Interviewee
Dr Mona Shattell, Assistant Professor in the School of Nursing, University Of Greensboro, North Caralina, USA.
Article
Shattell, M., Starr, S., & Thomas. SP., (2007) Take my Hand, Help Me Out: Mental Health Service Recipients Experience of the Therapeutic Relationship. International Journal of Mental Health Nursing 16:4: 274-284.
Summary
Michael Bouwman talked with Mona Shattell about her study and article on mental health service recipients' experience of the therapeutic relationship. Mona and Michael discussed Mona's findings that touch, self-disclosure, and blunt feedback challenged some long-held beliefs. Mona also talked about other factors that she found to be important in what makes the "therapeutic" in a therapeutic relationship. Michael and Mona also talked about what feedback has come from health professionals or consumers and how that is making a difference in the real world.
Transcript
Michael Bouwman: Introducing Dr. Mona Shattell, Assistant Professor in the School of Nursing at the University of Greensboro, North Carolina, USA. I’m speaking with Mona about her article, ‘Take my hand, help me out: Mental health service recipients’ experience of the therapeutic relationship’, which she co-authored with Ms. Sharon Starr and Dr. Sandra Thomas. Hi Mona, welcome to IPP-SHR Podcasts, our congratulations on a thorough and insightful article. Could you please provide a brief summary of the aim and methods of your project?
Mona Shattell: Well the study was a secondary analysis of a previous study of the experience of being understood. That study was published last year in Archives of Psychiatric Nursing and in that study we looked at twenty individuals who lived in the community who had a mental illness. Most of the individuals were euro-American or Caucasian, mostly female, mostly fairly educated. Mental illnesses or diagnosis varied in our sample, mostly mood disorders, anxiety disorders and schizo-effective disorders. We asked participants in that study to describe what was it like to be understood. We found lots of evidence of therapeutic relationships, so we went back and did a secondary analysis and asked of the text, what is therapeutic about the therapeutic relationship and we came up with some themes for the experience of therapeutic relationships.
Michael Bouwman: And your findings on the use of touch, self-disclosure and blunt feedback challenged some long held beliefs. Could you outline these findings and talk about what you think are the implications for practice?
Mona Shattell: Well touch, self-disclosure and blunt feedback were three of the sub-themes under the major themes of the study, of the therapeutic relationship and the major themes were, relate to me, know me as a person and get to the solution. But touch was interesting in that it was talked about both physically and metaphorically and physically participants wanted a connection, a physical connection with their providers. They felt that the physical touch helped providers relate to them. Metaphorically, in fact that’s where the title of our paper came from, take my hand, help me out. Metaphorically, participants described touch as a way to help them get to the solution through the therapeutic relationship. Self-disclosure, participants thought that this helped providers relate to them, it equalized power in an otherwise unequal relationship between provider and patient and also provided some sort of authenticity on the part of the provider. From the patients’ perspective it was more real when the provider self-disclosed something about themselves and also helped them to relate. Blunt feedback also relates to authenticity in that patients believe that if providers were really blunt and honest and direct with them it would better help them get to the solution, the therapeutic relationship would then serve them better if the provider was more blunt with them. I know that blunt feedback, self-disclosure, touch are all somewhat controversial but in our study we found that it was really useful and meaningful in the therapeutic relationship. Implications for practice, I always tell my students that it really must always be for the patient. If you’re going to use touch and self-disclosure, especially, it must be for the patient or care recipient not for you, the healthcare provider and it also has to be thoughtful and deliberate yet authentic and seemingly spontaneous.
Michael Bouwman: And what are the other factors you found to be important in what is therapeutic about therapeutic relationships?
Mona Shattell: Well there’s some personal attributes on a provider side that seems to be important. Being non-judgmental and patient, soft spoken, open, genuine, calm. Providers who exhibit genuine concern or care, sincerity and understanding, there are some communication techniques that are also important such as summarizing, clarifying, reflection, reassurance, and an interesting finding, we found that venting alone was not enough or ventilating, having providers who just wanted patients to talk about how their feeling, that was not enough. It really had to be towards some solution. Eye contact very important, full attention and expression of emotion. If the provider felt some emotion it was ok, almost encouraged on the patient side for the provider to actually express that and that probably relates to authenticity and sincerity. Patients wanted providers to get to know them as people, as persons not as a diagnosis or certain diagnosis. They wanted providers to ask them about themselves, questions that didn’t necessarily relate to physical or their mental illness. They wanted providers to have an in-depth knowledge about them and that takes understanding and time and this in-depth knowledge was required if they were going to get to the solution of the problem. Again this power sharing where the provider is a guide and not a director of interaction seemed to be very important in which the service recipient or patient and the provider really functioned as a team together.
Michael Bouwman: Well that’s a wonderful analysis of what mental health service recipients want out of their relationship with their healthcare professionals, thank you very much for your time and thank you for talking with me today.
Mona Shattell: Thank you very much.
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