Interpersonal Skills and Therapeutic Communication Introduction The task we were asked to do was to record a video displaying a role play based on an experience that we had either experienced or observed in a situation where therapeutic communication took place. My video involved myself and a 5-year-old child trying to create a Christmas decoration in reception, the class that I work with in my placement.
Due to confidentiality, I could not name the child by their real name and so I refer to them as Neil, the name of my colleague who was playing the child. In this reflective essay I will be describing and analysing the interpersonal communication and therapeutic relationship within the scenario. In doing this I will engage reflective skills based upon Johns’ model (2000), and will be using evidence from other communication theorists.
Johns’ reflective model is laid out in the following steps: Phenomenon – description of the experience; Causal – what essential factors contributed to this experience; Context – what are the significant background factors to this experience; Reflection – what was I trying to achieve, what were the consequences, how did I and the client feel about the experience, what factors/knowledge influenced my decisions and actions; Alternative actions – what other choices did I have and what would the consequences of these have been; Learning – what have I learnt from this experience, could I have dealt with the situation better.
I will be using these steps in order to reflect on the interaction and behaviour involved in my role-play. Main Body Therapeutic relationships can be interpreted in many different ways. Ramjan (2004) suggests that there are key elements involved in a therapeutic relationship. These elements are: ‘Trust and commitment; Accurate empathy, unconditional positive regard and genuineness; Honesty and support; Confidentiality, non-judgemental attitude, responsiveness and consistency’.
I feel that all of these elements are essential in developing a therapeutic relationship with a client, in addition to maintaining professionalism, being aware of certain barriers, listening, appreciating other people’s beliefs and values and being non-biased. There is a great importance for professionals in health and social care to develop effective skills in therapeutic relationships. Many of these skills contribute to therapeutic relationships, which include elements such as active listening, empathetic interaction and a non-judgemental attitude. However there are other aspects that need to be considered.
Egan (2002) developed an approach called ‘The Skilled Helper’. In this approach, he suggests a key element that health and social care practitioners should use in order help young people become better at helping themselves in their everyday lives through development and therapeutic relationships. Skills that are involved in a therapeutic relationship can be verbal or non-verbal. Practitioners can use their paralinguistic features, such as hand gestures, body language and eye contact, to be welcoming, reassuring and encouraging, amongst other interactions.
Egan (2002) also composed a non-verbal learning process, which can be used in communication as part of his approach. This process is known as SOLER. This is an acronym for: ‘S Sit SQUARELY on to the client, preferably at a 5 o’clock position to avoid the possibility of staring O Maintain an OPEN posture at all times, not crossing your arms or legs which can appear defensive L LEAN slightly in towards the client E Maintain eye contact with the client, without staring R RELAX. This should in turn help the client to relax’.
Ahmad et al (2005) composed a list of characteristics that professionals should possess which are considered as helpful to young people. One of these characteristics is to be welcoming and make the young person feel comfortable. I feel that I displayed this in my role-play by leading Neil into the classroom by holding his hand and using an excitable tone. I made him feel comfortable by bringing a chair directly in front of me so that we could maintain good eye contact and so that I could give him reassurance.
Before starting the activity I chatted to him briefly about Christmas to get him excited and make him feel more at ease. I gave him encouragement once he started to carry out the task correctly. This gave him reassurance that he could do it again. The social learning theory, composed by Bandura, suggests that behaviour that receives positive reinforcement will be replicated. So, the praise that I give to Neil for doing it right could mean that he would then be confident to then do this again.
This positive reinforcement can also lead to a boost in their self-esteem and make them feel pride. Transactional analysis, a theory developed by Eric Berne, is seen as a way of looking at what goes on between people and inside people. Berne suggests that all interactions are made up of strokes, which is defined as a unit of recognition. I give Neil several strokes throughout the video, which mainly consist of recognition, encouragement and appreciation. A transaction is an exchange of strokes.
Transactions are evident in the role-play in examples such as, when we both clapped in unison when Neil had finally completed the task. Berne also suggests that there are different ego states that we can undertake in different situations. These are: Parent – Said to develop as a consequence to all the things we’ve been taught – Sometimes described as being either critical or nurturing Adult – Described as your rational part of self – Thinking part – Level-headedness Child – Like to have fun – Natural or free – Can be adaptive or manipulative
I feel that I maintained a parent ego state throughout the video as I spoke to Neil in a nurturing tone and clearly explained things to him, which can also be seen as part of the adult ego state. I also adopted a critical tone, which can be considered as a weakness but is also part of the parent ego state. Neil maintained the child ego state throughout. Another characteristic from Ahmad’s list is to explain things in an ordinary way. I feel that the first time I explained the task that we were going to undertake was clear and easy for him to understand.
However, when I then had to explain it again after he did it wrong twice, I noticed that my tone was more impatient and patronising. When reflecting, it is equally as important to recognise your weaknesses as well as your strengths and in doing this, I identified this issue. I feel that if I were to do this again I would be more tolerant and appreciate that a child’s understanding, at this age, is much more complex than we sometimes realise. This now leads me on to the importance of self-awareness. Knowing our own strengths and limitations, understanding our own emotions and the impact of our behaviour in diverse situations serves to enhance therapeutic relationships with others in the mental health setting’. Jack & Miller (2008). My interpretation of this is that in order to understand others, particularly children, it is important for us to know ourselves and this can help us to avoid stigmas and to stereotype people with certain mental conditions. Being self-aware can help us to relate our own feelings and experiences to that of the client, which helps us gain more understanding and easier to develop a rapport.
This is confirmed by Burnard (2002) who states that: ‘Being self- aware enables us to identify our own thoughts and problems, and those of others’. It is equally important in self-awareness to identify our weaknesses and ways of improving them. An effective way of doing this is by carrying out a SWOB analysis. This involves identifying your strengths, weaknesses, opportunities and barriers. When suggesting your weaknesses, it is thought that you should not necessarily think about what is bad about you, but things that you feel you can improve. You can then think about ways of improving them.
From reflecting on my role-play I can identify some of my weaknesses and think of ways of improving, which can help me avoid barriers and seek opportunities. Conclusion In conclusion, I have found that reflecting on experiences is an important part of being a health and social care practitioner. There is great importance on identifying your weaknesses and appreciating what you could have done better. When I identifying my own weaknesses I also managed to establish ways of improving them and I feel that through observation I can find strategies to assist me in this.
Self-awareness is a big part of reflection but also I can now appreciate that knowing yourself helps you to understand others and their individual differences. I have learnt from evidence from communication theorists, such as Ramjan (2004) the key elements of a useful and effective therapeutic relationship. I have also learnt that non-verbal skills are just as important as verbal skills when communicating with a client, which I did not know before. I now feel confident in reflecting effectively on future experiences and understanding behaviour and interactions that I come across in my practice.