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 isnt 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 isnt 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 5 Building 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 clients feelings
• Relationship builing component
• Empathizing statements
• Disclosing clinicians feelings, being aware and
  reflecting clients 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 clients 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
  physicians 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 isnt validated
• Patient feels like another number
• You spend less time
• You dont 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 patients 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.

21
Backdrops - These are full sized backdrops, just
scale them up! - Can be Copy-Pasted out of
Templates for use anywhere!
www.animationfactory.com