Psychosocial Resources in a Therapeutic Relationship

Psychosocial Resources in a Therapeutic Relationship This essay considers the psychosocial resources implicated in a successful therapeutic relationship. Several fundamental theses seem 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 such as empathy, trust, and warmth, seem crucial in most scenarios. Thirdly, the assumptions and beliefs of both therapists and patients regarding the therapeutic alliance need to be identified, and if necessary remedied, to achieve a successful interaction. The terms ‘patient’ and ‘therapist’ may 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 role where the therapy is psychological (e.g. psychoanalysis) and the therapist a psychologist or professional which similar training (e.g. social worker, counsellor). Peplau’s theory of the nurse-patient relationship provides a useful basis for conceptualising the role of psychosocial resources in successful therapeutic relationships (Peplau, 1965, 1974a, 1974b; Douglass et al, 2003). Although Peplau focused primarily on nursing care, her model seems applicable to most therapist/carer-patient scenarios. According to Peplau a favourable therapeutic relationship is essential for successful treatment outcomes. She identifies several psychosocial variables that are pertinent. These incl ude trust, interpersonal 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 plethora 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 approachable 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 towards the patient. This is particularly 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 participate 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 identify deeply with their problem, and keen to engage in conversation at a deep emotional level (Paulson et al, 1999; Gamble, 2002). Psychosocial factors are especially pertinent in psychotherapies, especially cognitive therapy. A successful therapeutic relationship is heavily influenced by what is referred to as a â€Å"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 generate unfavourable emotions such as dislike and resentment. The patient may also become unnecessarily reluctant to follow psychological advice. The possibility of premature termination 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 ‘Therapist’s Schema Questionnaire’, which measures fourteen typical mindsets therapists may hold about therapy, themselves, or their patients, including ‘demanding standards’, ‘special superior person’, ‘excessive self-sacrifice’, ‘rejection sensitive’, ‘abandonment’, ‘autonomy’, ‘control judgement’, ‘need for approval’, ‘need to like others’, and ‘emotional inhibition’. Participants 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 perso n’, 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 idealise 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, leaving the practitioner perceiving the patient as needy and vulnerable, and bending over backwards to meet patient demands. Treatment boundaries aren’t set, or if the y are, aren’t adhered to, resulting in prolonged 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 therapists, 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 , affective 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 spontaneity 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 importance of psychosocial factors, as perceived by the patient. Unfortunately, the correlational design precludes any inferences about causality. Thus, while it seems commonsensical that perceived support may strengthen relations with a therapis t, 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 Peplau’s 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 between 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 retention after a year. The setting for this study was a community based outpatient methadone trea tment program in two urban areas. Participants were users of opiates/cocaine admitted to the program, and subjected to various 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 their patients: â€Å"easy to talk to†, â€Å"warmth and caring†, â€Å"honest and sincere†, â€Å"understanding†, â€Å"not suspicious†, and â€Å"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 drug 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 psychosocial 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. References Barker, 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, PA:  Beck Institute for Cognitive Therapy and Research. Cooper, D. E. (1999). Existentialism: A Reconstruction, 2nd ed., Oxford, UK:  Blackwell. Dermot, M. (2000) Introduction to Phenomenology. Oxford: Routledge. Douglass, J.J., Sowell, R.L. Phillips, K.D. (2003) Using Peplau’s theory to examine  the psychosocial factors associated with HIV-infected women’s difficulty in  taking their medications. The Journal of Theory Construction and Testing, 7,  pp.10-17. Gamble, C. (2000) Using a low expressed emotion approach to develop therapeutic  alliances. In Working with Serious Mental Illness: A Manual for Clinical  Practice (Gamble C. Brennan G., eds), Balliere Tindall, London, pp.115-  123. Haarhoff, B. A. (2006) The importance of identifying and understanding therapist  schema in cognitive therapy training and supervision. New Zealand Journal of  Psychology, 35, pp.126-131. Hewitt, J. Coffey, M. (2005) Therapeutic working relationships with people with  schizophrenia: literature review. Journal of Advanced Nursing, 52, pp.561-570. Johansson, H. Eklund, M. (2004) Helping alliance and ward atmosphere in  psychiatric in-patient care. Psychology Psychotherapy: Theory, Research,   Practice, 77, pp.511-523. Lambert, M.J. Barley, D.E. (2001) Research summary on the therapeutic  relationship and psychotherapy outcome. Psychotherapy: Theory/ Research/Practice/ Training. 38, pp.357-361. Leahy, R.L. (2001) Overcoming resistance in Cognitive therapy. New York: The  Guildford Press. Luborsky, L., Barber, J.P., Siqueland, L., Johnson, S., Najavits, L.M., Frank, A. Daley, D. (1996). The revised Helping Alliance questionnaire (HAq-II): Psychometric properties. Journal of Psychotherapy, Practice and  Research, 5, pp.260-271. Moos, R.H. (1974) Community-oriented Programs Environment Scale. Palo Alto, CA:  Consulting Psychologists Press. Paulson, B.L., Truscott, , D. Stuart, J. (1999) Client’s perceptions of helpful  experiences in counselling. Journal of Counseling Psychology, 46, pp.317-324. Peplau. H.E. (1965) The heart of nursing: Interpersonal relations. Canadian Nurse 61,  p.273. Peplau, H.E. (1974a) Concept of Psychotherapy. San Antonio. Texas: RES.  Productions. Peplau. H. E. (1974a) Criteria for a Working Relationship. San Antonio, Texas: RES.  Productions. Pinikahana, J., Happell, B., Taylor, M. Keks, N.A. (2002) Exploring the  complexity of compliance in schizophrenia. Issues in Mental Health Nursing,  23, pp.513-528. Repper, J. (2002) The helping relationship. In Psychosocial interventions for People  with Schizophrenia (Harris N., Williams, S. Bradshaw, T., eds), Palgrave,  Hampshire, pp.39-52. Rudd, M. Joiner, T. (1997) Counter-transference and the therapeutic relationship: A  cognitive perspective. Journal of Cognitive Psychotherapy: An International  Quarterly, 11, pp.231-249.   Simpson, D.D. Joe, G.W. (2004) A longitudinal evaluation of treatment  engagement and recovery stages. Journal of Substance Abuse and Treatment,  27, pp.89-97.

