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To explore the many aspects of communication and ethical practice within the client/practitioner relationship

identify and describe the ethical principles which commonly underpin standards of practice for natural health practitioners

describe both dual and multiple relationships and the differences between the two

describe professional communication and identify areas of application and the essential features

describe how ethical principles and professional communication impact the therapeutic relationship

justify the need for and process of referral

list a range of health practitioners for referral

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"Ethical communication relates to appropriate behaviour...and is necessary for the maintenance of harmonious, productive and beneficial therapeutic relationships" - O'Toole. G

However: the practice of ethics is NOT the application of rules; but the careful consideration of principles in the complex world of decision making about human action.

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"Professional Communication can be described as the various forms of speaking, listening, writing and responding carried out both in and beyond the workplace, whether in person or electronically".

oral includes face to face, telephone and video calls

written/ printed includes letters, signs etc; now largely digitally form

visual includes our appearance, body language, work environment

digital includes email, SMS, twitter, social media chat apps etc;

Critical Features
Be mindful. You are communicating with another person. Whether this is face to face or not, ask yourself?:
what is my intention and purpose?

what effect might the communication have?

is the information accurate not only in information/content but also in grammar, spelling and punctuation?

is the communication clear and precise?

is the communication specific enough?

Essential Skills

listen well

be aware of non verbal communication

be clear and concise

be personable

be confident

show empathy

keep an open mind

convey respect

give and receive feedback

consider the appropriate medium (text, email, in person)

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In health care there are a number of ethical principles commonly used to guide practitioners in their decision making when faced with an ethical dilemma:

autonomy

beneficence

non-malifence

justice

fidelity

veracity

Autonomy "Self Rule"

promotes clients to act as their own agents

clients can refuse treatment even if it is not in their best interest to do so

clients have free will with informed consent

Beneficence (Do Good or Provide Benefit)

the basic principle of "caring"

act in accordance with a client's welfare

health care providers develop and maintain skills and knowledge continually update training, consider individual circumstances of all patients and strive for net benefit

what is good for one patient may not be good for another, so each situation should be considered individually

Non-Maleficence

"first, do no harm"

this is the calculation of risk in treatment decision making and determining risk/benefit ratio

this principle operates constantly in our ethical decision making

Justice

be fair (distributive justice>entitlement) the appropriate distribution of limited resources, non discrimination

transparency accountability and consistency

Fidelity

based on loyalty and trust

maintain the confidentiality of all personal medical and treatment information

information to be revealed with consent and for the benefit of the patient; except when ethically and legally required

disclosure should not be beyond what is required

Veracity

truth telling

obligation to full and honest disclosure

related to principle of autonomy

clients can not make autonomous decisions if they do not know the truth about the situation

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Client needs to feel that information disclosed is "treated with a high degree of confidentiality". There are limits to confidentiality caused by:

need to keep records

counsellors own supervision

need to protect others

collaborative work with other professionals

when law requires disclosure of information

Informed Consent

client needs to be informed of treatment procedures including associated outcomes and risks (autonomy, veracity)

client needs to be informed if the health professional believes that information disclosed by the client needs to be shared with others

this involves:

explaining what you want to do and why

should be confirmed in writing

Interpersonal Ethical Issues

dual and multiple relationships

boundary crossings

transference and counter transference

Dual and Multiple Relationships

a dual or multiple role is when a practitioner is in a professional role with a client while simultaneously in another role with that individual (or someone closely associated or related to that person)

it can also be if a practitioner is in a professional role with a person and promises to enter into a another relationship in the future with that person or someone closely related to the individual

dual roles refer to two different roles and multiple roles are when more than two overlapping roles exist

the terms are often used interchangeably

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To explore the development of emotional wellbeing, resilience and self compassion

define and discuss emotional wellbeing

discuss strategies to improve emotional wellbeing

define resilience

formulate strategies for developing resilience in personal and professional life

understand the nature of self-compassion and its role in personal growth

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"People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within" - Elisabeth Kubler-Ross

