Psychosocial Resources in a Therapeutic Relationship

Psychosocial Resources in a Therapeutic RelationshipThis essay considers the psychosocial resources implicated in a successful cure relationship. some(prenominal) fundamental theses face to emerge from a review of the literature. Firstly, there is an abundance of relevant psychosocial factors, and these seem to vary across different settings. Secondly, factors much(prenominal) as empathy, trust, and warmth, seem crucial in most scenarios. Thirdly, the assumptions and beliefs of both healers and affected roles regarding the alterative alliance need to be identified, and if necessary remedied, to achieve a successful interaction.The terms patient and therapist whitethorn denote slightly different things, depending on whether the scenario is medical (Douglass et al, 2003) or psychological (or psychiatric) (Johansson Elkund, 2004 Haarhoff, 2006). Psychosocial resources may play a much more important purpose where the therapy is psychological (e.g. psychoanalysis) and the therapi st a psychologist or professional which similar training (e.g. social worker, counsellor). Peplaus theory of the nurse-patient relationship provides a useful basis for conceptualising the sh be of psychosocial resources in successful therapeutic relationships (Peplau, 1965, 1974a, 1974b Douglass et al, 2003). Although Peplau focused primarily on care for care, her model seems applicable to most therapist/carer-patient scenarios. According to Peplau a favourable therapeutic relationship is inborn for successful treatment outcomes. She identifies several psychosocial variables that are pertinent. These include trust, inter ain skills, effective communication, and anxiety. Crucially, these processes work gradually rather than abruptly as the patient and therapist develop a rapport, but what about empirical research? Studies suggest 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 p permithora 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 overtureable 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 supportive, explain professional jargon concerning treatment and value the patient, for example by involving them in decision-making (Barker et al, 1999). These psychosocial resources can be negated if the carer has a negative attitude to guards the patient. This is oddly 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 get into in/contribute to his or her own treatment then the therapeutic relationship is bound to suffer (Repper, 2002). Above all, the personal qualities (i.e. personality characteristics) of the practitioner are paramount. Patients need to view the therapist as trustworthy, able to key out deeply with their problem, and keen to engage in conversation at a deep horny take aim (Paulson et al, 1999 Gamble, 2002).Psychosocial factors are e supererogatoryly pertinent in psychotherapies, e particularly 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 behavioural responses. Consider for example a patient who perceives his therapist as impatient and overbearing. This negative thought may breed unfavourable emotions such as dislike and resentm ent. The patient may also become unnecessarily reluctant to follow psychological advice. The possibility of premature bourn 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 individual 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 superior person, high-spirited self-sacrifice, rejection sensitive, abandonment, autonomy, control judgement, need for approval, need to like others, and emotional prohibition era. Participant s were required to indicate the extent to which specific assumptions within each domain applied to them. The most commonly identified assumptions were demanding standards, special superior person, and excessive self-sacrifice.The first item denotes a view that there is a correct way of doing things. This may be triggered by a patients slow progress, or non-compliance. 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 become 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 regard a patient who is improving, or distance oneself from patients who make little or no progress. Self-sacrifice assumptions place too much emphasis on the patient-therapist relationship, leave the practitioner perceiving the patient as needy and vulnerable, and bending over backwards to meet patient demands. Treatment boundaries arent set, or if they are, arent adhered to, resulting in prolong 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 unaware 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) recovery that is the primary treatment objective, the success or failure of a therapeutic relationship is heavily dependent 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 individual rather than observers or objective inquiry. Like therapis ts, patients retain beliefs and assumptions about the therapeutic relationship, with potential implications for treatment outcomes. This is supported by some empirical evidence. Johansson and Eklund (2004) conducted a study to assess how psychiatric patients in an in-patient ward appraise 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, emotional disorders, mental retardation, and neurotic, stress-related and psychosomatic problems. They received supportive therapy, social skills training and other interventions. All 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 spon taneity 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 grandeur of psychosocial factors, as perceived by the patient. Unfortunately, the correlational design precludes any inferences about causality. Thus, musical composition 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) conceptualise psychosocial variables as precursors and hence determinants of a successful therapeutic relationship. So, for example, trust and empathy purportedly lead to a favourable rapport amongst patient and practitioner. Unfortunately, a paucity of randomised controlled trials negates any conclusive inferences about direction of causality. It is entirely plausible that an initially favourable interaction between a patient and carer improves the patients psychosocial functioning, which in turn further enhances the therapeutic relationship, and crucially improves treatment outcomes. Simpson and Joe (2004) conducted a comprehensive longitudinal study in which the quality of therapeutic relationships at one point in time was used to predict psychosocial functioning and treatment outcomes after one month, as well as treatment store 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 heterogeneous treatments and follow-up assessments. The favourableness of the therapeutic relationship between counsellor and patient was assessed using a scale that gauged six perceptions counsellors may have about the ir patients effortless to talk to, warmth and caring, honest and sincere, understanding, not suspicious, and not in denial about problems. Favourable 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 medicine use) after four weeks.All 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 develop successful therapeutic relationships. But perhaps it is Haarhoff (2006) who offers recommendations specifically relevant to psy chosocial 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 Mental 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). 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