...the client than other healthcare professionals (McCabe and Timmins 2006). Therefore, nurses have to pay more attention to improving their communication skills for better client care. In order to establish a positive relationship with the client, it is necessary to communicate effectively and subsequently improve the quality of nursing care (McCabe and Timmins 2006). Effective communication is key to a therapeutic relationship with the client. It is defined as a ''purposeful form of communication used in the helping relationship'' (Ruesch 1961 cited in Arnold and Boggs 2007, p18). It is developed by the nurse for the purpose of assessing, planning, implementing and evaluating client care (Arnold and Boggs 2007). The establishment of a nurse-client relationship was a key element of Peplau's (1952) work. Peplau (1952) suggested that the interpersonal relationship between the nurse and the client developed through four stages (orientation, identification, exploration and resolution) in order to accomplish client growth (McCabe and Timmins 2006). The purpose of therapeutic communication is not just about treating an illness but is also about giving the client a sense...
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...Video Vignette: “The Paramedic” What can I take away from the experience of observing this video that will help me build knowledge and Self-Awareness in Therapeutic Communication? In observing James (the paramedic) carry out a first aid attendance to a patient, Sally, who is 28-weeks pregnant, I was able to identify a range of Therapeutic Communication techniques and have gained to appreciate the significance of Self-Awareness and what it means to be patient-centred. Communicating therapeutically typically uses a combination of techniques such as empathy, touch, active listening, clarifying and open-ended questioning as noted by Day, J., Levett-Jones, T., & Kenny, R. (2015). Ultimately, it aims to create a space in which the patient feels sufficiently safe to express their feelings openly and disclose what may often be private and personal, so that practitioners can make accurate assessments and diagnoses. For example, Sally had difficulty speaking, so James worked around this roadblock by asking close-ended questions and held Sally’s hand before asking, “Have you got a headache? Just squeeze my hands if you’ve got a headache.” So as not to make the history note-taking difficult for Sally, James recruited her husband David, to answer the more probing questions relating to her medical history and genetic predispositions. David in turn responded in a cooperative manner which indicated the beginnings of rapport being established. The tone and quality of his voice projected...
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...In the following essay, I will be reflecting and evaluating a practice session on grief and loss counselling with the client, Gaye, who presented with concerns that have recently surfaced in her current relationship that are as a result of the loss of her previous marriage, with her “marriage dream” now broken. I will provide a brief summary of the session, which will then be followed with verbatim examples to identify and evaluate the effectiveness of the skills utilised supportive of the clients’ decisions she deems necessary to gain confidence in her beliefs and decisions. By displaying effective use of micro-skills including, but not limited to, listening skills and attending behaviour, and also foundation skills for grief and loss counselling,...
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...Outline the primary skills used in counselling relationships This essay intends to introduce the reader to the most important skills involved within developing and maintaining a therapeutic relationship between a client and the therapist or counsellor. The onus will be on Humanistic counselling but many of these skills are central to all counselling types. Humanistic counselling is a process whereby the eventual goal is to facilitate the client in developing a personal understanding of self, and form a realisation of their own psychological needs and desires. It is, in essence, a route to empowerment for the client. Carl Rogers, father of client-centred therapy, described the client as an ‘organism’ whose natural tendency is a need to grow and develop: "The organism has one basic tendency and striving - to actualize, maintain, and enhance the experiencing organism” (Rogers, 1951, p. 487). This ‘actualisation tendency’ can only happen with the help of the therapist and their establishment of the perfect growing conditions. It is these that help launch the therapeutic relationship between the counsellor and client: “If I can provide a certain type of relationship, the other person will discover within himself the capacity to use the relationship for growth and change, and personal development will occur” (Rogers, 2004, p. 33). There are six conditions involved in a therapist-client relationship. The first involves the client and therapist entering into a psychological contract...
