Words are perishable goods. With time they lose color and flavor, either rot away or dry into small hard things. I was thinking about this when contemplating the word encouragement. It once was and again can be so much more than what we often take it to mean. In fact, encouragement can be a core intervention we use as clinicians.

Sometimes ‘to encourage’ is used as a synonym for ‘I recommend’ as in, “As your high school counselor, I would encourage you to take more math classes and to turn in your college applications early.” Sometimes encouragement brings up the image of a pat on the back with a “at a boy” or “at a girl … you can do it.”

But encouragement is more than advice-giving or an isolated statement of “you can do it” said with befitting enthusiasm. The root of the word ‘courage’ is the Latin word for heart ‘cor’ and for millennia the heart has represented spirit, fortitude, inner strength, and the ability to do hard or dangerous things despite one’s fear. Such hard or dangerous things are not limited to activities that can lead to physical injury or death, but to psychological or spiritual injury or loss also.

A simple image that captures the power of changing behavior through encouragement is of a parent with their toddler who fears going up the ladder and coming down the slide. How does a parent encourage their hesitant toddler? Perhaps with these words: “Daddy will be right behind you as you climb the steps” or “Mommy will catch you as you reach the bottom.”

What is the parent offering their child? And what can we offer our patients? Here is a list of possibilities:

  • Safety: people willing to take risks are launching from a place of relative safety. Counterintuitively, the more vulnerable a person feels in their current situation, the harder it is for them to jump into something new that may only serve to increase their vulnerability. As clinicians, we can strive to make our offices and time spent with patients a refuge from the threats they often experience for the rest of their lives. Also, we can strive to help the patient set conditions that increase their sense of safety outside our offices. For example, we can encourage them to form new, healthy relationships or reconcile with estranged family and friends. Or we can teach them skills to ask for help from others.
  • Worthiness: a person needs to feel important enough to believe someone else will want to care about them and care enough to ‘not take their eyes off of them.’ As clinicians, we cannot be ever watchful over patients, of course, and it is countertherapeutic to make promises to patients that we cannot keep over the long term. Such unkept promises destroy interpersonal trust with incredible efficiency. But there are ways we can communicate to patients that they are important to us. Here are some simple interventions:
    •  Patient comes in and sits down. I say, “It’s good to see you. I was thinking about you this week …” What I’m doing is telling the patient that they exist for me even when they are not in front of me. I’m thinking about them even when I’m not being paid to do so. I’m doing it because I care about them and I care about them because they are worthy of care. My care is ongoing, transcending the limited moments of our appointment and even the times they are actively on my mind. I care even when sleeping.
    • I advise the patient to try a new adaptive coping strategy, for example, telling a socially anxious patient to join a club at school. In addition to planning the details of undertaking this new scary behavior with the patient, I say, “OK. So, after you meet with the group coordinator, I want you to leave me a message or email me right away. I would like to know how it went for you and we can then strategize some more the next time we meet.” I am communicating that I am invested in the outcome and that their experience is emotionally meaningful to me.
    •  The patient explains something about their experience to me and I say, “I want to thank you for sharing that with me. I don’t think I understood such experiences before you explained yours.” I am communicating that they have something to teach me and that I am grateful to them for enriching my life. Our relationship is not a one-way street, we’re mutually learning from each other. Patients are more likely to learn from me when they know I am learning from them.

As clinicians, our work transcends the technical expertise we bring to the table. The core of what we offer our patients is not simply knowledge or procedures, but the encouragement to take steps toward healing, growth, or change. Encouragement, in its truest form, is an essential tool for all of us, helping patients confront not just physical challenges, but also the psychological and emotional hurdles they face. In every interaction, we have the opportunity to create a space where safety, worthiness, and courage are nurtured, fostering resilience and hope in those who trust us with their care.

Until next time,

Jack Krasuski, MD

LanguageBrief

“Everything that happens to you matters to me.” – Cassandra Clare

“The courage to be is the courage to accept oneself, in spite of being unacceptable.” – Paul Tillich

“A dog has one aim in life… to bestow his heart.” – J. R. Ackerley

“The most critical time in any battle is not when I’m fatigued, it’s when I no longer care.” – Craig D. Lounsbrough