Practioner - Client Relationship

1. Practioner - Client Relationship End of Chapter 4 & Chapter 5

2. Why is this relationship inherently important? • Two reasons: • 1. Depends how you want to function in this relationship • Strictly - clinical and limit the interaction and alliance • Consequence, you still will influence your client. • The lack of interaction would also influences • Consider old psychoanalytic context • Patient on a couch and the therapist behind • It isn’t for everyone. • Vice versa • But if it is, know how to use it.

3. Why is this relationship inherently important? • 2. Individuals are social beings whether it be conscious or unconscious • They heal within a social context as well • If not they withdraw • Certain individuals will isolate themselves to heal: retreat. • In these cases there is a re emerging. • The social context is influencing their healing whether it be conscious or unconscious • Why not make it conscious

4. Why is this relationship inherently important? • As mentioned previously, other healers use the relationship to contribute to the healing process. • Frank & Frank talk about the healing process including a persuasion process if the clinician chooses. • When done consciously, the healer is attempting to persuade the patient in a certain direction in order to to elicit the mind – body relationship to work together in order to contribute to the healing. • Persuasion vs Coercion • Cultural conditioning can contribute to this process by the way of having conditioned into the client expectations regarding your abilities (Shamans, healers, etc..) • For you: • Magical powers • Sage like healer • Clinician with an alternative and health promoting approach • Teacher regarding self regulation and health promotion

5. Why is this relationship inherently important? • Remember, clients sometimes have seen other clinicians and influence by their working relationship • Depending on the amount of exposure the effect will be more condition

6. Client – Practitioner Communication • Communication has been divided into descriptive categories • Competence related • Informational • Partnership building • Questions • Socioemotional

7. Client & Practitioner Perceptions • Studies suggest that their perception converge due to the relationship • However, there are cases in which isn’t the case • In fact, it has been seen that clients with injuries underestimate how disruptive their injuries will be • Is this a coping method • Similarly, some clients overesitmate how serious their injuries are • Likewise, dsicrepency can occur as related to the level of emotional distress. • This can result an underlying level of emotional distress sabotage the overall healing process.

8. Chapter 5Building Working Alliances

9. Building Working Alliances • Require colllobarative relatinship • Collobarative empiricism • Collaboration & • Modeling empiricism • Collaborative relationship • Climate of trust • Emotional bond • (this may occur whether you encourage it or not – internalizing the therapist) • Clear agreement about treatment goals • Clear roles • Clinician superior • Clinician – client partnership • Client controls • May be a result poor health care experiences • Personality issues • If it about being assertive then it will most likely fall under partnership

10. Building Working Alliances • Initial contact between clinician and client sets tone and structure • Three proposed models • Szybek multidimennsional • Working alliance • Transference • Real relationship • Client – practitioner collaboration • Working relationship • Mutual inquiry • Problem solving • Negotiation (why do patients negotiate) (example recently)

11. Building Working Alliances • All of these models propose interactions that generally will lead to clinet satisfaction, reduction in client concerns and increased disclosure of psychosocial issues. • Speigel study correlates with previous point of persuasion eliciting the mind body relationship • Speigel study looked at women with breast cancer in a support group living 18 months longer than women not in a group • Three elements that appear to contribute are • If you can spend more time • Some physical contact as in massage or acupuncture • Some noticeable results even if minor for persuasion sake

12. Building Working Alliances • Owen and Goodge • Direct and advice giving • Asking direct questions • giving advice • Ignoring client’s feelings • Relationship builing component • Empathizing statements • Disclosing clinician’s feelings, being aware and reflecting client’s feelings and point of view • Constructive feedback • Praise, positive reinforcement • Counseling statements • Reflecting and paraphrasing

13. Three facilitating Conditions • Acceptance • Uncondtional, non judgmental • Genuinness • Being authentic • Empathy • Attuning with a client’s point of view or feelings in order to address them • Another approach to facilitate this state: • Look, listen, and feel

14. NON Verbal Communication • Everything not stated • Two types affiliative and dominant • Similar to interpersonal styles Three categories Kinesics gestures, posture, eye contact, contact Proxemics distance Paralanguage voice, volume, tone of voice (i.e. psychotic patients or brain injured patients)

15. Non verbal is the backdrop of communication • Similar to perhaps when you observe posture and health related habits in comparison to what they say they do. • It is continuous versus verbal having a beginning and an end. • Communicated in different formats • Facial • Distance • Gestures • Postures • It conveys attitudes, feelings and quailty of interpersonal relationship

16. Client satisfactoin has been relateed to physician’s nonverbal communication and their ability to read their patients’ non verbal. • When there are mixed messages the non verbals tend to prevail. • Interpret non vrebal with caution by the way of clarifying • To learn your non verbal often requires self monitoring and feedback.

17. Building rapport • Matching or finding commonalities • Listening to the patient’ agenda • When establishing a working alliance Meichenbaum & Turk recommend the following: • Explore the personal meanings that clients ascribe to their injuries • Explore clients’ worries, fears, or concerns about their injuries • Explore clients’ expectations about treatment and their healthcare providers

18. Open versus close ended questions • P64 • Asking what instead of why • P65 • Pace before you lead - matching

19. Empathetic Listening • Related to the communication going on at the moment • Intent of communication • Impact of communication • Related to central/content vs peripheral/process communication • Some clinicians assume they know what the patients • This may work against you in that it puts on a pedestal • Patient isn’t validated • Patient feels like another number • You spend less time • You don’t explore their idiosyncratic details as relate to the issue.

20. Research has noticed that healthcare professionals often overestimate their ability to be empathetic. • Dockrell 1988 found discrepency between what students reported to do in bulding rapport and what their actual behaviors, with only 7 out of 20 demonstrating true attending behaviors • Gillium & Barsky 1974 two thirds of health care professionals thought that adherence issues were caused by patient’s personality • Makes it easier on the the professional • Only 25% considered that their methods/behaviors may have contributed. • Many professionals are unaware of their behaviors or limited self awareness.

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