How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 24

This book is in B&W, not color - Print page in Grayscale for Correct view! 3. Communication and psychosis / I: It’s good to talk, but how? Rose McCabe and Stefan Priebe Summary Communication between clinicians and patients is at the heart of psychiatric practice and particularly challenging with psychotic patients. It may influence patient outcome indirectly or be therapeutic in its own right. Appropriate conceptual models, evidence on effective interventions and specific training are required to optimise communication in everyday routine practice. Declaration of interest None. This work was, in part, supported by the Medical Research Council (grant GO401323) Rose McCabe is a senior lecturer at Barts and the London School of Medicine and Dentistry. Her research focuses on linking treatment processes, particularly therapeutic relationships and interactions, with outcome. Stefan Priebe is Head of the Social and Community Psychiatry Research Unit at Barts and the London School of Medicine and Dentistry. His research addresses concepts, processes and outcomes in mental healthcare. Clinicians communicate with patients. In psychiatry, this is arguably the main part of what they do in their daily practice. Yet, does it matter how they communicate? Both the General Medical Council and the Royal College of Psychiatrists highlight the role of good communication in achieving therapeutic relationships. Effective communication, and the related construct, the therapeutic relationship, may have an impact on patients’ engaging in treatment in the first place, following treatment suggestions, satisfaction, symptom severity, referral to other services and willingness to file lawsuits.1 It may even be therapeutic in its own right. The therapeutic relationship is negotiated and reflected in patient–clinician communication and appears to predict outcome in different samples and settings across mental healthcare. If communication may be influential in patient outcome, there is a challenge to understanding how these processes work in psychiatry. This may feel especially difficult when communicating with patients with psychosis whose contributions may appear to be inappropriate both in their content and placement in the interaction. The first step is good research. Studying communication Communication is difficult and cumbersome to study. A typical approach involves recording the interaction. Videotaping one session can be the minimum. This is easier in a clinic setting than in various community settings. Audio taping alone is problematic given how much information is contained in non-verbal aspects such as posture and gaze. A long gap in a consultation has a different meaning if the clinician is writing notes in that gap or has eye contact with the patient and is not responding to a patient’s question. Most methods involve transcription, ranging from basic (content only) to highly detailed transcripts (content plus intonation, pauses, overlap, gaze, etc.) followed by time-consuming and labour-intensive analysis; linking one-off consultations with long-term clinical outcome is inappropriate given the complexity of treatment processes. It is likely that a series of consultations need to be studied to establish factors that have an impact on clinical outcomes. Simpler methods may need to be developed to capture intermediary outcomes of communication so that they can be assessed in pragmatic studies with sufficiently large samples. Setting aside the methodological problems, a key conceptual issue is that, even in the social sciences, there is no definitive model of ‘good communication’. A focus of positive communication throughout healthcare is patientcentredness. One component is shared decision-making. People with schizophrenia have a slightly stronger For [email protected] Property of Bookemon, do NOT distribute 26