Therapeutic Relationship

• Therapeutic relationship


  The quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond
• The therapeutic relationship itself is essential to the success a patient experiences
• Therapeutic alliance


  • Empathy and genuineness
• By experiencing a secure attachment with the therapist


  The person can feel safe to start to resolve some of their old traumas and evolve their model of relating
• As the person peels back the layers of their defenses, they can start to recognize their unique wants and needs, what they wish to change or who they hope to become
• Therapeutic relationship


  The close and consistent association that exists between at least two individuals: a health care professional and a person in therapy
• Establishing a therapeutic relationship is a vital step in the recovery process
• This helps the therapist to better comprehend the affected person's point of view, feelings, and motives, allowing them to provide the most appropriate treatment and employ the most effective strategies
• Warning signs of inappropriate therapist behavior

  • Pays no attention to the changes the client wants to make and the goals they wish to achieve
  • Is judgmental of the client's conduct, lifestyle, or situation
  • Encourages the client to blame friends, family members, or a partner
  • Provides no explanation of how the client is supposed to know their therapy is complete
  • Tries to be the client's friend outside of therapy or start a romantic relationship
  • Tries to touch the client without prior consent
  • Talks too much or not at all
  • Attempts to push their spiritual beliefs on the client
  • Tries to make decisions for the client
• Each person has the right to quality mental health care
• Good therapy relationship


  • Unconditional positive regard (therapist truly thinks the best of the client)
  • Empathy (therapist really gets the client)
  • Congruence (therapist is genuine)
• In counseling


  Client can try a different kind of relationship, one defined by positive regard instead of criticism
• Skills needed by therapists

  • Knowing when to speak and when not to
  • Knowing when to show empathy, and when to push
  • Careful not to bring their own bad relationships into the room
• Countertransference


  The unconscious feelings or emotions that a therapist feels towards their patient
• Components of a therapeutic alliance

  • Agreement on goals (Collaborative Goal Setting)
  • Agreement on interventions (Shared Decision Making)
  • Effective bond between patient and therapist (The Therapeutic Relationship)
• Collaborative Goal Setting


  1. Set SMART (Specific, Measurable, Attainable, Relevant and Time Limited) goals

  2. Agreement of goals between patient and therapist increases adherence to those goals

  3. Adherence leads to improved outcomes, patient satisfaction and motivation
• Shared Decision Making


  1. Choice Talk - Step back, Offer choice, Justify choice, Check reaction, Defer closure

  2. Option Talk - Check knowledge, List options, Describe options, Harms and benefits, Provide patient decision support, Summarise

  3. Decision Talk - Focus on preferences, Elicit preferences, Move to a decision, Offer review
• Empowerment begins


  By recognising a patient's powerlessness or sense of powerlessness
• Lack of self-efficacy


  Poses a challenge to the patient asking for help to manage their recovery
• Dimensions of empowerment


  • Meaning
  • Competence
  • Choice
  • Impact
• Empowerment


  A complex experience of personal change
• Locus of control


  Internal locus of control is the perception of one's control over personal competence and motivation
• Intrinsic motivation


  The perception of self-competency shapes it, successful attempts and acquisition of new skills and task completion reinforce competency, which fuels motivation
• Therapeutic alliance


  A sense of collaboration, warmth, and support between a client and their practitioner, associated with emotional flexibility, interpersonal communication, and trust
• Patient empowerment


  Begins with patient education and ends with the patient's active participation in their physical therapy, transcendence and sustainable management of the patient's impairment or dysfunction by the patient being given autonomy and authority over their rehabilitation and life
• Social support and reinforcement complete the transcendence of empowerment
• Patient/client Ellen


  Demonstrates empowerment through her resilience, self-efficacy, and positive mindset
• The variability and intensity of the programme, along with the group dynamic, reinforced Ellen's empowerment
• The researchers handpicked this interviewee as someone who exemplifies empowerment
• Reflective practice


  Thinking critically about practice
• Effective communication


  Can create a more effective therapeutic setting, thus leading to improved outcomes and the attainment of goals
• Language barriers can lead to negative health outcomes, decreased adherence to treatment plans or a patient's unwillingness to participate in rehabilitation treatment
• Creating a therapeutic space

  • Foster trust, safety and respect
  • Encourage participation of the patient in creating goals
  • Adjust the physical space to create a positive environment that ensures privacy
• Vulnerability


  An individual's condition or life circumstances may disadvantage them compared to others
• Interpreter


  A skilled and trained person who converts oral information into another language
• Translator


  A skilled and trained person who converts written information into another language
• Communicating with interpreters


  • Use certified interpreters with adequate language and interpreting skills
  • Consider the age, gender and diversity characteristics of the interpreter
  • Address and make eye contact directly with the displaced person, not with the interpreter
  • Avoid talking to the displaced person "through" the interpreter
  • Shorten the sequence of your sentences
  • Select your words carefully
  • Adjust the kind of language that you normally use
  • Ensure that the information and correct meaning is not lost in translation
  • Apply triangulation techniques to minimise loss of information
  • Encourage the interpreter to translate EXACTLY what the patient has said
  • Ensure interpreters have breaks and adequate rests
• Communicating with displaced persons

  • Pay attention to cultural considerations
  • Utilise a client-centred approach
  • Provide culturally sensitive care
  • Acknowledge and respect differences in beliefs, values, and ways of thinking
  • Avoid generalisations about cultural groups
  • Facilitate the dialogue so the client has an opportunity to present their story
  • Use active listening techniques
• Active listening


  • Physically adjust your body to encourage two-way communication
  • Listen carefully without judgement, by giving your full attention and avoid interrupting
  • Pay attention and minimise distractions
  • Show interest and create a positive atmosphere
  • Use reflections
  • Don't get emotionally involved
  • Use non-verbal cues to show you are listening, such as nodding or say "I see"
  • Invite further disclosure with phrases such as "tell me more"
  • Clarify with open-ended questions, particularly when seeking a description or an elaboration on an answer
  • Paraphrase what they have said to demonstrate that you have listened, understood correctly and to show that it is important to you
  • Use non-judgmental phrasing in your responses and follow-up questions
• Non-verbal communication


  • Gestures, facial expressions, movements and tone of voice can convey receptivity, interest, comprehension, hostility, disinterest, anxiety or discomfort
  • Non-verbal communication tends to outweigh the verbal message
  • Empathy and emotion are communicated more clearly via non-verbal communication than verbal communication