Use of Communication Skills to Facilitate Therapeutic Relationships - Essay Example

Use of Communication Skills to Facilitate Therapeutic Relationships Use of Communication Skills to Facilitate Therapeutic Relationships Relationships are forged and broken depending on individual needs and interests. These include intimate, therapeutic and social relationships. Of interest in psychosocial studies is therapeutic relationship. This type of relationship occurs between a nurse and a client. It is the basis for psychiatric nursing treatment approaches. This type of relationship facilitates communication of thoughts that are distressing. The Nurse aims to assist the Client in solving their problems and in doing so help facilitating activities of daily living. The Nurse also helps the Client(s) to re examine their issues and explore alternatives. In psychiatric setup, the nurse aims at helping the Client to become independent and establishing confidence. Williams& Irurita (2004), states that disclosure is the cornerstone for this relationship to be effective and also for the achievement of self-disclosure. There is need for trust, intimacy, effective relational communication and the assurance of confidentiality (Popoola et al 2012). According to Cull (2012), the Nurse uses their communication skills to understand human behaviors and personal growth so as to ensure Client’s growth. Communication enhanced through an emotional supportive enquiry. The nurse aims to familiarize themselves with the Client and their situation. This can be done through listening, taking notes, clarifying and checking perceptions. It is important to confirm that one has understood what the Client needs. This can be achieved through reflective conversation, reflecting feelings and silence. Thereafter, the Nurse should lead the conversation. Focus should be on the Client’s ideas, expression and feelings and the nurse should be friendly but not a friend to the client. This line needs to be clearly drawn by the nurse. It is important that the Client should be safe, confidential, reliable and consistent with the existing boundaries. For these to happen, the nurse should be genuine, empathetic and positively regard all Clients regardless of their mental state. Genuineness in this case is the self awareness of the Client’s feelings as they arise in the relationship and the ability to communicate them when necessary. This works to build trust and further prompt the client to open up. The Nurse should be capable of empathy. This is the ability to understand the ideas expressed by the Client as well as the sensitivity to their feelings. The nurse should be able to not only listen but appear to do so. Unconditional positive regard is also an important skill. This is basically about respect and understanding that all clients deserve respect and care. When practicing in a diverse population in terms of ethnicity and age, it is important to re evaluate the communication style. The communication should be culturally sensitive in that, the nurse needs to understand the norm or what is acceptable in a community or country (Sutton, 2007). Care needs to be taken not to portray gestures and actions that would instead be interpreted as hostile. These are culture specific, for example, in some cultures, direct eye contact is considered rude. This should therefore not be used as a means to foster openness. Again, the directness of the questions could affect the client’s response as it may be viewed as rude and the client may recoil as a result. The key to effective communication in a therapeutic relationship is not to appear judgmental or threatening. It is important for a nurse not to personalize a client’s needs. This is the difference between empathy and sympathy. In cases where the client develops feeling towards the nurse, it is the nurse’s duty to set this straight in a professional way explaining carefully that friendship is not within the mandate. “Bucket” of stress and vulnerability for a Friend Boyfriend abusive and chases her (21) Attempted rape by step father and moved out (20) Failed in final secondary school exams (19) Abusive step father (11) Mother leaves (8) Father commits suicide (7 years) Relocates to the rural area (7) Father is abusive (6/7 years) Timeline DATE SIGNIFICANT EVENTS MENTAL HEALTH ISSUES Born in 1990 Good childhood, father’s favorite child. Mother works 1993 Started school. Good friends and playmates. Father is distant and quarrelsome towards mother Blames self 1994 Proceeded to the next class. Father is warm and treats mother and family well Happy 1996 Joined Primary 1. Father lost his job and was getting meaner daily. Beating mother Sad 1996 November Father beat mother almost to death and mother escaped with children to maternal grandparents home. Traumatized 1997 Started new school Father committed suicide Trouble making friends at school 1998 Trouble at school, expelled for misconduct. Physical reprimand at home. Shame 2000 Transferred school and went to live with mother Happy DATE SIGNIFICANT EVENTS MENTAL HEALTH ISSUES 2004 Joined Secondary school. Made close friends. Started smoking marijuana Alcohol consumption 2007 Form 3 Tried heroine through injection ecstatic but later feels alone in the world 2008 Final year. Final exams pending Depressed and anxious about performance Paranoia, feeling that people hate her. She is a loser and the reason why father died 2009 Examination results showed a C Grade Mother is disappointed and tries to hide. Mother refuses to pay college fees Smoking marijuana, taking alcohol and going to parties Disappointed 2010 Moves in with boyfriend when mother’s new husband tries to rape her Feeling she is to blame. Shame 2011 Boyfriend chases her, she cannot go back home and lives on the streets for 6 months, taking drugs and prostitution Shame, guilt, despair DATE SIGNIFICANT EVENTS MENTAL HEALTH ISSUES 2011 Diagnosed with HIV Despair and suicidal thoughts 2012 Contacted mother and she welcomed her back home. Started HIV treatment and counseling Despair but experiencing positive outlook on life 2013 Joined a peer group promoting awareness on drug abuse Continued therapy and counseling. During the bucket and timeline exercises, sensitivity towards