ESUOT

Why engage?

- not going to comply with therapy

- loss of potential benefit to health and wellbeing

- service not person centred

- negative view of health service

- Lack of clear communication leads to:

- misunderstandings

- lack of trust

- increased risk of harm

- Risk to career

- No collaboration = lack of goals

Effective Communication

Person centred, holistic practice, advanced communication skills,(Adam et al, 2013) 

SU perspective of OT relates to compliance (White et al, 2015) 

Effective Therapeutic Relationships

OTs must build effective therapeutic relationships (COT, 2014)

Fundamental to individualised, authentic and effective practice (Tickle-Degnen, 2014)

6 modes of interaction - advocating, empathising, encouraging, instructing, collaborating, problem solving (Taylor, 2008)

Involve SU in decision making (Sumsion, 2006)

OT to use:

self-awareness, intuition, communication skills, emotional intelligence, empathy and interpersonal skills to enagage the service user (McKenna and Mellson, 2013)

Temper pragmatic reasoning to become an effective listener

Effective communication is described by Petrovici and Dobrescu (2014) as 'Emotional intelligence in action'

Service user view:

Good relationship is key to establishing and maintaining engagement of the service user

Communication Skills

• Environment creating
• Relationship building
• Verbal and non-verbal communication

Also includes

Observation skills - paying attention, observing body language, looking for patterns

Listening skills - active listening, acknowledgment, provide feedback, be available

Questioning skills - open/closed, funnel, probing, leading

Advanced Communication Skills 

are skills that  are used for WORKING THROUGH, EXPLORING and CLARIFYING

• Reflection
• Paraphrasing
• Summarising
• Concreteness
• Clarifying
• Focusing
• Confrontation
• Handling silence
• Handling strong emotion
• Giving permission
• Immediacy

Self-awareness - of your own beliefs and values and the effect they may have on the r/ship

Cultural - awareness of other cultures norms and values

Relationship Building Skills

As said by Rogers (1957) you need:

• Respect
• Warmth/genuineness
• Empathy
• Congruence
• Unconditional Positive Regard

Professional Guidelines

HCPC published revised Code of Ethics in 2016

Specifically relating to communication were the following:

• standard 7 - reporting escalating concerns around wellbeing and safety
• standard 8 being open and honest when things go wrong
• changes to the structure of the standard so they are easier to understand for SU

Ethics

• Trust
• Professionalism
• Code of ethics
• trust and departmental policies and procedures
• Boundaries
• Supervision

Three Circles of Energy Rodenburg, 2009

1st Circle - self and withdrawal

You are ignored or left out, people don't hear you speak, you feel self-concious

3rd Circle - bluff and force

Too loud in speech or laughter, don't notice people around you, take control of conversations you are not part of

2nd Circle - energy of connecting

Centred and alert, people see and hear you, you notice things about others around you, curious and not judgmental, hear clearly

Mindfulness - being mindfully present creates a good therapeutic relationship Reid 2009

S.P.I.K.E.S.

1. Setting up interview - Arrange for privacy, grab some people for support, sit down and connect, manage time constraints and interruptions

2. Perception - Assess the patients perception of current condition with open ended questions

3. Invitation - obtain patients consent to give them the information

4. Knowledge - give the patient the information in small, understandable chunks and check frequently that they understand what you are saying

5. Emotions/empathy - observe the patients emotional response and give an appropriate empathic response

6. Strategy and summary - re-check understanding, give a clear and concise summary and suggest a course of action

Self-Management is a concept derived from cognitive psychology

• Bandura - Social learning theory (1963)
• Rogers - Self concept theory (1959)
• Mazlow - actualization (1943)

Skills for self-management 

• Modelling
• Prioritise
• Specify
• Communicate
• Use time effectively DO NOT PROCRASTINATE
• structure environment to suit needs
• establish a routine
• manage stress

BE ASSERTIVE DO NOT BE PASSIVE/AGGRESSIVE

Emotional Intelligence and the Occupational Therapist

Emotional intelligence has impact on OTs ability to engage people and it is congruent with holistic practice and person centred care

Gardeners (1983) multiple intelligences

Mayer and Salovey (1997) created the concept of EI being perceiving, managing, using and understanding emotions

Goleman (2006) adds impulse control, delayed gratification and handling stress/anxiety are all EI traits

