Consultations do not always have happy endings, with the patient going away with a clear action plan. When we are aware that our time for this meeting is running out, it can be tempting to try and push towards action to finish things up neatly. However, to do so is to run the risk of raising resistance, as the patient feels pressurized. Have you ever been considering buying a jacket and ended up leaving the shop without it because an over-pushy sales assistant tried to make the sale while you were still thinking about it? Or, have you ever considered a major purchase and then gone home to sleep on the decision before committing yourself? Hasty decisions are not always the best ones.

Our consultations are short. However, the journey towards change may be long. Early in the previous century, children would play a game bowling hoops along the road. The hoop had an impetus of its own. Its natural inclination was to roll along. Occasionally, it needed a nudge from the child to keep it on track or stop it falling over. Our consultations might be like the child’s nudge: helpful from time to time, but the real momentum for change is in the patient. Consequently, each consultation might be seen as one fragment of an overall process, rather than a discrete event. So what we need is a way of closing the session without closing the process. We may need to free ourselves from the assumption that a good consultation has to finish with a positive action plan. We do not have to ‘close the sale’ as they say in marketing.