RelationshipBased Therapy Extending Current Practice

1
Relationship-Based TherapyExtending Current
Practice

• What is it and how does it work?

2
Relationships

• Strong relationships
• Help clients perceive highest quality of service
  and work to achieve highest goals for
  communication success
• Create a safe environment for clients to ask
  questions and express themselves
• Take risks in therapy and push themselves to
  achieve
• Professionals to communicate and collaborate
• Helps realize they are part of a greater cause
• It is not just communication, it is quality of
  life
• Improved relationships with others, being able to
  work successfully, to have fun

3
Relationship-Based Practice

• Relationship-based thinking can play an
  important role in assessing personality, feelings
  and behaviors, how an understanding of
  relationships can be used to guide and focus
  treatment interventions and how relationships
  affect not only clients but (practitioners) too.
• David Howe, 1998, Social Work

4
Relationship-Based Therapy

• Primary Relationships
• Practitioner Client
• Parent/Spouse Client
• Practitioner Caregiver (Parent / Spouse)
• Practitioner Practitioner
• Supervisor Practitioner
• Organizational Framework

5
Relationship-Based Skills

• Listen carefully
• Demonstrate concern and empathy
• Promote reflection
• Observe and highlight the caregiver-client
  relationship
• Respect role boundaries
• Respond thoughtfully in emotionally intense
  interactions
• Understand, regulate, and use ones own feelings
• Gilkerson Taylor Ritzler, 2005
• Open communication with clients and families,
  professionals

6
Relationship-Based Care

• Significantly Linked to Improved Treatment
  Outcomes
• Increase in Therapeutic Outcomes
• Patients adherence to advice recommendations
  from practitioner
• Improved treatment outcomes
• Clinical status
• Functional Status
• Increase in Business Outcomes
• Patient Retention, Patient Loyalty
• Decreased Client Problems Negative Issues
• Safran et al. 2005

7

• All learning takes place in the context of
  relationships and is critically affected by the
  quality of those relationships
• Norman-Murch, M.D., 1996

8
Practitioner Client Relationship

• Focus on using specialized expertise, and
  knowledge of therapeutic skills with the child
• Build relationship with your client using
  underlying emotions

9
Therapeutic Alliance

• Associated with significant increases in
  therapeutic outcomes (Kazdin et al., 2005)
• Alliance
• Child feels the therapist is on his or her side
• Likes spending time with the therapist
• Feels he or she can tell the therapist problems

10
Caregiver Client Relationship

• Must incorporate parents / spouses and family
  into therapeutic goals.
• Ethnographic Therapy Model
• Consider
• Family Community Relationships
• Parent Parent Relationships
• Family Dynamics, Priorities, Resources

11
Practitioner Caregiver Relationship

• Build individualized, respectful, responsive,
  supportive relationships with families
• Skills
• Listen carefully
• Demonstrate concern and empathy
• Promote reflection
• Observe and highlight the parent-child
  relationship,
• Respect role boundaries
• Respond thoughtfully in emotionally intense
  interactions
• Understand, regulate, and use ones own feelings
• Open communication with clients and families

12
Therapeutic Alliance

• Therapist - Parent relationship recognized as
  important part of child therapy
• Measured alliance on a Working Alliance
  Inventory
• Therapist-parent agreement on tasks and relevance
  in therapy
• Extent of positive personal attachment,
  acceptance, confidence in the relationship
• Associated with significant improvements in
• Parental behaviors
• Childs therapeutic outcomes
• (Kazdin et al., 2005)

13
Goals of Talk For Success Model

• Attend Relate to Others
• Increase and Foster Purposeful Communication
• Use language to link thoughts causally and
  logically for the purpose of communication

14
TFS Principles For SLPs

• Responsive Interactions
• Be responsive to clients initiations
• Language Stimulation
• Use milieu teaching principles
• Emotionally-Based Interactions
• Create them in focused activity
• Expand them in dedicated activity
• Reward and build upon them when initiated by
  client in organic activities

15
Emotionally-Based Interactions

• Capitalize on emotions that are happening for the
  client at any given moment
• Use them as mechanisms for learning
• Examples
• Trying to open bin frustrated
• Functional Communication Goal I need help
• Seeing spouse return happy
• Functional Communication Goal I love you!
• Jumping on trampoline pleasure
• Functional Communication Goal This is great!

16
Importance of

• Emotionally-Based Interactions
• Encourage emotional self-regulation
• Impact on Communication
• Development of Affective Signaling
• Develops into requests for help and eventually
  conversational initiation
• Social Skills
• Back and forth of communication
• Particular need for kids with ASD and other
  developmental delays

17
TFS Steps

• Focused Activity
• Systematic Instruction of a functional
  communication skill
• Dedicated Activity
• Create a more naturalistic activity that you
  still remain some control over and have created
  specifically to develop skill
• Designed to create opportunities for practicing
  the functional skill
• Organic Activity
• Arrange environment to create opportunity for
  naturalistic practice of functional skills
• Then employ milieu teaching techniques

18
Focused Activity

• Example
• With Shake and Go Car at Table
• Functional Goal More, I want more.
• Adam Video

19
Dedicated Activity

• Example
• Using car with track but still controlling the
  situation
• Responding, stimulating language within
  naturalistic activity, expanding his language
• Adam Video

20
Organic Activity

• Example
• Just playing with track independently and when
  car stops, waiting for initiation responding
• Adam Video

21
Action Plan For Infusing

• Where will relationship-based principles fit
  within your therapy session with your chosen
  client?
• Where else in your clients day can these
  principles be infused?
• One step that you can do to incorporate
  relationship-based principles into your practice?