Client Practitioner Relationships

1
Client Practitioner Relationships

• Week 3

2

• Why is the PRACTITIONER/PATIENT/CLIENT
  relationship so important?
• Components of the therapeutic relationship that
  enhance effective communication
• Transference and Countertransference
• Applications to Practice

3
Relationships

• Clients that described good therapists as those
  that showed an interest (Ford Gordon, 1983).
• Quality of the working alliance is the key
  predictor of adherence to rehab programme.
• Working alliance is central to success of therapy
  and accounts for up to 45 of the variance in
  achieving desired outcomes.
• (Horvath Greenberg, 1989)

4
Communication Roles

• Traditional medical model.
• Types of communication (Owen Goodge, 1981)
• (Direction advice giving, relationship
  building).
• Psychotherapy model (Szybek et al. 2000)
• (Based on the working alliance, transference
  configuration, and the real relationship).

5
Transference and Countertransference

• Transference - clients transfer their feelings,
  thoughts, and reactions to significant others,
  generally authority figures.
• Countertransference - Authority figure transfer
  their feelings, thoughts, and reactions about
  others to patients, clients etc.

6
Therapeutic relationship

• Acceptance
• Genuineness
• Empathy

7
Kinesics Proxemics

• Physical appearance
• Posture
• Gestures
• Touching
• Eye contact
• Facial expression

• Aspects of personal space
• Environmental aspects
• Paralanguage
• Particular vocal characteristics

8
Attending skills

• Attending understanding your clients agenda and
  from their perspective assumptions can hinder
  effective communication! (pg.66)
• Engagement - Open/closed questions.
• Sending and receiving (intent impact).

9
Listening barriers

• Inner voice
• Being Judgemental
• Evaluative praising
• Defensiveness
• Changing subject
• Cliché reassurance

10
Strong listening skills

• Enable
• Practitioner - Congruent caring messages
• Client/patient - Clear communication of their
  expectations, concerns and strengths
• Development of a strong working alliance

11
Working alliance - rapport and clear
communication

• Develops - verbally and non-verbally
• Includes application of listening and attending
  microskills of
• Summarising
• Paraphrasing
• Accurate reflection of feelings

12
Non Verbal

• Kinesics
• Proxemics
• Paralanguage

13
Self-awareness

• Develop Self-awareness as far as possible before
  you begin practice!
• Develop self-awareness during practice
• HOW?
• Reflection/ Feedback from clients and
  supervisors/colleagues.

14
Humor (fun)? Seriously!

• Humor and fun important for rapport and may
  strengthen working alliance.
• Timing, content, and duration need to fit with
  your client/patient background
• Lift the spirits of your clients/patients

• Patient has chest pain if she lies on her left
  side for over a year.
• On the second day the knee was better, and on the
  third day it disappeared.
• The patient is tearful and crying constantly. She
  also appears to be depressed.
• Discharge status Alive but without my
  permission.
• The patient has been depressed since she began
  seeing me in 1993.

15
Application

• Groups of 3 client/practitioner/observer
• Each student take a turn at being c, p, and o.
• Client choose injury/condition any
  comorbidities, state of mind note on your
  sheet.
• Practitioner (first time) do all the wrong
  things (v non-v) with your client
• Practitioner (second time) practice good
  attending (v non-v skills)
• Observer watch interaction, note interaction on
  sheet provided, give verbal feedback to
  practitioner get feedback from client