.

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1108