Therapeutic Relationship

Therapeutic Relationship

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1a. Explain your understanding of a "therapeutic relationship" with a client.
A therapeutic relationship with a client is a well planned and goal oriented connection between the clinician and the client in order to meet the therapeutic needs.
The clinician would develop and maintain mutually beneficial association with the client and his family. He always believes the client as a person of goodness, dignity and strength.

1b. what are the benefits of a therapeutic relationship?
Encourages Positive Interaction
Encouraging a patient to express himself allows you to get more information of the client's emotional tendencies and helps determine the most beneficial treatment approach. By exemplifying empathy, respect and a nonjudgmental attitude, you promote the positive side of self-expression and encourage a mutually trusting relationship.
Supports Personal Accountability
By teaching and providing the patient with the tools he needs to acknowledge the challenges he's facing and improve life situations, you empower a client to become more aware of his own behavior and self-correct it.
Promotes Openness
When the lines of communication are open, patients are more likely ask for help and more prone to be open about persisting symptoms or difficulties they may be experiencing. A client's honest summation of how the therapy is helping or impairing her allows you an opportunity to address problematic issues immediately and reevaluate treatment options.

1c. Explain in your own words how you would achieve this relationship.
Unconditional Acceptance and Non judgmental – Whatever your client and his representatives say, should be accepted unconditionally as all the aye important facts to diagnose and give the appropriate treatment. Secondly, you should not be critical and negative of his ideas and opinions and your attitude should be non-judgmental.
Empathy – This is about as to how you build up the relationship with your client that he knows his feelings can be shared with and confident of your input for his recovery.
Attending & Listening - when the client feels the there is some one here to listen to; he would like to share his feelings and thoughts which creates a strong relationship.
Open- You have to be an open minded and prepare to share everything in relation to the matter you are dealing with.
Professionalism – a professional approach to the matter points out the client of your subject knowledge, education and experience and that leads the client to admire of your ideas
Genuine - Being genuine to the matter and the client would always develop the strong relationship.

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Respecting the clients feelings and expressions, making eye contacts and your gesture and posture all accumulate the client’s mind set about your genuine effort towards him.

2. Why is it so important to use a "client centered approach" when assessing needs and planning goals with your client?
This is the most productive approach in mental health counseling developed by Carl Rogers. The importance of this approach is, the client finds his own solutions to his problems and as the clinician, we only assist him to find them. Client centered approach is incredibly leads to a successful therapeutic relationship between the client and the counselor.
3. Explain the relevance of each section below when conducting an assessment in the community:
a) Occupational Health & Safety. (For example, when conducting an assessment in the community) It is important that a risk assessment is conducted initially before entering a person's home. You need to be sure before working in the person's home that it is safe. Eg. no wires exposed, nor cords that are hazardous, no dangerous dogs in the house.
This is true; your safety is first and foremost more than anything else. In some occasions, the atmosphere for an assessment is unsafe with the dangerous setting. So, what you need to do is, do not conduct the assessment or if it is already started, terminate the assessment immediately and let the person know that they have to ensure the safety of the site before the next appointment.
b) Rights & Responsibilities of consumer & support worker e.g. Duty of Care.
Rights and responsibilities of consumer and support worker have clearly stated in mental health standard 2010 in which the total mental health service if protected by duty of care. For an instance, consumers to be treated with respects and dignity at all times.
c) Values & attitudes of consumer & worker
Each party has to be accepted and respected values and attitudes of the others in order to conduct a successful assessment. Ex: In Indigenous culture, they prefer to share discuss family history with others so that as a support worker we have to respect these values whether we like it or not.
d) Mental state of consumer.
This is an indication of the mental health situation of the consumer. Understanding mental state is vital for an assessment. A violent mental state may result to immediate termination of the assessment.
e) Substance Use. – If the consumer or his family is under the influence of drug or alcohol, we cannot proceed the assessment.
f) Consent/authorization to release confidential information to other agencies if required.
As a support worker you are legally bonded to protect your consumer’s privacy and take all the measures to ensure the confidentiality of information gathered from him. This is excluded if the situation is worse such as if the client has suicidal thoughts or a plan.
g) Organizational policies & procedures.
Despite there are some barriers when stick in to organizational policies and procedures, we have to follow those guidelines to provide a better service to our clients. For an example, we cannot keep private relationship with our clients.
h) Relevant Acts of Parliament – Legislation – All care delivered to consumers are explained in Commonwealth, state and territory mental health legislation and related acts and the assessment has to be in accordance with the relevant legislation and acts.
4a. Re: Case History - "Going to the Patient" pg 6 (resource below)
Describe the skills/strategies that the staff would have used to gain the trust of this woman (who by nature of her illness was paranoid and very suspicious of other people) so that she would accept treatment. (Minimum 250 words)
Although we may talk about formal or informal assessments - often it is not the worker who chooses whether to assess informally or informally; but rather the situation/clients mental state that dictates the most appropriate method.
Building therapeutic relationship is the most relevant and practical approach to build up the connection with this particular woman. In this case how they have engaged in the situation was absolutely successful. They had offered her foods and cloths first and built the initial rapport. The location of the interview is also important in order to gain the best result, it would be ideal a place for conduct a mental assessment where the client preferred to be. A clinical facility or a formal office set up would make the client more frustrated.
Attend to patient’s other major concerns is also one of the successful factors to build up an excellent relationship. This particular woman was given medications for her chest infection and her basic needs and this is why she agreed to the nurse visiting her on a regular basis.
Supporting her to find accommodation, arranging her pension and travelling stuff have clearly shown the indirect contribution of the person-centered approach.
To win her trust the nurse had only joined the GP who is known to the patient before and they did not call police or council workers in to the scene. You should not call the police unless the situation is violence. Just in case if Police came in to the scene the outcome may be worse.
Tone and volume of voice – speak in a calm, quiet voice. If they yell or raise voice she become frightened or panic or may be violence.
Even the patient is aggressive or impulsive we have to stay calm and our aim should be bring her calm down as soon as possible
Ask open-ended questions that show her you are trying to help. If possible collect additional information of the patient from the community.

4b. Explain the advantages/disadvantages of using a Mental State Examination (M.S.E.) in this situation.
MSE is a structured way of observing and describing a patient’s current state of mind, under the areas of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgment. It is clear that this particular patient is an unkempt, dirty and bedraggled woman with physical illness. She was looking for food in rubbish bins. She is isolated, frightened and refused assistance.
MSE records only observed behavior, cognitive abilities and the real experience of the patient and most successful way to measure the mental state of the patient.
MSE is fast and only take few minutes to administrate. Especially situation like this the patient is refused assistance and frightened to others, this is the quickest way to examine the patient and diagnose the problem and start treatments.

I some extreme cases, patients are delirious, severely demented or grossly psychotic cannot provide reliable information. And some patients can answer questions in a straight forward, logical and demonstrate no obvious abnormalities of behavior but still have a serious mental illness. So MSE we cannot say the most successful assessment method.
The questions are difficult to formulate because they are not asked in the other types of interviews or in the other areas of medicine, psychology and nursing ect.

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