From The Rainbow Machine: Tales from a Neurolinguist’s Journal by Andrew T. Austin.
“Everything is all right” can be a remarkably unconvincing thing to say to someone whose experience plainly tells them otherwise. The intention is reassurance. The effect may be to demonstrate that the speaker has not understood. When a frightened child has an obviously injured arm, telling him that everything is fine does little to explain why he should allow another adult to come near it.
The opening story of The Rainbow Machine grew out of my work in hospital care and my interest in how experienced staff secured cooperation. What caught my attention was often an apparently small difference: the words used, the number of people involved, the way an approach was made, or the moment when the patient recognised that someone understood.
Learning from the people who knew children
When I did agency work on paediatric units, I found that nursing children required skills I had not acquired simply by working with adults. I did not have children of my own. My personal experience of childhood consisted largely of having been a child, which did not automatically equip me to work well with a frightened patient.
Experienced paediatric staff knew how to invite participation in unfamiliar procedures. A hospital contains needles, noisy equipment, imaging machines and people who want to examine things that hurt. What is routine for the staff can be frightening to the person encountering it for the first time. A child needs some way to make sense of what is happening and what will happen next.
I paid attention to how those colleagues approached the task. In other departments I sometimes saw a less skilful sequence: reassurance failed, the child resisted, and the adults moved towards physically overpowering the child. The immediate procedure might be completed, but the interaction had become a contest in which the adults’ ability to impose themselves replaced cooperation.
An arm that was plainly not all right
One incident in an accident and emergency department has stayed with me. A boy, perhaps eight or nine years old, arrived with a badly broken arm. It was visibly the wrong shape. He was frightened, in pain and understandably defensive about people approaching it.
A group formed around him. Staff, doctors and family members tried to reassure him. Everything was fine. Everything was all right. Yet from the child’s position, his arm was not fine, the pain was not fine, and a collection of adults appeared determined to get close to the very thing he wanted protected.
Attempts to approach him brought screaming and further resistance. The proposed next step was to hold him down so that the examination and treatment could proceed. Then a more senior doctor intervened. He reduced the crowd, sending people away, and attended to the boy and the arm.
Acknowledging what the patient already knows
The doctor did something very simple. He acknowledged that the injury was bad. That sounds obvious, but it was the opposite of the repeated message the boy had been receiving. Here was an adult whose description finally matched something the child could recognise.
In recalling the incident, I am careful about the exact wording. I remember the doctor making clear that the arm looked very bad. I cannot reliably reconstruct every phrase, and it would be easy to embellish the account with a dramatic claim that it was the worst injury he had ever seen. The useful distinction does not depend on that embellishment.
What changed was the relationship between the adult’s message and the child’s experience. Previously, reassurance had sounded like denial. Now the doctor was saying, in effect, that there was something here worth taking seriously. The boy no longer had to be the only person insisting that something was wrong.
Showing understanding before asking for movement
The doctor then brought his hand gently towards the arm without touching it. As it came close, he reacted as though he could appreciate how painful it was. The gesture and reaction made his acknowledgement visible. He was not merely delivering a sentence about understanding; he was behaving in a way that showed attention to the boy’s pain.
This should not be confused with a claim that he literally felt the child’s injury. It was an interpersonal demonstration. The child could see that the doctor was taking care around the arm and responding to the seriousness of the situation.
The doctor then indicated that he thought he knew what could be done and invited the child to come with him to another location. The boy went with him. The account concerns that transition from resistance to cooperation. It does not supply a detailed medical record of the subsequent treatment or establish that the conversational manoeuvre alone determined the outcome.
Pacing and leading without a script
In NLP language, this can be understood as pacing and leading. Pacing begins with something that fits the person’s current experience. Leading introduces a possible next step. The order matters. Asking someone to follow before they have any reason to think you understand can intensify the effort to keep you away.
The useful lesson is not to copy a theatrical response to pain. A mechanical imitation could seem patronising or frightening. Nor is the lesson to exaggerate an injury in order to obtain compliance. It is to notice whether reassurance is contradicting something obvious and whether the proposed next action has become intelligible to the patient.
Several changes occurred together: fewer people crowded around, one experienced person took responsibility for communicating, the injury was acknowledged, physical approach became more careful, and a next step was offered. A retrospective story cannot isolate the contribution of each element. It can still draw attention to details that are easily missed when a situation is described only as a child being difficult.
Cooperation is part of the clinical task
The child’s reluctance was not an interruption of the real work. It was part of the situation the staff needed to address. Describing a patient as uncooperative can obscure the fact that the proposed cooperation involves allowing strangers near an injured body. The patient has reasons, even when staff urgently need to proceed.
Communication does not replace pain relief, assessment or appropriate treatment. It shapes how those things can be explained and carried out. When clinical urgency limits available choices, the person’s fear and understanding still matter. When there is room to slow down, a small improvement in the interaction may prevent a much larger struggle.
The practical questions are ordinary ones. What does this person think is happening? Which part of our reassurance might sound implausible? Are too many people speaking at once? Have we explained the next step in terms the person can understand? Is there a way for them to participate rather than merely submit?
The authority of a book and the value of observation
Publishing The Rainbow Machine changed how some people responded to my work. The same person who had previously been another therapist or former nurse became someone who had written a book. The material had not acquired certainty merely by being printed, but its social status had changed.
That distinction is worth keeping in view when reading any practitioner’s stories. A published account can be useful, engaging and carefully observed without becoming proof of a universal method. A website, conversation or demonstration may contain equally valuable observations. The medium and the reputation of the author do not remove the need to ask what the account actually shows.
Experience also changes how an author understands earlier work. Returning to an old case can reveal an overlooked detail, a claim that was too broad or an explanation that no longer seems adequate. In this story, the enduring detail is the mismatch between “everything is fine” and a child’s plainly injured arm. It is a useful place to begin noticing how our attempts to help are heard by the person we intend to help.
More from The Rainbow Machine
Browse the Rainbow Machine article index for the complete series of stories and related explorations of language, perception and therapeutic practice.