Psychosocial Resources in a Therapeutic Relationship

Psychosocial Resources in a Therapeutic RelationshipThis essay considers the psychosocial resources implicated in a made therapeutic kind. Several fundamental theses seem to emerge from a review of the literature. Firstly, there is an abundance of germane(predicate) psychosocial factors, and these seem to vary across different background knowledges. Secondly, factors such as empathy, trust, and warmth, seem crucial in near scenarios. Thirdly, the assumptions and beliefs of both therapists and patients determineing the therapeutic alliance need to be identified, and if necessary remedied, to achieve a thriving interaction.The damage patient and therapist may denote slightly different things, depending on whether the scenario is medical (Douglass et al, 2003) or mental (or psychiatric) (Johansson Elkund, 2004 Haarhoff, 2006). Psychosocial resources may play a much more important role where the therapy is psychological (e.g. psychoanalysis) and the therapist a psychologist or passkey which similar training (e.g. social worker, counsellor). Peplaus theory of the nurse-patient transactionhip provides a useable basis for conceptualising the role of psychosocial resources in successful therapeutic family relationships (Peplau, 1965, 1974a, 1974b Douglass et al, 2003). Although Peplau focused primarily on nursing c be, her puzzle seems applicable to most therapist/carer-patient scenarios. According to Peplau a fortunate therapeutic relationship is essential for successful handling outcomes. She identifies several psychosocial variables that are pertinent. These include trust, interpersonal skills, effective communication, and anxiety. Crucially, these processes work gradually rather than absolutely as the patient and therapist give out a rapport, but what closely empirical research? Studies kindle that basic psychosocial resources such as warmth, empathy, trust, and good communication, are integral to a successful therapeutic relationship (Lambert Barley, 2001).Hewitt and Coffey (2005) carried out a review of the relevant literature that highlighted several themes. Firstly, there is a plethora of psychological variables that seem essential to a successful therapeutic relationship. These include having a carer or patient that exudes trust, respect, sensitivity, warmth, is accessible and likeable, and has a sense of fair-play. It is important for the carer to show empathy, listen, tell the truth, share personal information, be have a bun in the ovenive, explain professional jargon concerning treatment and value the patient, for example by involving them in decision- fashioning (Barker et al, 1999). These psychosocial resources can be negated if the carer has a invalidating attitude towards the patient. This is particularly the case with mental health patients, for example those who commit deliberate self-harm. If a therapist believes that a patient is too disturbed or ill to participate in/contribute to his or her own tre atment then the therapeutic relationship is bound to suffer (Repper, 2002). Above all, the personal qualities (i.e. character characteristics) of the practitioner are paramount. Patients need to view the therapist as trustworthy, able to identify deeply with their problem, and acuate to engage in conversation at a deep mad level (Paulson et al, 1999 Gamble, 2002).Psychosocial factors are oddly pertinent in psych differentapies, especially cognitive therapy. A successful therapeutic relationship is heavily influenced by what is referred to as a therapeutic belief system (Beck Beck, 1995 Rudd Joiner, 1997 Leah, 2001 Haarhoff, 2006). Both patient and therapist may have particular beliefs or assumptions about the course of treatment, themselves, and each other, which may trigger different emotional and doingsal responses. Consider for example a patient who perceives his therapist as impatient and overbearing. This negative public opinion may generate un prospering emotions such a s dislike and resentment. The patient may alike perform unnecessarily reluctant to follow psychological advice. The possibility of premature termination of treatment is increased, with detrimental consequences for the patients psychological health. Similarly, a therapist who views a patient as lazy and dishonest, may dislike the individualistic as a result, and be less enthusiastic in administering therapy.Haarhoff (2006) recently conducted a study that demonstrated the intricacies of such beliefs, and the potential impact they may have on the therapeutic relationship. Therapists enrolled in a cognitive behaviour therapy program were administered a Therapists Schema Questionnaire, which measures fourteen typical mindsets therapists may hold about therapy, themselves, or their patients, including demanding standards, special spiffing