Creating the right conditions for the relationship with the patient

As a support worker working with people from many different backgrounds, you will need to communicate in a way that builds trust in the people you work with. In the field of counselling, there is a very well-known seminal thinker called Carl Rogers. Rogers is known for having created a school of person-centred counselling that thrives today, and, yes, the phrase ‘person-centred’ does have its origin there. Rogers shared a lot of similar beliefs about human beings and how they thrive with Abraham Maslow, mentioned in Chapter 2. He believed that, in order for people to grow in a counselling relationship, they need to have the right conditions. He wrote a seminal article in 1957 called ‘The Necessary and Sufficient Conditions of Therapeutic Personality Change’ and is known for putting the client at the centre.

Core conditions

Congruence

Another word for this might be ‘genuineness’. The support worker role can sometimes make us feel distant from those we work with. It is not always possible to agree with our patients and the decisions they make, but usually people respect a professional if they can see a genuineness or authenticity to their work with them. Patients will notice when you hurry them or address concerns that relate only to your agenda, but they will respond better if they notice you are authentic in your response to them.

Reflective exercise

How do you observe genuineness in the people in your life? It might be they listen well, without interrupting, and you can tell they have listened to you because they can detail the words and language you used as you were talking. They may also be open and honest if they don’t know the answer to questions, but instil confidence that, even though they did not have the answer, they were clear they would find it out. They do this because they care and they take responsibility for the gaps in their knowledge. Because they do this, you can feel your confidence in your relationship with them grow.

Unconditional positive regard (UPR)

In your work, you will meet people who will test your patience and behave extraordinarily badly. Of course, none of us goes to work to be verbally or physically abused or assaulted, and appropriate and immediate action should be taken in these circumstances. However, some people you work with will, for complex reasons, have little or no self-worth and will have never experienced a positive relationship, and they only know how to lash out when they seek help. In these circumstances, the support worker has an opportunity to demonstrate acceptance, kindness and understanding in their actions toward these patients and clients. Taking a UPR approach can sometimes show to people in crisis and at their worst that they are still worth something. However, there are consequences.

Box 5.10 Scenario: Emily

Emily comes into A&E for the fourth time in 7 days, completely drunk again. She has now injured her hand, and it needs stitching. In her drunken state, she calls you a 'fat shit’ in a busy waiting room. Her behaviour is challenging, and she is particularly focused on embarrassing you. She clearly needs care, and her behaviour is not so bad that you need to call the police.

Your feelings

You do not like this woman; she is making you uncomfortable and your patience is being tested. She also reminds you of someone you do not like, but you must offer her care.

• • How would you approach Emily in order to provide her with compassionate care and demonstrate UPR?
• • What steps would you take to make sure you are ok?

Empathy

The empathy versus sympathy debate is quite an active one in the field of the health and social care. The reality is that, as a support worker, you will experience both and offer both to the people you work with. However, genuine empathy will help you see things from the patient’s perspective rather than your own, or, in the words of Carl Rogers (1957, p. 99), enable you ‘to sense the client’s private world as if it were your own’. In order to help people, you will have to walk in their shoes, and, although it is realistic to understand that the view from their shoes will be informed by who you are, working hard at empathy can help you build a positive relationship with a patient and it can also help you identify their resources and strengths, as well their needs.

Let’s return to Emily. This time, you take an opportunity to talk to her, even though she is drunk and has been abusive.

Box 5.11 Emily

YOU: Emily, this is your fourth visit to A&E this week?

EMILY: It’s not a bloody crime, is it?

YOU: I have just noticed that’s all. What’s going on?

EMILY: Social Services have taken my children. Fucking bastards!

YOU: So, you’re upset and because of this you are hitting the bottle more? EMILY: Yup.

YOU: That must be really tough for you.

In this scenario, the support worker does not get distracted by the combative response, but instead continues with reflecting back what they have noticed and showing an interest in Emily. The outcome of the brief exchange is that Emily gives the support worker an important piece of information that does, to an extent, provide an explanation for her behaviour. There is now a window of opportunity to support Emily more; it might also mean that she gets a more compassionate response, even though her behaviour is challenging.