CHAPTER 12 Behavioral History Taking
The first step in making a behavioral diagnosis, or list of differential diagnoses, is collection of a thorough and accurate history. Taking a thorough behavioral history is arguably the most important part of dealing with animal behavioral issues.5
It’s Not Just About the Cat
Good communication skills with clients are particularly important in behavioral medicine, and history taking is no exception. It is not just the content of questions that matters, but also the way in which these questions are asked and the answers more fully explored. Behavioral disorders can cause clients significant distress and may lead to disharmony among household members.4
Many clients greatly appreciate the opportunity to talk about their cat’s behavioral problem with someone whom they recognize as objective and understanding. This is particularly important given that many owners feel guilty about their pet’s behavioral problem.3 The time taken to collect an oral history can help build a strong relationship between the veterinarian and the client and allow for clarification of any complex issues.
Empathy
Empathy underpins all counseling. Empathy is a skill that “creates a climate for acceptance, support, disclosure and a working alliance. It is crucial for the building of a trusting relationship.”13 Empathy includes being sensitive to the feelings of the client without making judgments. It requires respect and interest in the client and constructive honesty to enhance the cat–human bond. The veterinarian must remain sufficiently objective to make rational and well-informed decisions.
Counseling Skills
Many of the basic counseling skills employed in various forms of psychological counseling are appropriate for history taking in a veterinary context. The need to develop rapport and understanding with the client is critical in both instances. These skills include the following13:
1 Reflective listening: This skill involves paying full attention to what the client has said and summarizing the main message. It can be useful to allow the client to express anything the client feels is critical to the veterinarian’s understanding of the situation at the beginning of the consultation. For instance, if the client is concerned that the veterinarian does not fully understand the sentimental value of an item that was ruined after the cat urinated on it, then this may reduce the client’s desire to collaborate in formulating a useful treatment plan for the cat. Later in the consultation it will be necessary to add more shape and structure to the conversation. The veterinarian should take time at the outset to reflect on the following:
2 Sensitive questioning: This allows clarification of the situation and permits a greater level of understanding by the veterinarian.
3 Accurate summarizing: A behavioral history requires collection of a great deal of information. Summarizing the major events, themes, and reactions as they relate to the client’s current situation can be very useful. It helps ensure that the veterinarian and client are on the same wavelength before moving on.
4 Focusing and structuring: This part of the consultation allows time to focus on the key concerns, clarify expectations, and set realistic goals.
5 Collaboratively formulating a management and treatment plan: Behavioral medicine is always interesting and challenging because no two situations are the same for any particular behavior problem. The veterinarian will be in the best position to recommend an effective treatment plan if the preceding steps have been taken in collecting a history that encompasses client concerns and expectations, as well as patient behaviors.
Organizing a Consultation
The type, duration, and intensity of behavioral problems vary enormously. This chapter focuses on issues that require a behavioral consultation to be addressed appropriately. A good starting point for behavioral issues is a thorough physical examination and, generally speaking, a blood profile and urine test to help rule out medical issues that could be contributing to the behavioral problem and that may also have an impact on the treatment plan.7 One case study showed the importance of a full medical workup of a cat presenting with feline idiopathic cystitis that could be successfully controlled with behavioral therapy alone.12 It is not uncommon for there to be a crossover between medical and behavioral issues, with both needing to be addressed. The results of such investigations will form part of the collected history and are addressed elsewhere (see Chapter 3).
A questionnaire not only provides structure for the veterinarian so that critical areas are covered but also helps clients see their cats’ issues more clearly. Encouraging input from all household members affords the best chance of obtaining an accurate history and identifying potential areas for disagreement that may need to be addressed. A number of textbooks have behavioral history templates that can be modified according to the style and preferences of the attending veterinarian (Box 12-1).6,8,10
BOX 12-1 Sample Behavioral Questionnaire
• Main reason for consultation:
• Any other behavioral problems:
• Medical history (if not readily available within practice):
• Name the people living in your household (including ages of children):
• Do you have any physical ailment(s) that influences your ability to interact with your cat?
• Have you owned a pet before you owned this cat?
• Where and at what age was your current cat acquired?
• Did your cat have any previous owners? If so, do you know why it was given up?
• Do you know any details about its parents or siblings?
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