Establishing a therapeutic relationship is one of the most important responsibility of the Health education team when working with clients.

Is a planned act using communication techniques to achieve a positive relationship and shared understanding of information for desired patient care goals

 The therapeutic use of self of the Health educator involves making appropriate communicative responses to the client.

 Contains words that can be understood by the client  Is clear in meaning  Allows a response from the client  Deals with the cognitive and emotional aspects of the client  Is consistent: the communication implies the same through time  Is repeated by the clinician  Is direct: the communication reflects relevant problems Characteristics of effective therapeutic communication

 1. Reflecting  2. Paraphrasing  3. Clarifying  4. Summarizing

 It focuses on the feelings of the client, enabling the client to express more, to become aware of the emotional feeling experience, and/or to separate a cluster of feelings into distinct ones. Although reflection is usually thought of as rephrasing what the client has just stated, it should involve different, feeling-oriented words.  Lead in words such as: - “It seems as if…. - “It appears to me…. - “I’m hearing a lot of …. These are the good beginnings to reflective intervention.

EXAMPLE  Client: I don’t even know who I am anymore. I’m changing and I don’t know what I’m changing into.  Health educator: I hear a lot of confusion about who you are. Or  Health educator : It sounds confusing and scary not to know what’s happening to you right now.

 This focuses on the content of what a client is saying in order to call attention to something that is unclear or, perhaps, noteworthy.  The above example ( lead-ins) can be paraphrased as:  Health educator : It sounds like your identity is shifting and you are wondering about it all. Or  Health educator : It seems as if you are experiencing a change from the way that you have been in the past.

 Most often it uses a question to verify what the client has said or to interpret an ambiguous statement or expression of feeling.  When using the clarification, it is important to refrain from beginning of the question with “Why.”  Why questions often make the client feels defensive or judged by the Health educator. Beginning question with” Tell me…, or “ I don’t understand..” is much more effective.

Using the example above:  Health educator : Tell me more about what you are feeling Or  Health educator : Describe this experience

 It is most often used at the end of a session to pull together the topics discussed into a few sentences.  Summarization entails two or more reflections and paraphrases combined together.

Example:  As we have explored your feelings and thoughts, it seems as if you aren’t sure who you are anymore, or what you are becoming. It appears that your identity is shifting, and this feels scary to you.

 Therapeutic listening can be described as hearing what the other person is saying without becoming judgmental or defensive.  The client can express dissatisfaction or anger toward the Health educator. But anger is not usually directed specifically at the Health educator receiving the outburst.

 Very often, clients have never had an empathic or sympathetic listener, but rather have had a family member or lover who was judgmental and defensive toward the client.  Allowing a client to express emotion with a supportive look and statement can ease the client’s distress and discomfort.

Another example:  Client: I’m sick of this place. And I’m sick of you always in my face trying to help. Just leave me alone.  Health educator: You sound really angry right now. It’s so hard to allow yourself to receive help, especially at times when it seems like you are hurting the most.  Client: Why do you have to be so nice? Why aren’t you like all the rest? Everybody I’ve ever know has treated me like garbage. Never listening, never asking, never being there (Begins to cry).

 Health educator : We are all here for you, and we do care about you. It hurts to think about others in your past. Your tears are telling you something. Do you know what it is?  Health educator : (tearful) That I deserve to be cared for? That it’s okay to count on people in here? Why does it so bad then? In this example, the health educator responded to the hurt and pain underlying the anger and the client responded by becoming tearful and in touch with feelings and past experiences.

 1. Probing  2. Information –Giving  3. Confronting  4.Interpreting

 Action responses attempt to move a client toward some change hence the term action response. Instead of responding to the client from the client’s point of view, as in listening responses, action responses move beyond the client’s viewpoint to state the interviewer’s perspective.

 Here the Health educator asks open-ended questions to encourage the client to elaborate or provide examples in order to further clarify content.  Example: The Health educator may say: Health educator : Give me an example of when you feel you don’t know who you are.

 Information –giving provides the client with needed data. It helps to decrease a client’s anxiety, especially if the client feels uncomfortable. The health educator can also use information- giving to share appropriate ideas or alternatives.

Example: Health educator : It is not uncommon for clients in therapy to feel the way you do right now  Or Health educator : It is not uncommon for clients to experience a shift in their identity as they begin to look more closely at their behaviors and feelings.

 Confronting is most often used to point out a contradiction in the client’s words and actions, verbal and non verbal behaviors, or feelings and thoughts.  It can be useful to clarify a mixed or unusual message that seems inappropriate at the time. When it is used, statements are made in an empathic, caring way, rather than in a critical, condemning manner.

Example:  Health educator : I hear you say that you feel a change in your identity, but you are laughing while you say this. Or  Health educator : At the beginning of the session, you stated that you felt secure in who you were. Now you say that you are unclear.

 It is a sophisticated means of presenting the client with a connection or reason behind a statement or feeling.  Health educators are able to interpret client’s statement or feelings when they know the clients well and have trusting, empathic relationship with the clients.

Example:  Health educator : I wonder if you feel a shift in your identity because you will be visiting your parents this weekend? You and I have talked about how controlling your mother can be with you.  Health educator: perhaps you feel unsure of your self or your identity in therapy as you and I talk about uncomfortable thoughts and feelings.

The appropriateness of client silence depends on the context of the interview situation. Client silence is not interrupted when:  The client uses the quiet time to formulate thoughts or feelings  The client attempts to understand what the clinician or another client ( in a group) has said.

 The client is not familiar to therapy and does not know where to begin  The client indicates, nonverbally, that something is happening. For example: The client seems angry, yet does not mention it. The health educator could say, “I notice that your fists are clenched. What are you thinking?.. What are you feeling?  The client experiences anxiety to the extend that the client’s thoughts are blocked. The health educator should provide some structures for the client, such as,” You stopped talking. What are you feelings?’

These attitudes foster an atmosphere of trust and caring in a therapeutic interchange that can lead to therapist being warm and accepting. 1. Genuineness- means being oneself without being phony or playing a role.

2. Positive Regard  This includes the ability to “value the client as a person with worth and dignity.” The therapist tries to help and to understand the client, thus indicating that the client is important.

3. Warmth  This is demonstrated through the clinician’s tone of voice, eye movement, and in other ways. It serves as a way to reach out to the client to comfort and to indicate that help is available within the clinician-client relationship. It can also decrease the client’s anxiety.

4. Honesty It is the ability to relate one’s perception of what is true in an experience or situation. Stating the truth is not done to hurt others.  Honesty includes the traits of sincerity, fairness, and ability to be truthful.

5. Immediacy  When the Health educator has an attitude of immediacy, he/ she seeks to provide assistance when it is needed, and as soon as possible.  The health educator does not rush the client, yet does not withhold information that could be useful. Once the norm of immediacy has been established an atmosphere of trust can be established.

6. Empathy  The client is understood by the Health educator, and the client has the positive benefit of feeling understood.