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Aristotle (Eudaimonia)

view of life based on cultivation of virtue or character

development of one's potentials in the quest of meaningful goals

Epicurus (Hedonia)

idea that pleasure in the sense of satisfaction of desires is the highest good and proper aim of human life

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The Focus of Attention

the moment by control of attention, being in the present moment

mindfulness, meditation, focus, awareness and attention

from this develops self awareness and self management and setting of goals

demonstrated in expressing wonder and interest, curiosity and enthusiasm, investigating, imagining and exploring

Understanding Your Emotions

understanding emotions in present moment experiences

identifying emotions and emotional associations

identifying positive and negative emotions and mood including facial and emotion expression and reactivity

from this self awareness and self management develops

demonstrated by an increased ability to understand and self regulate emotions and to understand the feelings and needs of others - which facilitates positive relationships

Coping with Stress/ Developing Resilience

the ability/ skills to cope with difficult situations or adversity

the characteristics of this capability are resilience, coping, post traumatic growth, hardiness

self management in the form of confidence, resilience adaptability and appropriate expression of emotions

demonstrated in accepting challenges, making choices, managing change, coping with frustrations, dealing with the unexpected

Setting Goals and Healthy Habits

striving for goals, motivation and developing healthy habits

the characteristics of this capability are persistence, engagement flow, perseverance, growth mindset, self regulation

self awareness and self reflection, self management in the ability to develop self discipline and to set goals

demonstrated by seeking out and accepting new challenges, celebrating own and others achievements, initiating opportunities for new learning, increasing awareness of healthy lifestyle and good nutrition

Developing Social Skills

connection to peers, parents, colleagues, a broad range of social interaction with a feeling of connectedness to individuals and community

the characteristics of this capability are social relationships, friendship, gratitude and empathy, attachment and interpersonal relationships

reflected in social awareness and social management

demonstrated in working collaboratively with others, connecting to others, awareness of needs and rights of others, recognising contributions of others, interacting with care, empathy and respect

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The Three Elements

self kindness vs. self judgement

common humanity vs. isolation

mindfulness vs. over identification

Self Kindness Vs. Self Judgement

"...being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism"

important to recognise that being imperfect, failing and experiencing life difficulties is inevitable

being kind and gentle with ourselves when confronted with painful experiences rather than getting angry when life falls short of set ideals

Common Humanity Vs. Isolation

"frustration at not having things exactly as we want is often accompanied by an irrational by pervasive sense of isolation - as if "I" were the only person suffering or making mistakes"

all humans suffer

the very definition of being "human" means that one is mortal, vulnerable and imperfect

therefore self compassion involves recognising that suffering and personal inadequacy is part of the shared human experience - something that we all go through rather than being something that happens to "me" alone

Mindfulness Vs. Over Identification

taking a balanced approach to our negative emotions so that feelings are neither suppressed nor exaggerated

the process of relating personal experiences to those of others who are also suffering, thus putting our own situation into a larger perspective

the willingness to observe our negative thoughts and emotions with openness and clarity, so that they are held in mindfulness awareness

Vulnerability

you bring into your relationships your feelings of security or insecurity and your fears and anxieties

vulnerability can help others feel that you and they are part of the human race

it provides the opportunity for caring and being cared for

you can share your own and another person's vulnerability in ways that enhance and deepen your relationship

mutual sympathy and liking develop from sensitive understanding of each other's vulnerabilities as much as from appreciation of strengths

if you are unable to acknowledge your own fears and anxieties you may lack responsiveness to other people's

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This foundational subject focuses upon interpersonal and interpersonal communication, knowledge, and skills essential for developing an effecting therapeutic relationship with clients. It further encourages students to pursue growth in both self-knowledge and reflection and enables them to evaluate the role of ethics in a healthy therapeutic relationship. This is a core subject across all Complementary Medicine disciplines.

