Therapeutic Relationships Flashcards
Define Therapeutic Relationship
Mutally beneficial bond that exists btw healthcare professional and their patient
Define Personal Relationship
A relationship with a person that has elements of specialness, exclusivity, or intimacy
Expectations of Therapeutic Relationship
Therapist places patient needs first
Therapist will not exploit the relationship
Therapist will manage relationship components
APTA Code of Ethics and Guide for Professional Conduct
Power
Imbalance of power exists
Possible contributors (education, license, knowledge)
Impact on patient - vulnerability
Trust
Patient trust in PT competence
PTs responsibility not to exploit the patient or do harm
Impact on patient - breach of trust
Respect
PTs responsibility to treat patients with respect regardless of personal bias/differences
PT allowing patient to participate in his or her care
Impact on patient - feeling devalued
Personal Closeness
Nature of PT and client relationship requires various levels of physical, emotional, and psychological closeness
Impact on patient - vulnerability
Elements of effective therapeutic relationships
Trust - influenced by competence, honesty, reassurance Integrity Courtesy Caring behaviors Focus
Individualized Approach
Personal comfort
Personal interests
Expanding patients’ awareness
Empathy
Challenges to Therapeutic Relationships
Anxiety/fear Attitude/bias Resistance Communication barriers Distractions Casualness Irreconcilable differences Transference - shifting feelings from one person to another Bias
Ways to undermine therapeutic relationship
Encourage patient to establish personal relationship
Attracting attention to yourself
Socializing with patient outside of sessions
Doing favors for patient that you wouldnt do for all patients
Time to Refer
Lack experience or knowledge needed
When there is serious personality conflict pr challenge to safety/respect
There is negative bias toward the person or group with which they belong
When there is too much dependency
Professional Boundaries
Physical and emotional boundaries
Goal of patient well being
Maintaining caring respect
Physical Boundaries
Informed Consent Unconsented Touching - Battery - Sexual Touching - Sexual Harassment
Sexual Harrassment
Title VII and Title IX
Over 90% of PTs experience some sort of innapropriate sexual behavior during work
Emotional Boundaries
Dual Relationships
Sympathy vs. Pity
Overidentification
Caring too much
What can we do - Pity
Use your communication skills to redirect conversations
Refer patient to appropriate member of health care team
What can we do - Personal Identification
Refrain from sharing similar experiences
Stress uniqueness of patent’s situation
Listen First
What can we do - Caring too much
Refrain from visiting patient outside treatment sessions
Limit depth of conversation
5 Levels of Communication
- Cliche Conversation
- Reporting Facts
- Personal Ideas/Judgements
- Feelings and Emotions
- Peak Communcation
Patient Loss
Physical Function Cognitive Function Physical Appearance Life Roles Self-Image Relationships Finances Control
Intensity of Loss Determined by
Pathology
Change in environment
Change in roles and values of these roles
Coping mechanisms
Addressing Patient Loss - PTs role
Acknowledge the loss and its impact on the patient
Create an effective plan of care to address primary contributors to the loss
Identify and engage other team members
Identify resources - psychological support, spiritual support, family support, community resources
Terminating the Patient
Could be loss for both parties Start discussing plans for discharge at initial visit Provide rationale for discharge Collaborate with others Provide patient with follow up plan
