THERAPEUTIC

RELATIONSHIPS
DIANA
KARAMACOSKA

Building Therapeutic Relationships

Therapeutic relationships begin with:
• Trust
• Respect
• Empathy
• Understanding
• Non-judgement
• Co-operation

Emotion in the Therapeutic Relationship

Strong emotion can be present in therapeutic
relationships. Due to:
• Stress
• Pain
• Fear
• Worry
• Baggage
• Grief
• Confusion

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Signs of Emotional Distress
• Withdrawal
• Talking constantly
• Sobbing or crying
• Aggression or attack
• Irritation or snappiness
• Restlessness
• Disinterest

Dealing with Extreme Distress

When communicating with a person who is in
extreme distress it is important to:
• Empathise and validate
• Listen actively
• Be silent if appropriate
• Comfort and affirm without ‘rescuing’

Strategies
• Be willing to sit in silence
• Avoid mind reading or ‘second guessing’
• Be aware of appropriate touch
• Consider gender specific care
• Use appropriate CALD workers if
appropriate
• Debrief confidentially if required

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Strategies
A person who will not engage is one who:
• Verbally or non-verbally refuses to engage
• Denies there is a problem
• Appears aggressive
• Will not look at the health professional
• Withdraws from the health professional

Strategies to Engage a Person

• Check they can understand you
• Remain calm
• Check your body language
• Explain each occurrence clearly
• Clarify when there is uncertainty
• Ask if they want treatment
• If aggressive or violent – call for assistance

The Person Who is Depressed

• People who are depressed sleep a lot or
sometimes have little sleep
• Have eating problems – either too much or too
little
• Find it hard to concentrate
• Present as ‘flat’, irritable, angry
• May engage in risky behaviours
• Use self loathing or negative language

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Strategies
• Demonstrate unconditional positive regard
• Validate
• Actively listen
• Use positive messages and language
• Do not ignore attempts to discuss the issue
• Reinforce abilities
• Do not use placating terms
• e.g. “Just snap out of it”

The Older Person

Older people, especially those who are lonely or who
have little contact other than the health professional
may:
• Talk constantly
• Tell a long tale, often off track
• Have multiple co-morbidities
• Be fearful of treatment or what it entails
• Become confused or forgetful

Strategies
• Demonstrate respect
• Ask what they would like to be called (Mr, Mrs
may be more appropriate than first name)
• Treat the elderly as equal, regardless of
gender, culture or abilities
• Show empathy
• Provide clear information, written is best
• Listen actively
• Remember their story

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 THERAPEUTIC
RELATIONSHIPS
DIANA
KARAMACOSKA

WORKING IN
TEAMS
DIANA
KARAMACOSKA

Working in a Team
Intra-disciplinary communication
• Communication between member of the same
health specialty
• e.g. Two occupational therapists talking to each
other
Inter-disciplinary communication
• Communication between different health
professionals.
• e.g. An occupational therapist talking to a nurse
Adams and Jones (2010)

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What is a Team?
A small, relatively permanent group of members
who meet regularly.
• The members are interdependent (at least to
some extent); their members need to
communicate and work with one another to
achieve a common purpose.
• Each team member has a
defined role relevant to the
team goal(s).
Firth-Cozens, 1998 (as cited in Renouf & Meadows, 2001)

Working in Teams
Working in teams is important to avoid the
following problems:
• Clients/patients ‘falling in the gaps’
• People may benefit from 2 or more services
but because they ‘fall in the gap’ they do not
receive any service.
• Wasteful overlap
• Clients/patients receiving 2 or more services
leading to inefficient use of resources
Thompson (2009)

Working in Teams
Working in teams is important to avoid the
following problems:
• Pulling in different directions
• Clients/patients receiving 2 or more
services which may be competing with
each other or may have vastly
different goals/objectives

Thompson (2009)

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Why Work in Teams?
• Providing comprehensive treatment
of the key issues
• Solving problems
• Sharing expertise
• Instigating systemic change
• Maintaining accountability
• Developing new skills in novice
professionals.

WORKING IN
TEAMS
DIANA
KARAMACOSKA

FORMING TEAMS &

COLLABORATION
DIANA
KARAMACOSKA

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Stages of Team Formation
• Forming
• Storming
• Norming
• Performing
• Adjourning

Forming
Individuals gather together in an
effort to join forces in pursuit of
common goals/purpose.
• Communication is usually cordial &
polite as members are still getting to
know each other.

Tyler et al. (1999)

Storming
Emerges when there is serious conflicts due to
disagreement over policy matters (eg. goals,
process, roles, tasks).
• Group may disintegrate at
this stage or may split
• Groups often overcome such
problems and remain intact &
move into next stage (Tyler et al., 1999)

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Norming
Emerges when conflict is resolved to the point
where the majority of the group members
agree upon the major direction of the group (ie.
goals, methods, leadership).
• Power relations and group
leadership style stabilise.
• Relative positions take hold.
(Tyler et al., 1999)

Performing
Occurs when people start
working towards the goals set
and start accomplishing related
objectives (Tyler et al., 1999)

Adjourning
Is reached by groups that were formed in
an effort to achieve a specific goal in a
specified time frame.
• This step does not occur for ongoing teams
(Tyler et al., 1999)

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The Interprofessional Team
Individuals in the team must know their:
• work
• partners
• process
• outcome

Principles of Effective Collaboration

Avoid stereotypes
• Our interactions with other professionals must
relate to real people rather than stereotypes or
distorted ideas about roles and personality types.
Understand each other’s roles
• Unless we are attuned to the roles and duties of
staff from other disciplines, we may miss
opportunities for collaboration.

Principles of Effective Collaboration

Avoid hierarchies
• In health care we prefer collaboration rather than
hierarchy.
• Does that mean there is no hierarchy in health
care?
Be sensitive to different values, priorities and norms
• Different professional groups tend to develop
different values and priorities.
• We must not allow differences of perspective to
undermine the quality of service provided.

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Principles of Effective Collaboration
Avoid preciousness
• Recognise that you aren’t the only person working
with the client.
• What does this look like in a practical sense?
e.g. sharing/negotiating timeslots
Use ‘I’ statements to communicate emotions
• “I feel frustrated when you are late finishing your
group as it impacts on time I spend with the clients”.
Rather than “You always go over time in your
group”

FORMING TEAMS &

COLLABORATION
DIANA
KARAMACOSKA

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