Communication, Psychology, and Conflict Resolution

PTAS Admin 103

communication

we work to establish a therapeutic relationship with each client- care is a partnership with PT, PTA, client; components of communication

we work to establish a therapeutic relationship with each client - communication

as caregivers we…; steps towards establishing the therapeutic relationship

as caregivers we…- communication

value the client, are attentive to the client’s needs, acknowledge the client’s message, genuinely empathize (ability to imagine yourself in client’s place to understand them), strive to provide the best possible care

steps towards establishing the therapeutic relationship- communication

greet client and provide a non-threatening environment, show sensitivity towards cultural influences, position yourself to avoid power differential (eye level), establish the role the client must play in your relationship- and communicate it, educate client in POC and goals (which should be client driven), address questions and concerns in constructive and timely manner

greet client and provide a non-threatening relationship

include your name and title, differing opinions about us using the client’s first name- ask?

educate client in POC and goals (which should be client driven)

educate regarding interventions- give client control/autonomy and gain informed consent

components of communication

includes both verbal and non-verbal communication; requires focus; must listen objectively without personal belief/judgement

must listen objectively without personal belief/judgement- components of communication

effective listening requires active reflection and clarification of client’s message; pay attention to non-verbals (posture, tone, gestures); make sure your non-verbals show your engagement

client challenges to establishing an effective therapeutic relationship

disability- is a loss, especially of control and self-identity; depression

disability

requires adjustment to loss- grieving process; stages of adjustment- adjustment is a normal process, but not linear- variable for each individual

stages of adjustment- disability

shock- early; denial; expectancy of recovery; adjustment/acceptance

shock- early- stages

few minutes to a few days; incompatibility between self-image and the reality of what is happening; immediate, but variable in length; “numb” feeling/dissociative

denial- stages

a coping mechanism (reality cushion); helps person avoid becoming overwhelmed; initially adaptive- ok TEMORARILY

expectancy of recovery- stages

unrealistic expectations of recovery/return to “normal”; may blame healthcare provider if not achieving goals; anger- may even include some aggressiveness; bargaining; depression may occur when anger and bargaining don’t work

adjustment/acceptance- stages

starts with small accomplishments tied to realistic expectations; adaptation to new roles (people born with disabilities often are better adjusted than those that acquire later in life)

depression

most common psychological complication following disability; symptoms; suicide

most common psychological complication following disability- depression

3rd most common illness after infectious disease and heart disease (80-90% don’t get recognized/treated); 11% of all healthcare workers suffer from depression

symptoms- depression

loss of interest; inability to feel pleasure; fatigue/decreased energy/sluggishness; sadness/feeling guilty; insomnia or hypersomnia; unclear thinking'/difficulty concentrating; feeling of worthlessness, helplessness, and hopelessness; restlessness and irritability; heart palpitations; increased dependency; low self-esteem and low self-confidence; feeling powerless (may not cooperate); decreased immune function; avoidance (missed appointments?)

suicide- depression

25% of people who are depressed attempt; get pt help and document

“difficult” clients

ways of being “difficult”; types of “difficult” clients- most often linked to LACK OF CONTROL; steps to dealing with difficult clients- CALMER approach; overall, think before you speak and stay calm

ways of being “difficult”- “difficult” clients

withdrawal- refusal to cooperate due to fear, protest, etc.; passivity- over reliance on others; manipulation; confrontation and aggression

types of “difficult” clients- most often linked to LACK OF CONTROL- “difficult” clients

childlike; stubborn and resistive; unmotivated/ambivalent; needy and dependent; incurable; angry or aggressive

childlike- “types of difficult” clients

common when sick; avoid getting angry/frustrated- they take cues from you as the caregiver/authority figure; stay calm and resistive

stubborn and resistive- “types of difficult” clients

regression, depression, or denial; can’t push- try to put them in a position to do the “right thing”

unmotivated/ambivalent- “types of difficult” clients

no interest in tx- have others make decisions for them; caused by depression; involve client in decision making

needy and dependent- “types of difficult” clients

make demands on everyone around them- need lots of attention; may be manipulative- make demands/complaints (intimidate); set firm relationship limits; this is one client you do not necessarily want to give more control

incurable- “types of difficult” clients

don’t get better no matter what; secondary gains- illness is more important to them because it meets a need

angry or aggressive- “types of difficult” clients

results from angered or altered state of reality; anger is a natural part of the acceptance process- let them vent (safely); acknowledge feelings but avoid starting and speak calmly and confidently; DO NOT TAKE PERSONALLY; don’t get pulled into argument and above all- stay calm

steps to dealing with difficult clients

CALMER approach

C- CALMER approach

catalyst for change- remind client what you can and cannot change about the situation

A- CALMER approach

alter thoughts to change feelings- how are your feelings effecting the interaction?

L- CALMER approach

listen- hear what the client is telling you objectively

M- CALMER approach

make and agreement- agree to work together, but both parties have responsibility

E- CALMER approach

educate- give client assignments/goals

R- CALMER approach

reach out and discuss your feelings- talk with a trusted coworker

psychological contracts, boundaries, and roles

this is not a friendship; therapist (you) sets roles and boundaries; healthy boundaries; good practices

this is not a friendship- psychological contracts, boundaries, and roles

friendship loses objectively

therapist (you) sets roles and boundaries- psychological contracts, boundaries, and roles

maintain a professional relationship at all times

healthy boundaries- psychological contracts, boundaries, and roles

signs of inappropriate behavior (discussing intimate or personal issues with client; engage in flirting; spending more time/attention than needed; speaking poorly of coworkers/MD with client/family; showing favoritism); meeting client outside work time/location

good practices- psychological contracts, boundaries, and roles

dress appropriately/professionally; show respect (how are you addressing client? word usage- slang/cussing/tone?); avoid making the communication about you; create an environment of credibility and confidence; display a professional attitude; avoid social media with client and/or their family