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8_28
Thanks for coming in.
other
communication behavior
11_0
What else has brought you here?
other
communication behavior
11_2
Mm-hmm.
other
communication behavior
11_4
Mm-hmm.
other
communication behavior
11_6
Just enough for your own use?
question
communication behavior
11_8
Yeah. Yeah. Yeah.
other
communication behavior
11_10
Yeah, we-- You know, we have about 15 to 20 minutes to talk today, total. Um-um, which certainly it's just the first of-of some sessions that we'll have together over the next six months. It'd be a natural question you'd wanna know how much time this will take, of course. Um, what else would you like me to know about you and your perspective that you think will help me work with you over this time?
therapist_input
communication behavior
11_12
Okay. You're more focused on what you need to do to get this behind you?
reflection
communication behavior
11_14
.Okay, mm-hmm. Well, I'm wondering then if it's okay with you and-and I have a form that we can use if you'd like, um, just to put out some different ideas on an agenda that we could share as we're working together so that I-I can support you to be successful in getting this behind you. Would-would this feel like a natural time to-to move towards figuring out where we might go together?
question
communication behavior
12_0
Sarah, I'm so glad you came in for your well-woman exam today. I think we addressed a lot of your concerns. However, I would like to ask you more about your smoking. Would that be okay?
question
communication behavior
12_2
Okay. So about how much are you smoking over the course of a day? You had said it had increased over once or twice a day.
question
communication behavior
12_4
Okay. So about eight cigarettes. So over the course of a day, just under half a pack?
reflection
communication behavior
12_6
Okay. And that's changed over what period of time?
question
communication behavior
12_8
Okay. So over the past year, the smoking has increased. And that's been mainly in the evening?
question
communication behavior
12_10
Mm-hmm. Well, that's the time when you can relax and unwind.
reflection
communication behavior
12_11
Yeah, exactly. You know, I told you, my-my schedule is kinda crazy right now. I, um, I work full-time and I just started back at night classes. So, you know, all that combined, you know, I enjoy that time to myself in the evening.
other
communication behavior
12_12
Sure. Sure. Well, it's a time to relax and you've got a lot going on.
reflection
communication behavior
12_14
So are there other things you do in the evening to relax?
question
communication behavior
12_16
Okay. A drink or two. So about how many drinks would you say you have over the course of a day?
question
communication behavior
12_18
Two max. How many drinks would you say you'd have over the course of a week?
question
communication behavior
12_20
No, I understand- I understand. And I'm certainly not here to tell you what to-to do, Sarah. I'm interested in hearing your thoughts and sharing some information with you, and what you do with that information is totally up to you. You've got a lot going on. You're a mother, you're working, you're going to school, and our healthcare team wants to make sure that you have all the resources available to you to meet your goals, including good health. And my job as your healthcare provider is to listen to you and to share information with you, including healthcare concerns associated with smoking and alcohol. Would that be okay with you?
question
communication behavior
12_22
Okay. Well, we do know that an increase in smoking and alcohol is associated with certain kinds of cancer; colon cancer, cervical cancer, breast cancer, lung cancer, and, um, also pancreatic cancer. It's also associated with liver and lung disease as well as heart disease, diabetes, and hypertension. So that's a lot of information, but I'm-
therapist_input
communication behavior
12_24
-interested in what your thoughts are, Sarah.
question
communication behavior
12_26
So you're consciously trying to cut back.
reflection
communication behavior
12_28
I have a readiness ruler in my pocket here, 0 means not ready to stop smoking at all and 10 means absolutely ready to stop smoking. Where do you see yourself on that scale?
question
communication behavior
12_30
About a five. So you're halfway there. So why did you choose a five rather than a four?
question
communication behavior
12_32
Right. Well, that's a lot of information to think about. So given, the fact that these healthcare concerns are a possibility, and that you're worried about your family and you certainly have goals you want to succeed at, where are you in your consideration to making a change? In other words, what steps would you consider taking for this number to move closer to a 10?
question
communication behavior
12_34
Okay, great. Let's quantify that a little bit. So how many cigarettes would that be?
therapist_input
communication behavior
12_36
Okay. So you-- that's cutting back quite a bit. That's a big step. So since we're kind of running out of time here today, I'm wondering if we could-- would be willing to come back in about four weeks to review this plan?
question
communication behavior
12_38
Okay, good. So we can go over your laboratory results at that time, as well as review your plan. Now, would you like some information on smoking cessation?