William Shakespeare :: English Literature

William Shakespeare The Globe William Shakespeare was one of the most famous play writers of all time. He was born in Stratford-upon-Avon in England more than four hundred years ago. At the young age of eighteen Shakespeare wedd a woman by the name of Anne Hathaway whom was eight years older than him. Together they had a daughter called Susanna and twins Hamnet and Judith. Shakespeare decided to start travelling and to go to London. Luckily for Shakespeare just before he went to London, theatres had been opened for travelling actors for they weren’t respected and a man by the name of James Burbage wanted to change that. He did this so that actors could gain more dignity. This led to the first public playhouse being built in England. This playhouse was a great success and was very popular so gradually more and more were built. In a playhouse there were three tiers of galleries which looked down to the yard where most of the audience stood. For it was only a penny to stand in the yard whereas in the gallery benches it was two pence. To sit on cushions in the gentlemen’s rooms it was three pence and for six pence the well-off would sit in the Lords room. The stage came out into the yard and was open to the sky. Over the back of the stage ran an upper stage and beneath the upper stage was what was known as the tiring house. The tiring house was concealed from the audience by a curtain which would be drawn back to reveal an inner stage. There weren’t any large curtains to conceal the whole stage so all scenes on the main stage began with an entrance and ended with an exit so in tragedies the dead must be carried away. The fact that there was no scenery meant that there were no limits to the number of scenes as when a scene came to an end then the characters would just simply leave the scene. The audiences loved Shakespeare’s plays. Hundreds of people would squeeze into the theatre with their food and drink to watch. Sadly a deadly plague interrupted the theatres success and meant that for two years all playhouses were closed. During this time Shakespeare wrote several plays and two long poems. In 1597 the theatre was forced to close after twenty one years for it was on rented land and the agreement with the landowner had ended. The landowner wanted to keep the playhouse to himself and to reuse its valuable oak timber but that wasn’t the plan of the two brothers who