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...Introduction Davies and Bhugra (2004) noted that, the humanistic and cognitive-behaviour approaches to therapy share little more than a resounding belief in the need for a strong therapeutic alliance to affect positive and lasting change in behaviour, thoughts and attitude of clients seeking therapeutic intervention. The difference lies in the application of the techniques and the beliefs underlying the origins and treatment of psychological problems, which are associated with the physical illness and biological abnormalities of one sort or another. (Davies, and Bhugra2004). According to Barker (2003) a therapeutic alliance is a situation in which patient and psychotherapists are bound together in working towards mutual communication and understanding. This means that the professional hopes to engage with and effect change in a patient. In addition, Gabbard (1994) noted that the essence of therapy is a transaction between two collaborating human beings with the goal of helping the patients, and that there is no right treatment approach. Different theoretical models and treatments strategies may apply flexibly over the course of treatment. This essay will compare and contrast humanistic approach and cognitive behaviour approach, and discuss their relevance to psychiatric nursing practice. Both approaches will be applied to the management of anxiety. The humanistic approach According to Bugental (1967), the humanistic approach is concerned with the...
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...POSTMODERN APPROACHES Solution-Focused and Narrative Therapies Key Terms: Alternative story- a story that develops in counseling in contradiction to the dominant story that is embedded in a problem. Co-authoring- a co-joint process where client and counselor share responsibility for developing alternative stories. Deconstruction- exploring meaning by taking apart/unpacking the taken-for-granted categories and assumptions underlying social practices that are guised as truths. Dominant story- understanding a situation that is accepted within a culture that appears to represent reality. Dominant stories are developed through conversations in social and cultural contexts and these stories shape how people construct and constitute what people see, feel, and do. Exception questions- SF counselors inquire about times when the problem(s) have not been problematic. Shows that problems are not ever existing and always overpowering. Externalizing conversation- a way of speaking about a problem as if it is a distant entity, separate of the person. Based on the premise that people who view themselves as the problem limit themselves to the extent they cannot effectively deal with the problem. Formula first session task- observation homework given that must be completed between first and second session. They must observe what is happening in their lives that they want to continue to happening. Mapping-the-influence questions- a series of questions asked about a problem...
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...Marriage Guidance – Summary MGG201W MGG201W – Marriage Guidance – facilitative couples counselling Theme ONE – Understanding couples Intimacy involves: love, affection and caring, deep attachment to another person. The TRIPOD of couple relationships An intimate relationship consists of three factors that form a tripod on which the relationship rests. 1. Passionate attraction (PA) 2. Mutual expectations (ME) 3. Personal intentions (PI) Passionate attractions (PA) → Individual experiences intensely pleasurable sensations when thinking about or being with a new partner. → Blushing, trembling, breathlessness, high sexual desire → Referred to as infatuation = passing love “a foolish and unreasoning love’ → Infatuation is not a realistic / accurate appraisal of the relationship / idealisation → Negative / flaws in the idealised beloved may be intellectually recognised, but disregarded as endearingly special. Person chooses to ignore the negatives → Normal phase in the process of relationships → Infatuation can lead to a lasting relationship – but it mostly fades away and relationship based on infatuation alone will fail. Love → Involves physical attraction - deeper → Love encompasses PA, ME and PI → People rely mostly on life experiences to guide them to their own unique way of demonstrating love. → Eric Fromm “love is active concern for the life and growth of the person we love” → Love is deep, unselfish, caring, deep respect Hauck’s basic principles about love • It is not just...