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Communication: Core Interpersonal Skills for Health Professionals (3rd Ed) by G. O'Toole

Communication Skills Handbook (4th Ed) by J.Summers & B. Smith

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1000 word count
Covers Weeks 1,5,6 & 7
Learning Outcomes 2,4,5
Due 12th-19th May
40%
Grade Received: 25%

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5 Minute Total
Covers Weeks 1-12
Learning Outcomes 1,2,3,5
Due 23rd-30th June
30%

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500 word count
Journal 2 Reflection
Learning Outcomes 1-5
Due 1st-7th July
30%

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Identify and analyse the importance of self-awareness and effective communication within a clinical setting

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Develop an understanding of the significance of interpersonal communication for the achievement of therapeutic outcomes

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Identify the basic counselling skills that are required to facilitate treatment

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Evaluate current research on the importance of professional behaviour and ethical practice within a clinical setting

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Develop an awareness of, and skills in, the importance of mindfulness, reflection, and self care in professional practice

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Boundary: prohibitions or restrictions designed to protect the client and foster a sense of trust and safety
Minor Boundary Crossings: departures from common practice
going to a long-term client's parents funeral
Major Boundary Violations: large unethical departures from common practice which lead to harm to the client
The "Slippery Slope": the possibility minor boundary crossings may escalate into major boundary violations

Individual Practice

less pressure to conform to standards & more pressure to cater for wider range of client's needs

burnout-lower standards of practice, boundary crossing

Location

home

client learns about private life, inappropriate personal information, more self-disclosure

boundary lines blurred

Small Community

difficult to avoid

can lead to breaches in confidentiality

Physical Contact

potential for misinterpretation by clients; cultural norms

Family and Friends

personal relationship existed first, likely to continue after treatment

may affect objectivity/ clinical focus

self disclosure

more personal/less professional service

may affect confidentiality

nosy family members

may lead to increased burdens for practitioners

mates rates, forged treatment certificates, etc;

Transference

clients develop intense feelings towards their therapist

client behaves towards the therapist as though the therapist were a significant person from the client's past, e.g; mother, father

transferences can be either positive or negative

Counter-Transference

counter-transference, therapist develops intense feelings towards their client

in a broader sense counter-transference is the therapists total emotional response to a client

if the therapist becomes aware of counter-transference it may be advisable to seek peer or professional supervision

Referrals

acknowledge/ recognise limitations in training and competence

provide services only within recognised areas of expertise: "scope of practice" important here

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To provide students with an understanding of what is needed for effective communication with a focus on non-verbal communication.

understand the role of communication in clinical practice

distinguish between non-verbal and verbal communication

identify the different types of nonverbal communication

identify the need to further develop the use of nonverbal skills for future clinical practice

understand the importance of nonverbal cues in effective clinical communication

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Basics

the message between a sender and a receiver

what is heard is filtered by:

previous life experience

own values and beliefs

previous experience of the person

previous experience of other professionals

Two Major Components

non-verbal

verbal

Role

good communication produces a more effective consultation for all parties involved

effective communication improves:

accuracy, efficiency and supportiveness

health outcomes for clients

satisfaction for both client and practitioner

the therapeutic relationship

Comparison

Verbal

discrete

uni-modal

voluntary control

communicates thoughts and ideas

Non-Verbal

continuous

multi-modal

operates at edge of conscious awareness

communicates attitudes, emotions and effect

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Non-Verbal communication is communication without words, messages created through the use of:

body motions

space

sounds

touch

silence

The Purpose

expression of feelings and emotions

regulation of interaction

validation of verbal messages

maintenance of self-image

maintenance of relationships

Defined By

posture

proximity

touch

body movements

environmental cues

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Posture

body movements and height

height can be related to perception of dominance or success

lower body to someone, indicative of respect and/or defeat

rigid body with raised shoulder. indicative of aggression

mirroring non-verbal behaviour can be used effectively in a consultation to convey empathy

Proximity

also known as proxemics

how the space is used

positioning and distance

Touch

also known as Haptics

touch varies across cultures

there are five classification types:

