Therapeutic communication in a specific situation: a disabled person is making decisions about living situations

Therapeutic communication in a specific situation: a disabled person is making decisions about living situations
Therapeutic communication can be very effective in dealing with disabled people, who are suffering emotionally and considerer themselves powerless to live full life, or to change the situation . Disabled people need special care and concern, life with them is not simple, requires special strength and energy. Many of the difficulties faced such people and by family members have long-term nature, so the family needed support and advice, as well as therapy sessions.
Often people come to the first meeting with a story that they are not able to influence the situation and are powerless to change anything. Family and individual counseling, participation in parenting groups and classes with a child, bringing to discuss remedial and developmental programs allow parents to understand the situations of their lives, which were displayed initiative, responsibility, ability to function and strength, and to actualize these opportunities. However, I would like to say that the initiative and responsibility, especially when they are just beginning to appear very fragile and require special support from others.

There are some guidelines in therapeutic communication, principles and techniques of therapeutic communication. The main responsibility on the therapeutic communication lies on nurse, who is a a non-directive listener, that means letting go of patient's own issues, needs, belief systems while listening. (Wachtel 1998)
During the therapeutic communication the most important are atmosphere and techniques of listening and speaking, that can make the therapy both effective or vice versa. Meanings, values and understanding, which arise as a result of conversations related to a number of factors: the situation itself that is spoken, the ratio of participants to each other, their intentions and objectives, introductions of the situation and intentions of other social and cultural rules pertaining to this communication situation, as well as the ever-changing meanings of the participants and understanding. (Wachtel 1998)

So, the doctor or nurse should use special therapy communication techniques and barriers to communication during the conversation.

If we consider the situation of communication with disabled person or a parent of disabled child, the doctor or nurse should follow the next principles, these principles will provide an opportunity for participants to move the conversation from the old, known, understanding of the experiences and meaning in the direction of detecting new and can be formulated as follows:

1. The doctor or nurse keeps conversation about the problem inside of the description field, which is set by party of conversation. At the beginning of the conversation doctor must provide space for all those features of a particular experience, understanding, experience in problem situations that already exist, that is, to what is already known, familiar. The movement to a new decision is impossible without the defining the current situation. Gradually, with the help of a certain kind of issues there is an opportunity for a new understanding of the situation, meaning that allows you to change the behavior. A new understanding, new stories about people and their lives are in such a motion with respect to all involved in the discussion of issues, including the moderator.

2. The doctor tends to choose the language of cooperation. He is serious about what he is told, regardless of how surprising, banal or bizarre it may sound. Questions which he asks should show respect, not condemnation of what was said. All this requires considerable linguistic mobility, but at the same time promotes dialogue for cooperation and understanding.

3. The doctor or nurse must be a respectful and impatient listener. The sooner the physician understands the party, the les sis the possibility for dialogue and the greater is the risk of misunderstanding, because too fast understanding leads to inconsistent interpretations of human experience, a different sort of attributing meanings, motives, etc. Too quick understanding also leads to the risk to block the development of a new meaning and new thoughts by speaker.

4. Doctor or nurse asks questions, and answers raise new questions. Doctor should tend to raise questions so that they are mainly focused not on the collection of specific data and information, or already existing leading hypotheses. The doctor asks questions with a view to generating new information and meaning, understood by the participants. Such questions encourage the mutual study and discussion, and they are called "reflexive" because of their ability to run the "reflexive" processes in the conversation. These include: the future-oriented and activated the observer's position to change the context containing assumptions associated with the comparison of standards aimed at clarifying the differences, questions about hypotheses, and to interrupt the process. (Hosley 2006)

In our example, the conversation with the diabled patient we can give examples of such questions:

1) Questions focused on the future: "What are the opportunities in education and the work you are considering? What are you going to do if this option is not realized? What are you doing now in this direction? ".
2) Questions that activate the position of speaker: "Can you imagine what can change this situation? What do you feel at that moment when you think so? ".
3) Questions to the changing context: "You said what heavy experience you have with regard to the fact that you have serious problems. Can you say that the family has changed also, whether there had been any positive or significant changes in connection with problems? ".
5) Questions of conjecture: "What kind of work and care you need most to live a normal life? Emotional support? Physical care?” .
6) Questions to interrupt the process: "Now, when you realize that your behavior is similar to the response at home, what can you do differently? How could you build a conversation, to feel better? What do you need to do? "

The doctor assumes responsibility for creating a context for the conversation, which favors cooperation in identifying the problem, but does not define the problem and directs the conversation to that of its definition, which previously seemed to him more useful. He also does not try to push the conversation to a common understanding of the perspective, and facilitates the work of the patient so that he was aware of creating new ideas, understanding and meanings.
All of the above concepts of therapeutic communication, together with barriers to communication are the basis of a therapeutic conversation. Therapeutic conversation – is an open conversation, in which the focus is set to deploy a new understanding of the problems and issues. (Journal of Communication 2006)
Talking about the problem is so that it is not "fixed" through language, and allowed in a conversation through the discovery of a new value, meaning and understanding.

The conversation must give the patient the possibility of independent vision, understanding and solving their problems, discover new resources. Despite the view expressed by a doctor and his proposed ideas, most important is the preservation of freedom for the patient and his understanding of the position that must be respected. The patient is an expert in his life, and behind him is the right to understand and choose what now for him is the best, possible, desirable.

References:

Defining "Therapeutic Communication". (2006) . Journal of Communication. Vol. 25, Issue 3, Pp 127 – 130
Paul L. Wachtel & Ellen F. Wachtel. (1998). “Therapeutic Communication”. Guilford Publications
Julie Hosley. (2006). “A Practical Guide to Therapeutic Communication for Health Professionals”. Saunders

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