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...Evaluate the claim that Person Centred Therapy offers the therapist all that he/she will need to treat clients This essay will evaluate the claim that Person- Centred Therapy (PCT) offers the therapist all that he or she will need to treat clients. I will define PCT, its origins and the theoretical constructs and philosophical influences that set it apart from other psychological theories, as well as explore how its founder viewed personality development, and psychological disorders. I will then weigh up the strengths and weaknesses of PCT, drawing upon criticisms by other writers, in order to conclude whether or not it can be used as a stand-alone tool for all clients. Person-Centred Therapy is also know as Client-Centred Therapy, or the Rogerian approach after its founder, Carl Rogers (1902 – 1987), who was an influential American psychologist and one of the founders of humanistic psychology. Developed in the 1950s, PCT is a non-directive form of psychotherapy within the humanistic approach, which is itself often referred to as the third force of psychology – the first two being psychoanalysis and behaviourism. In addition to humanistic philosophy, Rogers was influenced by existentialism, or free will, and phenomenology, or human judgement and emotion. Self-actualisation: Person Centred Therapy centres around the belief that human beings have one basic tendency, and that is to “actualize, maintain and enhance” (Rogers, 1951, p487). Person-Centred Therapy is therefore...
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...importance of understanding and implementing four concepts of thinking into daily nursing practice. According to Carper (1978:21-22) empirics, aesthetics, personal and ethical way of knowing in nursing are ‘necessary for achieving mastery in the discipline’. I believe that implementing those four patterns of knowing into daily nursing care is vital in order to provide best quality care for each patient. Nursing care should be implemented in flexible, thoughtful manner and should be carefully executed in unique situation with unique patients. Empirical Way of Knowing Empirical way of thinking is defined in article as a ‘factual, descriptive…exemplary, discursively formulated and publically verifiable which is ultimately aimed at developing abstract and theoretical explanation’ (Carper: 15). This way of thinking is executed using Evidence Based Practice. I have been a nurse for the past 10 years and I believe that empirical way of knowing is most familiar to me. For example, my facility is using Congestive Heart Failure protocol (policy created by facility based on clinical practice guidelines CPG) for patients admitted to hospital with either new onset of CHF or exacerbation of the disease. Each patient with CHF has comprehensive assessments, symptoms management, appropriate use of medications (ACE inhibitors), daily weight monitoring, resident and family education throughout the hospital stay. This is achieved by using multidisciplinary approach for patient care and...
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... Introduction. Motivational Interviewing is a collaborative, goal oriented style of communication with particular attention to the language of change, It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.’ Miller & Rollnick (2013 p. 29) The main idea of motivational interviewing is to purposefully create a conversation around change, without attempting to convince the person of the need to change or instructing them about how to change. Motivational interviewing (MI) is a therapeutic approach that was originally developed in the alcohol and other drug field by William Miller and Stephen Rollnick (Miller 1983 Miller & Rollnick, 1991). This approach was influenced by the principles and practices of a client-centred counselling to encourage the client to move through the stages of change and to make personal choices along the way. Definition: Motivational interviewing is a directive, client-cantered counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. Compared with nondirective counselling, it is more focused and goal-directed. The...
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...Unit 24 P.4-describe the importance of referral to other agencies What is a referral? What is the difference between a referral and a recommendation? As a counsellor you will often find yourself in situations where you can’t provide an appropriate or on-going service to your clients. This might be because your agency policies state that you can only assess clients, or work with clients for a specified timeframe. It also might be because you don’t have the skills necessary to deal with certain issues such as child abuse, sexual assault, marital issues, loss and grief and so on. It is important to realise that acknowledging you haven’t the necessary skills isn’t a sign of failure but rather a professional assessment of your strengths and weaknesses. By referring a client on to someone who can help them with their particular issue you are effectively meeting your client’s need and thus helping them move a step closer to resolve whatever is troubling them. Making a referral usually means putting people in touch with services that have the resources to help them achieve their goals. It is not just about handing out a number. You are responsible for bringing the person and the service together. When we make a referral, we are basically sending a person to another professional who specialises in working with particular needs or problems. Referring a client to another professional doesn’t mean that we stop working with that client but rather that we work as part of a team to best...