1. social/polite

2. functional/ professional

3. friendship/warmth

4. love/intimacy

5. sexual/arousal

Kinesics

orientation, inclination and body angle

facing someone squarely indicates interest

facing away indicates indifference or hosility

high synchronisation is indicative of greater support between individuals

Gestures

major focus on hand and arm movements

vary across cultures

some cultures are more physically expressive and convey a range of meanings:

insecurity

deceit

apathy

approval

disapproval

despair

hostility

confidence

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Facial Cues
facial expression discloses emotional state
strongly influenced by culture

Eye Behaviour

communication from the eyes can be both subconscious and unconscious

the role of eye contact varies across cultures and also within the one culture

eye contact can convey a variety of meanings

dominance/power

concentration

interest

Speech

also known as paralinguistic

can substantially modify word meaning

interruption patterns

silence

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Lights, noise, colour, room temperature, furniture arrangement and building structure all influence our communication
formality: can feel less relaxed, which might lead to more hesitant or difficult communication
warmth: can encourage us to linger, feel relaxed and comfortable
privacy: partitioned, curtained areas can foster more personal communication
constraint: physical constraints can enhance stress
distance: long corridors, distance from professionals can engender feelings of isolation for the client
familiarity: cautious or hesitant behaviour may result from client being in unfamiliar environments
sound: noise acts as another irritant and can cause interference in communication
furniture: therapists can elect to alter where they sit, circular arrangements are best
use of time: distinguishes between low and high context cultures with a focus on their use of time as a concept:

low context - monochronic, singular, linear events occur sequentially, scheduling matters

high context - polychronic, there are multiple times, time is circular, events advance at their own pace, multiple events occur simultaneously

Physical Presence: clothing plus bodily adornment, social class, indicates where you fit into society

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transparency myth: you can tell what someone is thinking by their body language
transparency truth: we can control many cues and it does not allow others to read us like a book

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To explore effective listening and verbal communication skills.

identify and describe listening skills and how to use them

discuss various aspects of verbal communication

demonstrate a range of listening skills

integrate listening skills in personal and professional communication

critique their application of communication skills in private and professional life

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Basics

the message between a sender and a receiver

communication is the process of transmitting information to another individual or group of individuals and having received and interpreted by them

communication may be voluntary or involuntary - the individual who unwittingly signals that he/she is nervous by fidgeting etc; is communicating this to the observer although not voluntarily

what is heard is filtered by:

previous life experience

own values and beliefs

previous experience of the person

previous experience of other professionals

Two Components

listening skills

leading skills

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Skills

listening

asking questions

hearing the point of view of others

sharing and giving feedback to client and relevant others

Initially the first meeting with a client is very important, first impressions influence whether they come back to us as a practitioner and whether they feel comfortable to share their problem with us as the practitioner.

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listen with interest to what the client is saying

the client is aware that you as the practitioner are total focused on what they are saying

they know that you understand and can comprehend what is being said

Skills

minimal responses

use of brief invitations

then

and

tell me more

would you like to tell me more

matching non-verbal behaviour

eye contact

physical closeness

facial expression

use of movement

the use of voice

includes tone, speed of speech, clarity and volume

Importance

assists the health professional to gather information to promote collaboration

encourages connection and a trusting relationship with the client

information can be gained that can positively influence the ideas and responses of the health practitioner leading to better outcomes for the client

active listening includes observation of the non-verbal behaviour and messages of the client

Listening Skills

attending

noting verbal and non-verbal behaviours

paraphrasing

responding to basic messages

clarifying

self-disclosing and focused attention

perception checking

determining accuracy of hearing

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Repeating in your own words what a person has said to you to:

gain understanding

shows you have learnt and understood what the person has said to you

shows you are listening

Paraphrasing Skills

concise

reflects only on the essentials of the speakers message using the listeners own words

focused on the content of the speakers message

facts and ideas rather than emotions

speaker acknowledges that you understand their message

Parroting

repeating word for word

not paraphrasing

not helpful

likely to annoy the client

does not assist them

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Two Types of Questions

Close Ended

Open Ended

Closed Questions

can be answered with either a single word or a short phrase

limit the response

useful as:

a conversational opener

to test one's understanding

to get facts

examples:

what type of car do you drive?

where is the pain?