question
communication behavior
12_40
Okay. Well, I've got a brochure here and this has-- it's a really good brochure. It has some distraction techniques in it in case you get those nicotine cravings. So it's-
therapist_input
communication behavior
12_42
-been helpful, um, in-- with patients before. I'd also like to ask you, would you be willing to see one of our counselors?
question
communication behavior
12_44
Well, Dr. Kirtley is one of our counselors and he is an expert in-- at discussing the association between alcohol and stress. I want to share something with you. The National Guidelines recommend that women have no more than seven drinks of alcohol per week to-to stay at that low risk level, to avoid the healthcare concerns that we spoke of earlier.
therapist_input
communication behavior
12_46
You've indicated that your alcohol consumption is a bit higher than that, putting you at risk. So that's why I asked if you'd be willing to talk to Dr. Kirtley.
therapist_input
communication behavior
12_48
Certainly, certainly. I'm glad you're willing to talk to him. So before you leave here today, we'll, uh, stop by the scheduler's desk and make an appointment for you to see me back in four weeks, as well as the appointment with Dr. Kirtley. And that way, before you leave, you're all set. So do you have any other questions for me, Sarah?
question
communication behavior
12_50
Okay. Well, it's very nice to meet you. I'll see you in a month.
other
communication behavior
13_0
Hi, Mrs. Smith. I wanted to let you know that at this appointment, we're gonna be giving Lilly some vaccines.
therapist_input
communication behavior
13_2
Hmm. Can you tell me more about your concerns about vaccines?
question
communication behavior
13_4
Okay, so you were thinking that maybe exposing Lily naturally to these diseases would be a better choice than using vaccines to help her get stronger?
reflection
communication behavior
13_6
That's right. Having chickenpox as a child means that you are less likely to have chickenpox as an adult because you've developed a-a natural immunity. Uh, but is it okay if I offer you a little bit more information about the other vaccines that we're- we were going to give her Lily today?
question
communication behavior
13_8
Okay. So, uh, before vaccines were developed, often when children had a natural exposure to some of these diseases, they ended up with, uh, sometimes death, disability, measles caused brain damage and, uh, deafness and blindness. Polio caused, uh, paralysis in children. And so, allowing children to have natural exposure to these diseases, sometimes was a little bit of a gamble, it could be dangerous.
therapist_input
communication behavior
13_10
Hmm. Some of these things I've mentioned to you, you're-you're not familiar with. Uh, and I think that's because we've done such a good job of eliminating some of these diseases that a lot of people your age, and even my age, are unfamiliar with those things. Um, so having shared this information with you, what do you think about the idea of vaccines for-for Lilly?
question
communication behavior
13_12
It's really important for you to make sure that she's protected and that you make good decisions and do your research before you make any medical decisions for her.
reflection
communication behavior
14_0
So, again, I hear your overall goal is really, to not give up these things you'd like but to cut back on how much you have-
reflection
communication behavior
14_2
-on that. All right. So, I'd like to ask you, uh, kind of a scaling question about this 'cause I'm hearing that this feels really important to you that you'd be way up there on the high- on the high end of importance.
reflection
communication behavior
14_4
So, I'm gonna ask the question this way, on a scale of 0 to 10, where 0 is not at all confident, and 10 is like, "I'm very, very confident," where would you put yourself on a scale right now of confidence in starting this new plan?
question
communication behavior
14_6
Mm-hmm.
other
communication behavior
14_8
A six.
reflection
communication behavior
14_10
Okay. All right. So, let's talk about that, um, so we should just assume we're gonna be at a four.
reflection
communication behavior
14_12
Okay?
question
communication behavior
14_14
So, why are you at a four and not even a lower number? Why are you not like a zero or a one?
question
communication behavior
14_16
Okay.
other
communication behavior
14_18
Okay.
other
communication behavior
14_20
Uh-huh.
other
communication behavior
14_22
Okay.
other
communication behavior
14_24
Okay.
other
communication behavior
14_26
Okay.
other
communication behavior
14_28
Okay, all right.
other
communication behavior
14_30
Okay. So, what would help increase that confidence? What-- Because that sounds like where we really need to focus on. What's gonna help you feel more confident about this?
question
communication behavior
14_32
Mm-hmm.
other
communication behavior
14_34
Mm-hmm.
other
communication behavior
14_36
Uh-huh.
other
communication behavior
14_38
Uh-huh.
other
communication behavior
14_40
Okay.
other
communication behavior
14_42
All right.
other
communication behavior
14_44
All right.
other
communication behavior
14_46
Okay.