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...WORD COUNT 4399 The assignment will discuss a critical incident from a nursing management perspective, being an admission assessment experienced during placement. It is not a care study. There will be an overview of the nurse-managers responsibilities during the admission assessment and attention drawn to local and government policy. Particular consideration is given to risk assessment, Essence of Care (DoH 2001) in respect of the Waterlow Pressure Damage Assessment (1985), pressure sores, nutritional screening and delegation. Other issues considered will be communication, partnership working, the therapeutic relationship, and the nurse as an agent of change. Findings will be supported by literature. Identifying factors have been changed to respect patient confidentiality. Mary had no previous psychiatric history. She was eighty-four and lived in residential accommodation. She had two adult daughters who were unable to attend Mary’s admission. Prior to admission Mary’s behaviour had changed over several weeks and she had been refusing to get out of bed during the day. During admission she showed occasional signs of confusion but was able to give consent. Physically, Mary was in a wheelchair, had a history of falls, pressure damage, skin flaps. and needed full assistance with mobility. My mentor facilitated her admission assessment. I observed this in preparation of undertaking future ones myself whilst under supervision. From a management perspective my mentor who was the...
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...Overview This paper offers the non-subject specialist an overview of the literature which has influenced the development of listening and interpersonal skills in UK higher education. It refers to articles, seminal texts and writers within the field. In order to provide some context, the first section of the review covers some issues relating to the definition of listening and interpersonal skills and some examples are presented to demonstrate their interdependence. The importance of these skills within occupational and educational domains is also highlighted. The review then goes on to place listening and interpersonal skills in context by exploring historical perspectives, factors influencing current developments and providing an indication of issues which may affect future development. The paper introduces different approaches to listening and interpersonal skills within some key disciplines and considers the extent to which the teaching and learning of listening and interpersonal skills has been integrated within these discipline. In conclusion we consider emerging themes relating to advances in technology and widening participation, including the cross cultural agenda. A glance at the definitions section below will reveal the substantial overlap that exists between this topic and some of the other LearnHigher learning areas, most notably those relating to oral communications and group work. Although we acknowledge this overlap at various points during the review, readers...
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...framework helps therapists gain an understanding and interpretation of what may be happening for the client. This paper demonstrates my understanding and application of two theories to conceptualize a case study. Lastly, I summarize how these theories could benefit the client. Case Formulation “Theories provide therapists with concepts that allow them to think systematically about human development” (Jones-Nelson, 2011, p. 8). Theories are particularly important for therapists as they provide a framework for helping the client. It helps to support therapists on how to think about a client’s behavior, how to treat them and how to respond to them during the sessions (Jones-Nelson, 2011). Summary of Case I selected the case formulation of Kasey, the 25 year old woman who has concerns about her Generalized Anxiety Disorder. I selected this case because it provides me with insight on how family dynamics and psychological vulnerabilities influence the development of anxiety disorders. Secondly, as a marriage, couple and family therapist in training, it is helpful to have knowledge of family systems and how these systems may affect the individual. Cognitive Theory The first theory that I will be applying in the case formulation of Kasey is cognitive therapy, developed by Aaron Beck. The cognitive therapy is structured, short-term, present-centered, problem-orientated, collaborative...
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...INTRODUCTION TO COUNSELLING SKILLS FOR A TRAINEE COUNSELLOR: INTRODUCTION: I am going to address some of the main points and processes that a trainee counsellor will need to understand, to use in counselling sessions. It will include the process of initiating, maintaining and developing a relationship between a counsellor and anyone using counselling for the first time. INITIATING A RELATIONSHIP: The initiating of a relationship in counselling could involve a telephone consultation to arrange appropriate appointment time and location where the first meeting will be held it will also have the name of the counsellor who will be holding the sessions. A letter could also be sent to start the initiating process between a counsellor and the client. It will contain the appointment time, location and the name of the counsellor who will be conducting the sessions. Before the initial meeting takes place the counsellor will ask the reception to inform them that the client has arrived. They will prepare the consultation room by setting the chairs in a position where eye contact can be maintained, but personal space respected. They will make sure the room is at the right temperature, if warm having a window open a little. Have tissues on the table in case they are required and check that any paper work is in the right order and the correct forms if any are required. On the arrival of the client the counsellor introduces...
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