Open Questions

require the person to answer in their own words

requires a complex, in depth answer

useful to:

develop a conversation

gain information on opinions and feelings

allow people to gain insight

example:

what did you do over the weekend?

can you tell me why that is so important to you?

describe how you feel when your friends don't invite you out?

Abuse of Questions

there are a number of problems that can occur if a practitioner asks too many questions

It can feel:

intrusive

interrogating

creating inequality

compromises the therapeutic process by controlling what is explored

inappropriate use of "why?"

satisfies the counsellors needs

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Give your physical attention to the speaker. It is largely non-verbal communication that tells the speaker that you are paying attention to what they are saying and that you want to listen. It helps to establish rapport.

establish contact through looking at helps when they talk

maintain a natural relaxed posture that indicates your interest

use natural gestures that communicate your intended messages

use verbal statements that relate to help statement without interruptions, questions or new topics

establish a permissive and non-distracting environment.

Don't read your mail, answer your phone, doodle, tap or shuffle papers, walk away

close the door if there are external noises or if the subject matter is private

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Responding to the clients basic messages.

listen for the basic message of the client

restate to the client a concise summary of the basic message

observe a cue, or ask for a response from the help that confirms or denies the accuracy of your paraphrase

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Brings vague material into sharper focus.

admit confusion about the clients meaning

try a statement or ask for clarification, repetition or illustration

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Verifies your perception of what the client said.

paraphrase what you think you heard

ask for confirmation directly from the client about the accuracy of your perception of what was said

allow the client to correct your perception

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Encourages client to explore their issues. Skilful open questions extend communication.

use open questions that cannot be answered with "yes" or "no"

ask questions that lead to clarification for the client rather than information for the helper

avoid asking too many questions

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To get Clients started.

determine the purpose of the lead clearly

keep the lead general and deliberately vague

use open questions

pause long enough for the help to pick up the lead

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Encourages clients to elaborate, clarify or illustrate what they have been saying.

determine the purpose of the lead

express the purpose in words tat elicit specific elaboration

use open questions

allow the client freedom to follow your lead

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Bringing the client to focus more on a particular issue.

use your own feelings of confusion and sense of client direction as a guide

be alert to feedback from the client about priorities

assist the client to focus on feelings that may be hidden

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Focus on the feeling rather than the content and bring vaguely expressed feelings into clarity. Communicates understanding and acceptance.

succinctly mirror to the speaker the emotions which they are communicating

reflect content and feeling

link the content to which feelings are associated

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Feedback about observations.

note the observable behaviour of the client

checks out the implied feelings of non-verbal behaviour

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Repeats in fewer and fresher words the essential ideas of the client. Similar to paraphrasing. Used to check your perceptions and to clarify what the person is saying or to show you have heard and understood.

provide a concise response

stating the spirit of the speakers content

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monotonous response

reflecting too often

overstating or interpreting

inappropriate language for the cultural and educational experience of the client

read the total message: stated feelings, non-verbal feelings, content

select the best mix of content and feelings to fulfil the goals for understanding at this stage of the helping process

reflect the experience just perceived

wait for the client to confirm or deny your response

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Being able to recognise and respond to feelings in self and if appropriate communicate them to the client. Be cautious about free expression feelings if:

person is known to have severe emotional disorders

their lives are fraught with crisis and emotionally demanding pressures

past history of dealing with emotional crisis is shaky

you note strong resistance to exploration of feelings

your experience of helping disturbed people is doubtful

your own emotional life is in turmoil

limited time is available

policy discourages exploration of intense feelings

attitudes and expectations of parents or guardians of young clients are not explored

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share your own feelings as a model

ask client to share their feelings

be cautious about the depth and extent of sharing

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Effective feedback from people who know and care can assist the client and fill in gaps of self awareness.

give opinions as feedback only when client is ready

describe the behaviour before giving your reaction to it

give feedback about the things the help has the capacity to change

feedback should be given in small amounts

feedback should be in response to current and specific behaviour

ask the client for reactions to your feedback

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Offering suggestions and allowing the client to initiate or be motivated to change of their own accord. Changing Thoughts, Steps for Clients:

1. you are in control of your life

2. be aware of negative thought patterns

3. examine flawed or distorted reasoning statements

4. restructure or reframe the negative statement to a positive

5. keep trying

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Interpretive Questions
Help to offer a new frame of reference.