Gerald graff pop culture in academics Essay

In Gerald Graff’s â€Å"Hidden Intellectualism,† Graff argues that schools should encourage students to think critically, read, and write about areas of personal interest such as cars, fashion, or music but as long as they do so in an intellectually way. I happen to agree with Graff and his perspective for many different reasons. I personally believe that students should be giving the opportunity to engage intellectually with pop cultural topics that interest them and get to apply their â€Å"street smarts† to their academic work. Teenagers can also relate to what’s going on in their own lives with the pop culture world. Sometimes it’s hard for teenagers to understand a certain topic but if teachers can explain it to them in a way that they can understand using pop culture, teachers should be allowed to do so. Pop culture should be allowed in the classroom as long as it’s used in an educational way and can help students learning. Graff talks a lot about â€Å"street smarts† in his essay. We all know someone who is â€Å"street smart† but they just don’t do to well in school and are unable to do well in academics. Some people may feel that it’s a waste of intelligence and knowing so much about life isn’t going to help you academically. Graff feels that it’s not those students fault and those students can be helped. He states that â€Å"What doesn’t occur to us, though, is that schools and colleges might be at fault for missing the opportunity to tap into such street smarts and channel them into good Gonzalez 2 academic work† (pg. 380). Meaning schools and colleges should be held accountable for not being able to help those street smart teenagers and help turn their knowledge of life into academic work. Teachers should help these students learn how to understand the academics their teaching them with examples of the street smart knowledge they already obtain. Personally, I feel that street smarts beat out book smarts in today’s world. Street smarts is something that’s real knowledge to me and can help someone in the future unlike book smarts where everything feels unreal. Graff’s speaks of his own experience in school and how he felt he was the typical teenage anti-intellectual. All throughout high school Graff hated reading and books. The only thing he truly cared for was sports, and the only reading he did was reading sports magazines. Graff says â€Å"I have recently come to think, however, that my preference for sports over schoolwork was not anti- intellectualism so much as intellectualism by other means† (pg. 382). What Graff is saying here is just because he had rather choose sports over schoolwork doesn’t make him unintelligent it makes him smart but in a different way. I can personally agree with Graff. I’m not very interested in academic work but I grew up watching sports. Sports are full of challenging debates, arguments, analysis, and statistics. You can debate which team is better so why not use that same tactic but a different topic. I remember being in class not doing my work and talking about football or basketball. If a teacher was to explain reading or writing to me with using sports as an example I probably would’ve understood what they were saying and succeed in school. Have teenagers analysis sports topic and have them relate to them and see if they agree or disagree with that sport topic. Schools should create debates or arguments that teenagers can relate to. It will get teens to feel more involved and they might actually engage in the Gonzalez 3 conversation. We should be able to incorporate sport topics in school because not many students find educational topics very understanding or interesting. Teachers can easily use sports as a topic in every classroom discussion. Music in pop culture today has such a big influence on students. Everyone listens to at least some type of music any chance of the day they get. One of the main influences is hip hop music. Hip hop is all over the radios and you can find it in at least the majority of student’s phone players, iPod, or even CDs. Music has a huge influence on myself, personally. Music helps me concentrate and even helps me learn academic material better. It even helps my mind grow and develop better. Music actually improves communication between the right and left sides of the brain, allowing you to gain better comprehension and memorization skills which develop your brain to a higher level. Music has so much to do with metaphors and understanding lyrics and truly understanding the meaning of a song. It even helps to improve reading and comprehensive skills. Take Tupac Shakur for instance, his rap music has such meaningful metaphors which should be used in the classroom because they can truly help teenagers understand the meaning of a metaphor and students will actually be interested in the topic. Music is such a complex language that even incorporates mathematics, science, history, physical education,  ­coordination, and even mental ability. Most teenagers find hip hop artist like Tupac interesting because they can relate to Tupac’s music about daily life struggles about gangs, drugs and growing up in the â€Å"ghetto†. Since teenagers go through these struggles we should help give them something to relate to so they can know the real world isn’t perfect and a lot of people can be going through the same struggles as you. Gonzalez 4 Most people will disagree with the fact that schools should allow pop culture influences in education. That schools are made for learning academics and nothing else, like pop culture, should influence anything not academic. An argument could be that pop culture is a bad influence and can send the wrong message to teenagers. For instance that sports can send the message of promoting violence and that teenagers should stick to their own personal friends and not communicate with other groups of people. It can cause tension in the classrooms over debates because not everyone has the same opinion about a certain team. Or the simple fact that not everyone is interested in sports or have knowledge of sports and they don’t want teenagers to feel as if they don’t fit in. A lot of people will have negative comments about music in education and academics. Most will argue that music send the wrong message to teens. Some can even say rap music like Tupac exploits women and uses vulgar language. It promotes violence and criminal like activity. Which in some rap music and even Tupac’s music is true. He uses extreme vulgar language and talks about the â€Å"thug life†. It even includes sexual conduct in his rapping. Some can even say hip hop music period is distracting and if we promote music in schools. Like this, it will promote teenagers to get the wrong idea about school and education. That teens will go out and join a gang, become sexually active, and do criminal like activity. Even though some teenagers have a hard life and can relate to this music we should not remind them of their personal life’s and keep everything strictly academic. In conclusion, you can see that there is a positive and negative to having pop culture in today’s education. I personally feel that there should be a connection to education which Gonzalez 5 teenagers like I should be able to be interested in as long as it’s educational. Not everyone will have the same opinion as Graff and I so there should be an option to be able to take classes which you can use pop culture in your learning process or if you want to keep it strictly educational you should be able to as well. Either way pop culture is huge to teenagers today. Everything from music, fashion, sports, TV and celebrities. Teenager’s world revolves around pop culture and if we want to keep teens interested in learning we should find ways, like using pop culture, to keep them interested. Works Cited Graff, Gerald. â€Å"Hidden Intellectualism. † They Say, I Say: The Moves That Matter in Academic Writing. Eds. Graff, Gerald, Cathy Birkenstein, and Russell Durst. New York: W. W. Norton and Co. , 2012. 380-87. Print.

