100 Caregivers Share their Insights about Therapeutic Relationships

 

September 11, 2013, Huron, Ohio

On the second day of Creative Health Care Management’s 2013 International Relationship-Based Care Symposium, fourteen intensive sessions were held. One of the morning intensive sessions was Excellent Patient Experiences: Authentic Connection IS the Answer, which was facilitated by Mary Koloroutis and Michael Trout, co-creators of The Therapeutic Relationship Workshop and the book See Me as a Person.

An overview of the practices that comprise the therapeutic relationship was briefly presented:

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Presence through Attunement:
Intentionally connecting with people exactly where they are and remembering that what might be routine for the caregiver is often life altering for the person receiving care.

Wondering: A practice of discovery grounded in curiosity and genuine interest in the other. Learning about the person is fundamental to the provision of safe, quality care.

Following: The practice of listening to, respecting, and acting on what we learn from our patients and their families.

Holding: Creating a safe haven for healing in which people feel accepted and held with dignity and respect.

Mary Koloroutis then spoke about the complicated contexts in which people are challenged to create therapeutic relationships; author and speaker, Marcus Engel talked about why therapeutic relationships are so vital to patients; and Michael Trout summarized and amplified all prior content and issued a call to action for all caregivers present to “dare greatly” by learning everything they can about creating authentic relationships with patients and their families and bringing them to life in every relationship every time.

Six more people, selected and prepared in advanced, were then invited to join the stage. They comprised a panel of individuals representing the voice of their various disciplines and positions: an experienced nurse, a patient, a physician, a nurse researcher, a family member of a patient, and a novice nurse.

After each panelist spoke, audience members were invited to ask questions of the facilitators and panelists. The conversation was lively, intense, and often emotional.

At the end of the session, audience members were asked to write down their most inspiring “take aways.” Here are the three most often noted “take aways.”

  1. Taking the time to get to know patients and families as people actually saves time in the end and keeps clinicians energized.
  2.  You can’t be compassionate with your patients if you’re not compassionate with yourself….and your co-workers.
  3.  When caregivers are vulnerable and authentic, even the smallest interactions can have a big impact.

All three of these insights are significant in that they reflect content that comprised a fairly small amount of what was presented, but seemed to have the broadest impact.

Taking time to Know Patients and Families

This is often seen as an unreasonable expectation by caregivers, and that is likely due to the fact that the therapeutic relationship is rarely part of the caregiving curriculum either in school or once a caregiver has begun practice. As was noted by Hannah Somers, RN, the panelist representing the voice of the novice nurse, nursing students have to seek out literature and other sources of information on the relational aspects of care. Until she found the therapeutic practices outlined in See Me as a Person, she had trouble articulating the kind of nurse she longed to be. She knew she wanted to connect, and she was troubled by the fact that nothing in her formal education seemed to be helping her figure out how to do that.

Several audience members commented that they had 30+ years of experience and were now re-inspired to make therapeutic relationships a focus. Many of them pointed to a wealth of experience that taught them that being proactive in building relationships with patients and families tends to head off difficulties down the road. One person stated that it is often the people we don’t take the time with in the first place, who become the “difficult” patients or family members. Taking time up front has numerous benefits, both practical and emotional/spiritual. In practical terms, forging good relationships with patients and families helps things go better. In emotional/spiritual terms, caregivers report that they are energized by connecting authentically with patients and their families. More than one participant said that he or she was “fed” by the experience of connecting authentically with—and really being able to be there for—someone in a vulnerable state.

Compassion for Patients, Compassion for Self, Compassion for Colleagues

One participant poignantly noted, “It can be a daunting task looking into the eyes of disgruntled nurses, but they need love too.” This loving and honest statement, brings a striking emotional maturity to an issue that has been more likely to show up on a list of complaints, than a list of things we’re resolved to address. The primary work of The Therapeutic Relationship Workshopand See Me as a Person is to help clinicians in all disciplines to learn, understand, reflect on, and deeply integrate into their work the practices of attunement, wondering, following, and holding. These are practices—things to do—and yet if we spend enough time working with them, they cannot help but affect who we are. We understand why we judge, so we forgive ourselves for it and retrain ourselves to replace wonder with judgment. We understand that when colleagues, patients, or their family members respond with anger or even rage, there is suffering beneath that rage. When it is we who respond with anger or rage, we see our own suffering as well, and we feel a compassion that may not have been possible without these new insights.

When People are Authentic, a Little Goes a Long Way

This idea showed up in countless ways in the comments of the participants. Less than an hour before this intensive, renowned researcher Brené Brown delivered a keynote that primed the participants to note the relationship between authenticity, vulnerability, and true courage. She said that vulnerability is the birthplace of creativity and innovation—that nothing new comes from stability and ease. In this intensive, many commented in the live discussion and in their written insights, that authenticity, in and of itself, is healing for both the patient and the caregiver. The general consensus seemed to be that to be inauthentic is exhausting, and to distance one’s self from the suffering of the person in front of you cannot be accomplished without an emotional cost to both the patient and the caregiver.

 

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