Fantasy & Metaphor
Symbolise ideas and feelings.

1. look for the basic message of the client

2. paraphrase these to them

3. add your own understanding of what their message means

4. keep language simple and close to their level

5. introduce statements tentatively "I wonder if..."

6. solicit client reactions to your own interpretations

7. teach client to do their own interpreting

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Giving Information
Some professional information about your work or options for clients.

Advice
May be appropriate in crisis situations has strong limitations in assuming the helper knows best.

Guidelines

1. be informed or know the sources of information in your area of advertised expertise

2. do not use educational or psychological test instruments unless trained in their used and limitations

3. don't use advice unless it is int he form of tentative suggestions based on solid expertise

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Tying together into one statement several ideas and feelings at the end of the discussion unit or at the end of the interview.

Guidelines

attend to the various themes and emotional overtones as client speaks

put together key ideas and feelings into broad statements of their basic meanings

do not add new ideas to the summary

decide if it would be more helpful to state your summary or ask them to summarise

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has decided what to say

speaks clearly

varies his/her voice

presents one idea at a time

looks at the other person

gives examples

pauses to allow time for questions

summarises to help the other person to understand

treats the other person with respect

provides verbal and non-verbal messages

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keeps eye contact with the speaker

faces the other person - seems relaxed and open

does not interrupt

asks relevant questions

appears interested

appears to recognise the other persons feelings

is not critical, impatient or bored

sits or stands still

speaks clearly

does not "take over" the exchange

summarises at the end

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To identify aspects of the development and manifestation of stress and methods for managing it.

explain the nature and development of stress

identify major factors contributing to stress

examine stress implications of grief and loss

develop relevant stress management programs for themselves and prospective clients

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Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources that the individual is able to mobilise.

Stressor
A stressor is any agent, positive or negative, that elicits a reaction in the body, this may be:

social

psychological

physical

philosophical

Types of Stress

Eu-Stress (Good): short term and arises in situations as planning a party, succeeding at sport, wedding day

Di-Stress (Harmful): acute (disappears quickly) unexpected shock, chronic illness, marital issues

Hyper-Stress (Burnout): overloaded with too many tasks and little time to complete them

Hypo-Stress (Boredom): unchallenged, not enough positive stress or stimulation

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Cognitive

memory problems

poor judgement

inability to concentrate

brain fog

indecision

starting many tasks but achieving little

self doubt

Emotional

depression

moodiness

irritability

fatalistic thinking

panic

cynicism

anxiety

feeling overwhelmed

frustration

Physical

chest pain

rapid heartbeat

aches and pains

frequent colds

skin complaints

indigestion

high blood pressure

Behavioural

increased intake of alcohol, cigarettes and caffeine to relax

isolating from others

sleeping too much or too little

demotivated

loss of sense of humour

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Problem-Focused Coping

I concentrate my efforts on doing something about it

I do what has to be done one step at a time

I try to come up with a strategy about what to do

I make a plan of action

I put aside other activities to focus on this

I try to get advice from someone about what to do

I talk to someone who could do something concrete about the situation

Emotion-Focused Coping

This is used if the event or situation is so overwhelming that action is not possible