Design Explication Of Robert Frost - 1040 Words

Professor Underwood English 1102 4 December 2015 Design Explication Robert Frost takes an interesting approach in his short poem entitled, Design. In the poem, Frost questions if there is a designer of life or if things just occur randomly. Frost believes that if there is indeed a designer of life, the designer produces both evil and good. Moreover, Frost considers that perhaps good could actually be evil if one is looking close enough, if so, the nature of the designer in the poem is contradictory. Frost s Design mastery in the poem is that its meaning is enhanced by its form, rhyme, and its imagery and connotations. Despite being considered a sonnet, â€Å"Design† does not express the true nature of a sonnet’s meaning. In contrast of pleasing or inspiring, it is unexpectedly doubtful. Frost made changes to the typical sonnet form. He made his own design. Primarily, the usual pattern of a question in the octave followed by an answer in the sestet, is reversed in this situation. The octave in the poem is an observation, and the successive sestet is a question. Additionally, Frost made changes to the usual rhyme scheme of a sonnet; the cdecde pattern in the sestet has been changed to acaacc.† The reader could possibly be caught off guard by the unexpected differences. Frost engages poetic structure to increase the irony of his poem, and interchanges between two different tones. Shock and appreciative are mixed together with lyrical lines. The tone shifts from rapid andShow MoreRelatedDesign Explication Of Robert Frost1020 Words   |  5 PagesDecember 2015 Design Explication Robert Frost takes an interesting approach in his short poem entitled, Design. In the poem, Frost questions if there is a designer of life or if things just occur randomly. Frost believes that if there is indeed a designer of life, the designer produces both evil and good. Moreover, Frost considers that perhaps good could actually be evil if one is looking close enough, if so, the nature of the designer in the poem is contradictory. Frost s Design mastery in the