EI gives the ability to deal with EVERYBODYs emotions (McKenna and Mellson, 2013)

Petrovici and Dobrescu (2014) "effective comms is EI in action"

Emotional Intelligence

The provision of holistic rehabilitation must encompass the ability to deal with the emotions of our service users, their carers and families, our colleagues, students and ourselves, regardless of the field or service in which the therapist  operates (Mckenna and Mellson 2013)

Emotional intelligence abilities can be facilitated within a collaborative relationship with [lots of peeps] supporting honest communication, expression, trust and empowerment, key elements of the efficacious, individualised practice which supports engagement of service users (Mckenna Roberts and Tickle 2016)

Managed  emotional responses and a positive attitude can assist with management of difficult situations (Telford et al 2006)

Mckenna and Mellson (2006) say EI makes you a better therapist.

Mayer and Cobb (2000) add EI OT is warm, genuine, motivated, optimistic and persistent

Anger - strong feeling of annoyance or displeasure, long continuum from irritation to rage, anger is cognitive and can be a response to internal or external stimuli

Aggression - a demonstration of distress and psychological dsisturbance which can interfere with rational thought. It is the expression of anger with the implication of violence

Violence - physical manifestation against self, others or property which is intenede to, or does, cause damage

Contributory Factors are an exhaustive list

Types of SU emotions

Manipulative - a calculated determination to obtain something of benefit to them

Defensive - in response to a perceived threat

What staff bring - prejudgements, stereotypes, labels. Need to remember prevention when possible, treatment takes priority over control

Negative traps for staff

• o   The helpless trap (ive tried everything!)
• o   The victim trap
• o   The ‘Its their fault’ view
• o   The ‘I want to punish them’ trap
• o   The ‘punishment works’ trap
• o   The ‘they will not change’ view
• o   The ‘that’s the way they’ve always been’ trap

Staff need an awareness of their own prejudices, perceptions, beliefs and values to ensure they are not impressing these onto the service user.

• 1.       Preparation and prevention – planning can prevent risk to yourself or the service user when there is a risk of altercation
• 2.       Diffusion and Prevention – Use effective communication skills to diffuse any potential aggression
• 3.       Reflection – important following any incident to reflect and debrief in order to effectively manage own feelings

Diffusing Potentially Violently Situations

Read Do’s and Don’ts

A – Anticipate the Problem/Avoid Escalation

C - Control of the Situation/Contain damage/injury

T - Train Staff/Treat service user

Consequences of Poor Management

Stress and burn out

Cost of Injury Sustained – Emotional and physical

Motivational Interviewing

MI is a direct, gentle and non-confrontational counselling style. Do NOT assume:

• This person ought to change
• This person wants to change
• This person is primarily motivated by health considerations
• If they do not agree to change the intervention has failed
• People are either motivated or not
• Now is the right time to consider change
•  A tough approach is always best
• I’m the expert, he/she must follow my advice

Spirit of MI

• Compassion – actively promoting wellbeing
• Partnership – not confrontational, invite to talk, do it with them, don’t fall in expert trap
• Evocation – motivation for change is enhanced by elicitation, encourage them
• Acceptance – absolute worth, autonomy. Accurate empathy, affirmation

Roadblocks to Listening

• Ordering, directing, or commanding
• Warning or threatening
• Giving advice, making suggestions, or providing solutions
• Persuading with logic, arguing, or lecturing
• Moralising, preaching, or telling clients what they "should" do
• Disagreeing, judging, criticising, or blaming
• Agreeing, approving, or praising
• Shaming, ridiculing, or labelling
• Interpreting or analysing
• Reassuring, sympathising, or consoling
• Questioning or probing
• Withdrawing, distracting, humouring, or changing the subject

Core Skills in MI – OARS

• Open Questions – questions that cannot be answered with yes or no
• Affirmations - Overlaps with empathy, should be genuine, accentuate the positive, recognise and acknowledge individuals inherent worth, support and encourage. Affirming reduces defensiveness and is different from a compliment
• Reflections – reflect back what the person says to you, either the same way or add on other clauses
• Summarise – make a brief summary of what the person has identified

Change Talk – discuss change, consequences of change, discuss how change could occur, provide information, make a plan.

Ask someone where on a 1-10 they are, ask what would make them change it to a higher number, or why they chose such a low number. Or why a 5 and not a 6?

Miller, 2002