There are many different strategies behavioural and cognitive

Social supports such as seeking sympathy and understanding from a friend

Taking walks in nature or going for a hike to lift mood

Engaging in pleasant activities

Look for meaning

Acceptance

Breathing Exercises
Use When:

you are feeling stressed or overwhelmed and want to calm down quickly

you are stressed and you want to think more clearly

you want to release tension in your body

you are feeling frustrated and want to "slow things down"

you are in the middle of an altercation and you want to feel more centred

Other

Power Naps

Visualisation

Exercise

Progressive Muscle Relaxation

Cognitive-Behavioural Perspective
We can change the way we THINK about a situation:

use the inner coach and positive

look for should, ought too, have too, and musts and change these to preferences

I'd have preferred to score well on that exam, but you can't do well every time

try to look at a problem/situation from a different perspective or look for alternate explanations for why things happened the way they did

reframe a situation in a positive way

We can't change the way we FEEL about a situation but:

some situations are just bad, and we can make bad feelings worse by continuing to struggle with the situation.

struggling with negative feelings is like playing tug of war with a building, you can keep trying and pulling, but you won't be able to make any progress until you accept the way things are

if you sit with your difficult feelings, oftentimes they will subside

you can't change how you feel, but you can try to accept the way things are and give up the struggle and usually the result is more inner peace

We can change our BEHAVIOUR in response to a situation:

we can exert positive control and do helpful behaviours

we can do relaxing, grounding or health related activities

we can do enjoyable activities

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Grief and Loss
Causes
Grief is a natural response to any loss:

death of a significant other

loss of job

moving house

death of a pet

a significant life transition or event

Normal Grief Characteristics
Physical

body distress

tightness

choking sensation

sleeplessness

digestive disturbances

sighing

shortness and weakness of breath

Feelings

emptiness

tension

exhaustion

loss of warmth

awareness of distance from people

Occasional

feelings of guilt over failure to do something

exaggerations of self accusations over small incidents

Changes

concentration and activity patterns

restlessness

aimlessness

searching for activity

lacking energy or focus to follow through

Responses Needing Specialised Care

Morbid: exaggerations of normal grief behaviours, maybe under-reaction or delayed grief

Prolonged Isolation

Refusing social interaction for long periods

Unusually strong irritability or hostility towards friends and relatives

Prolonged Depression

Chronic Sorrow

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What are the major causes of stress?

What are the warning signals and how do we recognise them?

What are the positive aspects of stress?

In what ways can stress arise at work?

What do we need to do about dealing with it in the workplace?

How can practitioners support clients dealing with grief and loss?

What are some stress management strategies that you can offer clients when taking time out isn't an option?

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To understand and demonstrate appropriate assertive and anger management skills.

identify assertive and non-assertive behaviours and attitudes

apply assertiveness skills in personal and professional settings

distinguish between the nature and impact of anger

formulate a healthy and practical approach to anger management

evaluate the power and influence of values and beliefs on anger responses towards people and events

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What is Assertiveness?

ability to express how you feel and what you want, whilst respecting the other person

ability to exercise your own rights without interfering with the rights of others

learning how to avoid being taken advantage of by others

acquiring more choice and control over your life

gaining increased self-respect

assertiveness is about achieving a WIN/WIN outcome in as many situations as possible

WIN/WIN involves compromise and seeing the other person's viewpoint and needs as being as worthy as your own

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STATE Model of Assertiveness

S: Specify

clearly what you want to say before you speak

T: Trigger

is the behaviour you want to draw attention to, use neutral words

A: Affect/Feelings

convey how you feel about it

T: Target Behaviour

is the desired outcome

E: Effect

that the desired change will have

Dealing with Criticism

Passive/Submissive

does not hear criticism or use it effectively, lost in self-reproach

Aggressive

impervious to criticism, see's it as a personal attack and responds automatically by fighting

Assertive

considers whether criticism is realistic or unrealisitic

Three Part "I" Message

1. Behaviour

describe the behaviour non-judgmentally

2. Feeling

identify and name the feeling

3. Effect

describe the effect the behaviour has on you/your life

Key Features of "I" Statements

firmness without domination

defends own position without violating the other person's position

provides space for recipient of message to come up with a resolution of the problem that preserves his/her self-respect and meets both parties needs

Relative Assertively

name the person and identify exactly what the problem is

say what you think and feel, clearly , directly and with conviction

say specifically what you want to happen

ask how the other person feels about your request and listen to the response

look for a joint solution

Other Assertive Statments

I Want Statements

I want to know what I did to make you angry, so that we can discuss it

Mixed Feelings Statements

I'm happy with my salary increase and I'm grateful for the work, however, it bothers me that my salary is still below that of others in the same position.