person, excessive self-sacrifice, rejection sensitive, abandonment, autonomy, go steady judgement, need for approval, need to like others, and emot ional inhibition. Participants were required to indicate the cessation to which specific assumptions within each domain applied to them. The most commonly identified assumptions were demanding standards, special outstanding person, and excessive self-sacrifice.The first item denotes a view that there is a rig way of doing things. This may be triggered by a patients slow progress, or non- submission. The therapist may regard the patient negatively (e.g. lazy, irresponsible), believe that treatment should work, if only it were properly assimilated by the patient, and hence live overly demanding and controlling. The special superior person mindset sees therapy as an opportunity to demonstrate ones excellence. The therapist feels special, unique, and superior to the patient. The result is a tendency to become overly close and idealise a patient who is improving, or distance oneself from patients who make little or no progress. Self-sacrifice assumptions place too much speech patter n on the patient-therapist relationship, leaving the practitioner perceiving the patient as needy and vulnerable, and bending over backwards to roleplay patient demands. Treatment boundaries arent set, or if they are, arent adhered to, resulting in prolonged treatment session, lack of structure, and other laxities. Overall, Haarhoffs (2006) study illuminates important psychological processes that may enhance or taint relations. Crucially, therapists may be insensible of their beliefs or assumptions, let alone how these may affect relations with their patients.Patients perceptions matter a great deal. Since it is the patients (rather than the therapists) recuperation that is the primary treatment objective, the success or failure of a therapeutic relationship is heavily drug-addicted on the patients own appraisals of the interaction. This view is consistent with existential (Cooper, 1999) and phenomenological (Dermot, 2000) philosophies, which define reality as viewed by an indiv idual rather than observers or objective inquiry. Like therapists, patients retain beliefs and assumptions about the therapeutic relationship, with potential implications for treatment outcomes. This is back up by some empirical evidence. Johansson and Eklund (2004) conducted a study to assess how psychiatric patients in an in-patient ward prize the therapeutic relationship, and other related clinical characteristics (e.g. perceived ward atmosphere). Patients suffered from a range of mental health problems including behavioural disorders, schizophrenia, affective disorders, mental retardation, and neurotic, stress-related and psychosomatic problems. They received supportive therapy, social skills training and other interventions. alone participants completed one questionnaire assessing the strength of patient-therapist relationship (Luborsky et al, 1996) and another assessing their perceptions of therapeutic relationships, specifically involvement, support, and spontaneity (Moos , 1974). Data analysis revealed that perceived support and spontaneity were strongly correlated with the strength of therapeutic relations the greater the level of support and spontaneity perceived the more successful the patient-therapist alliance. Clearly, this study demonstrates the importance of psychosocial factors, as perceived by the patient. Unfortunately, the correlational design precludes any inferences about causality. Thus, while it seems commonsensical that perceived support may strengthen relations with a therapist, a successful therapeutic relationship may also engender greater levels of support (e.g. a therapist may be more supportive of a patient if he/she gets on well with the individual).Treatment models such as Peplaus theory (1965, 1974a) conceive psychosocial variables as precursors and hence determinants of a successful therapeutic relationship. So, for example, trust and empathy purportedly lead to a favourable rapport between patient and practitioner. Unfor tunately, a paucity of randomised controlled trials negates any conclusive inferences about concern of causality. It is entirely plausible that an initially favourable interaction between a patient and carer improves the patients psychosocial functioning, which in become further enhances the therapeutic relationship, and crucially improves treatment outcomes. Simpson and Joe (2004) conducted a comprehensive longitudinal study in which the choice of therapeutic relationships at one point in time was used to predict psychosocial functioning and treatment outcomes after one month, as well as treatment retention after a year. The setting for this study was a community based outpatient methadone treatment program in two urban