the client worked well. The client was able to open up and share their feelings comfortable without fearing that they would be judged or criticized (Wilkins, 2010). The nurse and client were able to identify the areas that required addressing. This was done in phases and a plan of action was agreed upon. The atmosphere was that of warm and at the same time professional. Listening and reacting to the client’s comments ensured that the client felt that she had all the attention. By reflecting on what the client was talking about and using gestures like nodding, the client easily opened up to the nurse. Paying close attention and appearing to do so went a long way into showing the client that the nurse cared about her. The sessions were divided and took place in two different days so as to foster familiarity as well as to enable enough time to discuss issues exhaustively. There was an instant whereby making eye contact and holding it made the client hesitant and quiet. This was rectified by the nurse looking down occasionally while still engaging the client. When it came to talking about sexuality issues, the client was reluctant to describe how these made her feel. This presented a challenge as it was difficult to move to the next step of therapy. Because of the personal nature of the relationship in this case, that is communication with a friend, there were issues with professionalism given the conflict between the social and therapeutic relationship. It was difficult for the client to disclose some information and feelings for fear of being judged. However, the issue of confidentiality was emphasized and the client was assured that everything discussed would be subjected to the highest professional treatment. Some details were omitted as a result of the client inability to pinpoint the specific feelings they were experiencing but this was resolved through follow up interviews. It was challenging to be impartial given the nature of the relationship. A psychological assessment involves gathering information from the client about their mental, emotional, behavioral, and spiritual interactions. Through this, the nurse can be able to identify the client’s past and present level of functioning and in doing so assess their need (Sutton, 2007). In clinical practice communication and the use of “bucket” of stress and vulnerability and “timeline” tools, the nurse can establish a therapeutic relationship with a client. In practice, these tools would be useful in assessing the clients’ needs and planning an intervention. They are useful means of collecting data from a client while engaging them in meaningful conversation that encourages them to open up and feel that someone is ready to listen. These would be a guide for the nurse to avail support and assist in problem solving. The “bucket” would be useful in identifying the current mental state of the client and what needs immediate attention. As a practitioner, this is important for planning strategies that would alleviate the stress that causes mental disorder and psychosis in clients. It is therefore an important tool in interpersonal nursing. The timeline would act as a road map of the clients mental and behavioral history and serve to pinpoint the specific issues and areas that need attention, confronting and provide interpersonal feedback. Proper and professional verbal and nonverbal communication is important and should allow the client to express their feelings and concerns regarding their health and illness should aid the nurse in providing support. Stressors can be physical, psychological or a combination of the two (McMillan, 2008). Every individual has a level of stress in their lives, hence the bucket analogy and this is the base load of water in the “bucket”. These range from minor things that nag at them to major stresses like loss through death. Often, there are issues that arise and add up to the stresses. As long as one’s bucket can hold their stresses, then they are in the safe zone. A big bucket means that one can tolerate more stress before breaking down. When the stresses are too much, the bucket overflows and this is where mental illness sets in. There are mechanisms to alleviate these stresses like making a hole in the “bucket”. This is achieved via psychosocial counseling and medication where necessary. However, most people tend to resort to use of drugs or alcohol as a coping mechanism. This only serves to “block the holes” in the bucket adding to physical and psychological stress. It is therefore advisable that individuals check their stress levels and seek professional help where necessary. References Coll, X. (2012). Communication skills in mental health care: An introduction. London: Radcliffe Pub. Kuutmann, K., & Hilsenroth, M. J. (May 01, 2012). Exploring In-Session Focus on the Patient- Therapist Relationship: Patient Characteristics, Process and Outcome. Clinical Psychology & Psychotherapy, 19, 3, 187-202. Levy, S. T. (2000). The therapeutic alliance. Madison, Conn: International Universities Press. McMillan, F. D. (January 01, 2008). Stress, Distress, and Emotion: Distinctions and Implications for Mental Well-Being. 93-111. Popoola, B. I., Adebowale, O. F., Akintomide, A. G., & Olatomide, O. O. (January 01, 2012). Intimacy and Relational Communication in Online Counselling. Sutton, A. L. (2007). Stress-related disorders sourcebook: Basic consumer health information about stress and stress-related disorders, including types of stress, sources of acute and chronic stress, the impact of stress on the bodys systems, and mental and emotional health problems associated with stress, such as depression, anxiety disorders, substance abuse, posttraumatic stress disorder, and suicide; Along with advice about getting help for stress-related disorders, information about stress management techniques, a glossary of stress-related terms, and a directory of resources for additional help and information. Detroit, MI: Omnigraphics. Williams, A. M., & Irurita, V. F. (October 01, 2004). Therapeutic and non-therapeutic interpersonal interactions: the patients perspective. Journal of Clinical Nursing, 13, 7, 806-815. Wilkins, P. (2010). Person-centred therapy: 100 key points. Hove: Routledge. Read More