Flat-Out No Statements

No, that will not be possible

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Responding Assertively

take a deep breath

listen carefully

make sure you are clear what the other person is saying and why they are saying it

say where you stand and how you feel

if the aggression continues restate your position keeping your statement short, firm and basic

if the aggression continues indicate what the consequences will be

Using Assertiveness

note your immediate reaction and trust it

give yourself time

say "no" at the beginning of the statement without apologising or making excuses

don't hover around after you've said no

acknowledge your feelings and theirs

ask how they feel and offer an alternative where possible

Using Positive Assertiveness

look directly at the other without staring

smile

maintain a relaxed body posture

keep the message short and to the point

use "I" statements and include the other person's name

make the statement specific

Receiving Positive Assertiveness

thank the giver

use the person's name

maintain eye contact

smile

keep the response short

accept the praise if you agree with it

if you disagree with the giver's praise, still thank them, however qualify your reply

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a basic human emotion

associated with:

secondary emotions such as rage, disgust, envy and torment

tertiary emotions such as outrage, fury, wrath, hostility, bitterness, hate, vengefulness, resentment, contempt and revulsion

it has both physiological and psychological components

physiological: fight or flight response, increased heart rate and blood pressure

psychological: indignation, animosity, a desire to get even

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We can focus on how we THINK about the situation:

be conscious of triggers that might increase your anger

hunger, tired, stressed, in a rush

use positive self talk

this is upsetting, but I can deal with it

stay, calm, relax, have a few deep breaths

this is their issue, not mine, I don't need to take it personally

this is a challenge, this person isn't going to get me

great Job, you're handling this really well

reframe a situation in a positive way

this is stressful now, but at least we're addressing some important issues and it'll be done and dusted soon

We can change our BEHAVIOUR in response to a situation:

before hand and afterwards we can practice stress management

during the engagement we can notice physical tension and consciously try to relax it

look for clenched fists, open them

look for rapid breathing, take a ten second breath and say CALM yourself

ground yourself by noticing three things you can see, hear and feel

we can match posture and tone of voice, and then model a more appropriate posture and tone for the person we're engaging with

lean forward and speak up to match tone and posture, then adopt a relaxed pose and speak softly so the other person can mirror your behaviour

Myths

1. Assertiveness is basically the same as being aggressive

2. If I am assertive I will get what I want

3. If I am assertive I have to be assertive in every situation

Saying "NO"

saying no is refusing a request, not rejecting a person, and usually we think our refusal will put more hardship on the person than is realistic

its ok to say no, without explanation or excuses, you don't need to make up excuses or say "I can't because" jus to reduce your own anxiety levels

your body can react negatively when you do something you don't want to; if you want to say no and say yes, you may end up feeling unwell afterwards

don't be afraid to keep repeating your refusal no matter how many times the person repeats their request

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Aggression: any form of behaviour that is intended to harm or injure some person, oneself or an object.
Aggressive Behaviour: is into winning an argument and not valuing the other "I win you lose"
Submissive Behaviour: is into losing an argument and not valuing yourself "I lose you win"
Assertive Behaviour: is into compromise and valuing both oneself and the other "I win you win"

Assertive Behaviour
Distinctions:

Instrumental Aggression

intentional use of harmful behaviour to achieve some goal

Hostile Aggression

triggered by anger; intentional of use of harmful behaviour whose goal is to cause injury to another

Indirect Aggression

a form of social manipulation; attempt to harm another without face to face encounter

Submissive Behaviour

is approval seeking

conveys view of self as inferior to others

seeks to avoid hurting others and conflict

suggests lack of respect for one's own rights and needs

demonstrates acceptance of blame when things go wrong

Assertive Behaviour

demonstrates honesty with self and others

recognises needs of self and others

enhances confidence in self while recognition of value of others

entails negotiation