other
communication behavior
14_48
All right. Well, if it's okay, just for a moment, let's put the- let's put the changing the eating pattern off to the side, and let's take a look at some other time in your life that there was something you really wanted to accomplish and you did. And what is it about you- what was it about you? What kind of strengths did you bring to the table that allowed you to tackle something that felt like a challenge and-and allowed you to be successful?
question
communication behavior
16_0
So, Rick, just in regards to your flatmate situation at the moment with Tristan. Uh, you know, we talked about how walking through this program and with the support of your parents and having some positive influence to help you through this. I just want to rethink a bit if you stay living with Tristan. What are the sort of pros and cons of that? What are the good things about living there, what are the not-so-good things about living there?
question
communication behavior
16_2
Yeah. So, in terms of being supportive and a sort of support you're gonna need to make these changes.
therapist_input
communication behavior
16_4
What's your thinking around that?
question
communication behavior
16_6
Mm-hmm.
other
communication behavior
16_8
Yeah.
other
communication behavior
16_10
Right.
other
communication behavior
16_12
Okay. You're good to explore, but I just want to ask you about, how much does Chris-Christian-Christian know-- Tristan know about you changing your life? What does he really know about the changes you wanna make?
question
communication behavior
16_14
Mm-hmm.
other
communication behavior
16_16
Right.
other
communication behavior
16_18
Okay. What are some of the pros and cons about moving in with whāna, moving in with your auntie and uncle?
question
communication behavior
16_20
In terms of that freedom and in charge of yourself, and the changes that we're talking about, and building your own family, and to enable you to do that, where do some of that freedom stuff sit with re-engaging back with your whānau and your children, your partner? Is it something you're gonna wanna hang on to, or how you're going to manage that?
question
communication behavior
16_22
Mm-hmm.
other
communication behavior
18_0
So I get a sense it's a little anxious being here today and, uh, meeting someone like me, and, um, what we're gonna be doing today is-is inducting, but also I wanna talk about, um, yeah, the issues that-that have got you here and we need to do some sorting out around, um, yeah how serious you are to sort of sort those issues. So?
reflection
communication behavior
18_2
Sorry?
other
communication behavior
18_4
All right.
other
communication behavior
18_6
Yeah.
other
communication behavior
18_8
So first, it might be trying to sort out what are the important issues to sort out.
therapist_input
communication behavior
18_10
Yeah, that makes sense? Yeah? So how confident are you that-that, you know, you can sort out the issues related to, um, you know, uh, taking the money from your employer? And another thing, in your precinct's report, there were some issues around gambling, and some issues around alcohol use. So those seem to be important issues that are kind of getting out. So how confident are you that you can get those sorted in the nine months we've got?
question
communication behavior
18_12
Yeah.
other
communication behavior
18_14
Yeah, yeah.
other
communication behavior
18_16
Yeah. See one of the things I'll be really interested in-in talking with you about is, um, yeah, what's-what's the, um, what's the worst thing that has happened in terms of pokies, in terms of you know behavior around the pokies, what's the worst thing that's happened?
question
communication behavior
18_18
Yeah, yeah.
other
communication behavior
18_20
Yeah. So how often do you end up with no money in your pocket? Can be the times when you end up with money in your pocket
question
communication behavior
18_22
Yeah, yeah. So if we were to think back, say the last month, the last four weeks, how many times would you have gone down to the- to the pokies, the pub?
question
communication behavior
18_24
Yeah. Yeah.
other
communication behavior
18_26
That-that you're up for the money and-and then-then they slot you.
reflection
communication behavior
18_28
Okay. So-so thinking about this, say a couple times a week, you know, two or three?
question
communication behavior
18_30
Yeah, yeah, yeah? So that's 12 times. So how many times would you have walked away with money in your pocket after, any out of the 12, what's your- what's your sense?
question
communication behavior
18_32
Okay. Okay. So you're saying about 50-50?
question
communication behavior
18_34
'Cause you have to understand the odds are about-- sort of-of tend to be about 25% on the 100, that-that's [crosstalk]
therapist_input
communication behavior
18_36
Yeah, you might be lucky then. So-so what do you reckon like in terms of like you're saying you're not sort of sure if that's an issue, and that's probably something that we can be working with, uh, figure it is an issue.
question
communication behavior
18_38
And, yeah, it might be an issue, I don't know if it's an issue at this point. It'll be interesting to sort of talk about that. But I'm wondering what happens, yeah, when-when you get on the pokies out there, they're certainly at the pub, pokies around? So what happens in your body when, um—
question
communication behavior