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The Helping or Therapeutic Relationship. An-Najah National University Dr .Aidah Alkaissi. Objectives. Definition of The Helping or Therapeutic relationship . Characteristics and guidelines may be useful in developing and helping relationship . Ethics in communicating.
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The Helping or Therapeutic Relationship An-Najah National University Dr .Aidah Alkaissi
Objectives • Definition of The Helping or Therapeuticrelationship. • Characteristics and guidelines may be useful in developing and helping relationship. • Ethics in communicating. • Therapeutic Techniques. • Barriers to effective communication. • Stages.
The Helping or Therapeutic relationship Is a process by which one person promotes the development of another person by fostering the latter's maturation ,adaptation ,integration, openness, and ability to find meaning in the present situation.
The Helping or Therapeutic relationship • Created through the therapist: - Application of scientific knowledge. - Understanding human behavior and communication. - The commitment to the individual. - The values clarification and counseling can assist . So, it helps therapist to see individuals holistically and as unique persons.
The Helpingor Therapeutic relationship Characteristics • The following guidelines may be useful in developing and helping relationship: -- Purposeful communication. -- Rapport. -- Trust. -- Empathy. -- Goal direction.
Characteristics Purposeful communication - That the therapist focuses communication for a particular aim. - Goals guide the therapist in focusing communication. - Social chitchat communication without goal should not make up the bulk of therapeutic interaction.
Characteristics Rapport • Is a harmony and an affinity between people in a relationship. • To let people know that his or her concerns interest the therapist and that working together may alleviate some of his or her difficulties and encourage growth ,it is important to be genuine, صادقopen and concerned.
Characteristics Trust Evolves from rapport and is based on a belief that it is safe to be genuine and honest in a relationship because the other will respond in a respectful way.
Characteristics Empathy • Is feeling with another person and understanding the dynamic meaning of behavior. • It involves the ability to understand another's feelings without losing personal identity and perspective. • Using personal understanding while maintaining boundaries is the essence جوهر of empathy in helping relationship.
Characteristics Goal direction • Dissimilar to most human relationship that focus on mutual benefit. • A helping relationship is special in its goal-directed nature and exists solely to meet some need or promote the growth of the individual. Goals are: - Short-term goals are changes likely to be achieved within 10 days to two weeks. - long-term goals all others.
Characteristics Goaldirection All goals should : - Be stated in measurable terms. - Focus on a positive change. - Decrease of the problematic . Ideally ,a person works with the therapist to establish goals, but when person unable to negotiate appropriate goals the therapist establishes the goals.
Ethics in communicating • Frequently ,the therapist may wish to set goals that the individual does not want to reach, the therapist must remember that the problem belongs to the other person. • The therapist assists the individual in decision-making with the decision based on the individual value system. • However, the therapist should not take a laissez-faire approach وينبغي أن المعالج لا تأخذ جواز نهج عدم التدخل and avoid assisting the person. Recognizing this: - Therapist must clarify personal values. - Subsequently respect the individual's right .
Therapeutic Techniques • There is no magical saying that the therapist can always plug into an interaction to communicate successfully. المكونات إلى التفاعل على التواصل بنجاح. • Although some techniques are useful, they must be applied with purpose ,skill and attention to the context and individuality of each person.
Therapeutic Techniques • Focus on the individual. • Help the individual describe and clarify content and meaning. • Use reflection. • Use constructive confrontation. • Use nouns and pronouns correctly. • Use silence. • Accept communication.
Therapeutic Techniques Focus on the individual • focus on the individuals need by orienting the person toward who she or he and why the interaction is occurring. • Therapists should avoid delving into their own personal lives to extent that it diverts attention from the other person's concern. ينبغي المعالجون تجنب الخوض في حياتهم الشخصية لدرجة أنه يحول الانتباه عن القلق الشخص الآخر.
Therapeutic Techniques Help the individual describe and clarify content and meaning • To assist the individual in describing a particular experiences or concern. • Description is enhanced when the therapist prompts the person to clarify the description and interpret its meaning. (tell me, describe to me) and by seeking feedback. • The therapist should avoid threatening detective questions. why).
Therapeutic Techniques Help the individual describe and clarify content and meaning • Generally is more helpful to: - First: reformulating questions to obtain data. -Then: helping the individual to analyze links among events, thoughts, feelings, actions and outcomes.
Therapeutic Techniques Use reflection • Reflection is the statement of what the individual has said in the same or different words. • This technique can involve summarizing the person main point to indicate interest and to focus the discussion.
Therapeutic Techniques Use constructive confrontation • Confronting an individual means that the therapist points out a specific behavior and then helps that person examine its meaning or consequences. • This type of confrontation is not an angry exchange, but a purposeful way of helping the person examine personal actions and their meaning.
Therapeutic Techniques Use nouns and pronouns correctly • some individuals misuse pronouns by referring to we,us,they,him,and her,without cleary identifying the referent. • Others may use general nouns such as everyone ,people, doctors and nurse without clear communication about specificpersons. So: - The therapist should clarify by asking. - The therapist must be careful to use separate pronouns when speaking.
Therapeutic Techniques Use silence • Allowing a thoughtful silence at intervals helps the individual talk at his or her own pace without pressure. • Also permits time for reflection. • Particularly helpful to the depressed or physically ill person.
