Interview-e: Looking for Time to Think

Alongside her review of Time to Think, featured as the FMLM book of the month for June 2014, Business Coach Liz McCaw spoke with Nancy Kline, finding out something of Nancy’s remarkable personal history and the value to be gained from embracing a thinking environment in medical practice.

Time to Think – Listening to Ignite the Human Mind was the first ‘coaching’ book I read, and it all sounded so simple—just keep quiet, listen, interject one or two well-­‐formed questions and your subject would arrive at the perfect solution to their issue. What could be easier? Hadn’t I been doing it with my husband for years? It is, in fact simple, but not easy, and  applying  Nancy’s framework takes practice, commitment and belief.  But it does work.

Nancy Kline is one of those rare people who instantly make you feel good. Her gentle voice, her lilting US accent, her modesty and her curiosity all combine to create the sense that you are the only person in the world that matters right now.

I was slightly apprehensive before my interview with her—it is not every day that one gets to speak to a guru in the coaching world—but, fifteen years after she wrote Time to Think, she is clearly still as passionate as ever about spreading the word: “the world cries out for an understanding of what it takes to produce independent thinking, and we are still finding the answers… how do we help each other to think for themselves?”

She was heavily influenced by her parents —“independent thinking was a key parental value”— combined with a realisation that people think better with the right quality of attention from others. Readers of the Health chapter in Time to Think will know that she was given six weeks to live at the age of 26 after being diagnosed with cancer, and puts her survival down to the quality of attention that she received from her father and the subsequent decisions that she made. “I don’t know how well this will sit with the medical world (she turned down chemotherapy), but some of this was consolidated for me by my dad’s ability to care more about what I thought than what he thought.”

So how relevant is a thinking environment to the medical world? “There is huge potential for its application in medical context—both medical practice and the leadership of medical teams. It will sound basic and simple, and it’s not complex in the delivery. Taking the time to ask and listen thoroughly as a practitioner is, in the end, not only time — saving in the diagnosis and eventual treatment phase, but also creates more time to be an effective medic.”

Nancy believes that the relationship between medical expert and patient is often an unequal partnership. “In the medical space there are two experts (patient and doctor), and often medical professionals are led to believe that there is only one expert. They’re also lead to believe that they add value proportionate to how much knowledge they have, and share, and make clear  to  the patient.” She feels there is huge benefit to both patient and doctor in bringing what she calls “the expertise of generative attention” to the relationship. “When the professional understands the difference between listening to reply, and listening to ignite the mind of  the  other  person,  the internal world of the patient begins to change, they experience more ease, less fear… a real healing change happens. Physical things happen inside the body of a human being who’s being treated as a case. The patient’s physical progress is affected by the way they’re treated by the medical profession.  The physical implications of a thinking environment are very exciting.”

She cites Atul Gawande’s The Checklist Manifesto as an example of where asking the right questions has made a life-­‐or-­‐death difference to medical thinking about a patient’s case.

What about the application of the thinking environment to medics as leaders of people?  Nancy has seen amazing improvements in the way medical professionals interact with each other when these principles are applied: “they’re more imaginative and cutting edge when they’re not competing with each other. There’s a change in the way the  professionals  themselves  treat  each  other—their sharing and knowledge-­‐enhancing becomes far richer.”

Nancy lights up when I ask her how medical professionals could apply her principles right away:

“Start with your authority: where do you have influence? Where do you chair meetings? Are you in charge of a gathering or having a conversation? Don’t start with where you’d wish to see change. Gradually do a few things differently, and do it on your own authority.”

She’s also keen to see thinking sessions become more widespread between medical professionals.

“If they could find one other colleague whom they trust and the two of them could agree that at least once a week they were going to close the door and each take fifteen minutes in which each of them gets to choose a topic of their choice and they think it out. They can be quiet, think, talk and they listen to each other and then the other gets to exchange the favour, and until both of these things have happened there’s no dialogue. If one doctor could get one other doctor interested to become thinking partners, even for a six week trial that would be wonderful. Doctors do not have enough opportunity to be still and to think through (what they’re working with).”

Nancy is convinced that the way doctors set the tone of a consultation determines how quickly and easily the necessary information is exchanged. “If they want to change the  way  they  are  with patients, they can do this by communicating to the patient at the beginning of their time together that their experience and their thinking are as important as a doctor’s are, and there needs to be a combination of two minds at work here on this case. So I’ll listen to you without interruption, and in return I’d like you to be brief but speak to the core of your issue. Just for the patient to know they won’t be interrupted is going to make a difference.”

A final recommendation, which will resonate with anyone who has visited a GP or specialist recently and felt they have not told their whole story: “As a doctor you can say, at least once in the time together, ‘is there anything more that you think, or feel, or want to say?’.”

I wondered what had kept her so enthusiastic in the 15 years since she first put her thinking down on paper, and was surprised to hear that, as well as the “thousands of discoveries” made through thinking sessions over the years, it was “the joy of finding out where we’re wrong, as much as establishing a reasonable guess at what’s right”. And why is being wrong so important? “It’s discovering new things that we hadn’t seen before, so that it can be made even better. I remember the day when I first noticed I was not saying anything in a session and they would still carry on thinking. I said to myself ‘surely this isn’t working’. He talked for an hour, worked up to an exquisite outcome, thanked me for my ideas and left.  It was a big experience of being wrong.”

Being wrong has also led Nancy to write her latest book, to be published in August: Living with Time to Think – the Goddaughter Letters, based on collections of letters she wrote to her three goddaughters in response to some of the profound questions they asked her over the years. “Children instinctively know the questions to ask.”

You cannot interview Nancy without posing the question that is key to helping your thinking partner to explore their chosen topic: ‘is there anything more that you think, feel or want to say?’  I was glad I did! “I just want to say what a beautiful thinking environment you have been for me and how much I appreciate the quality of your questions and your inquiry – it’s been a chance for me to think afresh…I can imagine that you’re a wonderful coach!”