areas. Participants were users of opiates/cocaine admitted to the program, and subjected to various treatments and follow-up assessments. The favourableness of the therapeutic relationship between counsellor and patient was assessed use a scale that gauged six p erceptions counsellors may have about their patients easy to talk to, warmth and care, honest and sincere, taking into custody, not suspicious, and not in denial about problems. well-fixed psychosocial functioning was conceptualised as high self-esteem, social conformity and decision making, and low depression, anxiety, and risk-taking. Analysis revealed that a favourable therapeutic relationship predicted positive psychosocial functioning and improved treatment outcomes (no drug use) after four weeks. completely in all it is essential for practitioners to identify the system or beliefs and assumptions they have about their patients (Rudd Joiner, 1997). This can be achieved through self-administered questionnaires, such as the personal belief questionnaire (Beck Beck, 1995 Leahy, 2001). Hewitt and Coffey (2005) highlight the importance of equipping therapists with the necessary skills to gird successful therapeutic relationships. But perhaps it is Haarhoff (2006) who offers re commendations specifically relevant to psychosocial factors. She highlights the importance of practitioners not blaming patients, loosing interest, getting bored, making too many demands, or being overly structured in the approach. Instead, therapists must try to develop more empathy, identify/challenge assumptions about treatment, themselves, and the patient, and allow patients take the lead in making decisions.ReferencesBarker, P., Jackson, S. Stevenson, C. (1999) What are psychiatric nurses needed for?Developing a theory of essential nursing practice. Journal of Psychiatric psychological Health Nursing, 6, pp.273-282.Beck, A. Beck, J. (1991) The Personality Belief Questionnaire. Bala Cynwyd, PABeck Institute for Cognitive Therapy and Research.Cooper, D. E. (1999). Existentialism A Reconstruction, 2nd ed., Oxford, UKBlackwell.Dermot, M. (2000) mental home to Phenomenology. Oxford Routledge.Douglass, J.J., Sowell, R.L. Phillips, K.D. (2003) Using Peplaus theory to examinethe p sychosocial factors associated with HIV-infected womens difficulty intaking their medications. The Journal of system Construction and Testing, 7,pp.10-17.Gamble, C. (2000) Using a low expressed emotion approach to develop therapeuticalliances. In Working with Serious Mental Illness A Manual for ClinicalPractice (Gamble C. Brennan G., eds), Balliere Tindall, London, pp.115-123.Haarhoff, B. A. (2006) The importance of identifying and understanding therapistschema in cognitive therapy training and supervision. New Zealand Journal ofPsychology, 35, pp.126-131.Hewitt, J. Coffey, M. (2005) Therapeutic working relationships with battalion withschizophrenia literature review. Journal of Advanced Nursing, 52, pp.561-570.Johansson, H. Eklund, M. (2004) Helping alliance and ward atmosphere inpsychiatric in-patient care. Psychology Psychotherapy possibility, Research, Practice, 77, pp.511-523.Lambert, M.J. Barley, D.E. (2001) Research summary on the therapeuticrelationship and psychother apy outcome. Psychotherapy Theory/ Research/Practice/ Training. 38, pp.357-361.Leahy, R.L. (2001) Overcoming resistance in Cognitive therapy. New York TheGuildford Press.Luborsky, L., Barber, J.P., Siqueland, L., Johnson, S., Najavits, L.M., Frank, A. Daley, D. (1996). The revised Helping Alliance questionnaire (HAq-II) psychometric properties. Journal of Psychotherapy, Practice andResearch, 5, pp.260-271.Moos, R.H. (1974) Community-oriented Programs Environment Scale. Palo Alto, CAConsulting Psychologists Press.Paulson, B.L., Truscott, , D. Stuart, J. (1999) Clients perceptions of helpfulexperiences in counselling. Journal of counselor-at-law Psychology, 46, pp.317-324.Peplau. H.E. (1965) The heart of nursing Interpersonal relations. Canadian Nurse 61,p.273.Peplau, H.E. (1974a) Concept of Psychotherapy. San Antonio. Texas RES.Productions.Peplau. H. E. (1974a) Criteria for a Working Relationship. San Antonio, Texas RES.Productions.Pinikahana, J., Happell, B., Taylor, M. Keks, N. A. (2002) Exploring thecomplexity of compliance in schizophrenia. Issues in Mental Health Nursing,23, pp.513-528.Repper, J. (2002) The helping relationship. In Psychosocial interventions for Peoplewith Schizophrenia (Harris N., Williams, S. Bradshaw, T., eds), Palgrave,Hampshire, pp.39-52.Rudd, M. Joiner, T. (1997) Counter-transference and the therapeutic relationship Acognitive perspective. Journal of Cognitive Psychotherapy An InternationalQuarterly, 11, pp.231-249.Simpson, D.D. Joe, G.W. (2004) A longitudinal evaluation of treatmentengagement and recovery stages. Journal of Substance Abuse and Treatment,27, pp.89-97.