Therapeutic Techniques Accept Communication • Allowing the person to communicate verbally and nonverbally in his or her own fashion makes the person felt safe and respected. • The therapist must not always agree with the individual or tolerate inappropriate behavior within the established limits of the setting.
Barriers to effective communication • Anxiety • Attitude • Resistance • Transference and countertranferance. • Sensory barriers. • Failure to address concerns or needs. • Setting.
Barriers to effective communication Anxiety • When the therapist or individual is highly anxious during an interaction, perception is altered and the ability to communicate effectively is sharply curtailed. وتقلصت بشكل حاد • The use of defense mechanism reduces anxiety.
Barriers to effective communication Attitude Biases and stereotyped can limit the therapists and the individuals ability to relate . • When the problem is the individual problem the nurse can assist in examining these views. • When the problem is the nurse problem examination is crucial and when failed to examine his or her attitudes toward the person negatively may be communicated and the interaction may be distorted.
Barriers to effective communication Resistance • Comprises all phenomena that inhibit the flow of thoughts,feeling,and memories from both the therapist and patient. • Arises from anxiety ,the person implements resistant behavior :being late ,changing the subject ,forgetting ,blocking or becoming angry. • Anxiety reductions often a necessary step in dealing withresistance behaviors.
Barriers to effective communication Transference is reacting to another person in an exchange as though that person were someone from the past )such as a mother or father or even all authority figure). • Transference may involve host of feelings that are generally classified as: - Positive (love,affection,or regard). - Negative (anger,dislike,or frustration). • Persons in a therapeutic relationship often develop strong transference feelings toward the helping professional, arising from the interactions intensity and the care providers authoritative or nurturing role. مقدمي الرعاية أو دور رعاية موثوقة.
Barriers to effective communication Countertransference • Is the same phenomenon, but it is experienced by health care professional. • The therapist experiences many feelings toward the person, these feelings are not problems unless they remain unanalyzed and become potential blocks to the therapists ability to work effectively with the individual. • The therapist needs to examine his or her personal feeling to understand their source. Once understood, countertransference reactions generally cease to interfere with the relationship.`
Barriers to effective communication Sensory barriers • When the individual has any sensory limitations, the therapist need to use extra skill in communicating. • Therapists must be as creative as possible, learn from others who are skilled in alternative forms of communication, and make needed referrals.
Barriers to effective communication Failure to address concerns or needs This failure can arise from : • Inadequate assessment. • Lack of knowledge. • Inability to separate the therapist need from the individuals needs. • Confusion between friendship and a helping relationship,.
Barriers to effective communication Failure to address concerns or needs To correct this problem: • Using the supervisory process to determine the problem recourse. • The therapist should then take corrective action such as : - Obtaining more information or knowledge. - Performing a self-assessment with value clarification. - Examining reactions ,biases and expectations.
Barriers to effective communication Setting • The setting of the therapeutic interaction can affect the goals and the nature of the communication. • The most important aspect of any setting is the that the therapist and the individual are able to attend to each other.
Setting • The therapist should assess the possible influence of factors such as lighting, noise, temperature, comfort, physical distance and privacy ;potentially disturbing factors can be altered or controlled within the limits of the setting. • The therapist can also acknowledge verbally that some aspect of the environment, such as an interruption or noise, is bothersome. This strategy shows people that the therapist recognize possible concentration difficulties and is sharing the environment with them.
Stages • Therapeutic relationship follows sequential phases, which may overlap ,vary in length, or involve issues that appear over time rather than in a set sequences. • The phases that have been identified by researchers and clinicians are; • Orientation (introductory)phase. • Working phase. • Termination phase.
Stages • Orientation (introductory) • Begins when the therapist and individual meet, this meeting typically involves some feeling of anxiety ;neither party knows what to expect. • Discussion establishes a contract or pact and involves a mutual understanding of the parameters of the relationship and an agreement to work together. • Without successful transition through the orientation phase, no working alliance will exist and treatment goals will remain unmet.
Stages • Orientation (introductory) • Frequent , brief encounters may be less effective and more expensive in the long run than fewer sessions scheduled for long periods. • Moreover ,assessment of an individuals needs should be the primary guideline for session planning. • They identified the following helpful factors during the orientation phase :consistency,pacing,listening,positive initial impression and attention to comfort and control.
Stages 2 .Working phase. • Emerges when the therapist and the individual collaborate as partners in promoting the persons health. • The working phase may last for an established number of sessions or it may extend over an extended period if the therapist is the primary care provider for an individual and family. • During this phase goals are set and the therapist and individual work mutually toward their accomplishment.
Stages 2 .Working phase all parts of the working phase are: -- Solving problems. -- Coping with stressors . -- Gaining insight . • Overcome resistance behavior may be observed. • During the working phase change take place ,so it is the context for health promotion.
Stages 3.Termination phase. • Termination marks the end of the relationship established in the therapeutic contract . • Can cause anxiety for both the individual and the therapist. • Represents a loss (less of a relationship) ; Therefore .it can trigger feelings of sadness, frustration and anger. • Both the therapist and the individual can learn much during termination.
