How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 26

This book is in B&W, not color - Print page in Grayscale for Correct view! Interventions to improve communication In medicine generally, alerting clinicians to the patient’s concerns/ emotions and changing clinicians’ beliefs about communication have led to communication change. However, interventions to improve communication, and in turn outcome, in psychosis are rare. A simple communication checklist completed by patients before seeing their clinician improved communication and resulted in treatment changes. An intervention structuring patient–key worker communication elicited the patient’s satisfaction with a range of life domains, their needs for care and wishes for different help. Patients receiving the intervention had a better quality of life, fewer needs for care and higher treatment satisfaction after 1 year. It remains unclear, however, whether the structuring, focusing on the patient’s view, the forward-looking emphasis on treatment changes or a combination of these factors was crucial to the intervention’s success. Finally, an intervention to increase shared decision-making with in-patients with schizophrenia did not take up more of the doctor’s time, increased the uptake of psycho education and increased involvement in medical decisions. As in medicine generally, different approaches have been tried on a more or less ad hoc basis without explicit theoretical frameworks specifying key communication processes and the pathway through which they may influence health outcomes. The current state of the art cannot begin to address the question ‘Does one size fit all?’ (Which is unlikely). Different clinicians may have different communication styles and strengths which might have to be enhanced rather than eradicated. Also, a particular clinician’s communicative style may suit one patient and not another. Future research might address matching the right patient with the right clinician to achieve the best possible communication. Concluding remarks If psychiatrists want to make better use of everyday c ommunication as a core component of their trade, the ambition must be to develop better competence and skills to maximise its therapeutic effect, preferably based on sound conceptual models and evidence derived from them. Some of the required skills may be generic, whereas others are likely to be specific to communicating with patients with psychosis. Jaspers stated that ‘the ultimate thing in the doctor–patient relationship is existential communication, which goes far beyond any therapy, that is, beyond anything that can be planned or methodically staged’ (p. 798). Thus, not all aspects of how psychiatrists and patients communicate might be identifiable in research and teachable in the classroom or individual supervision. Yet, the challenge is to advance the state of the art to reveal as much as possible so that patients benefit from communication that is, either indirectly or directly, therapeutic. Clinicians may also benefit from enriching their therapeutic options and professional expertise. Rose McCabe, PhD, and Stefan Priebe, FRCPsych, Unit for Social and Community Psychiatry, Barts, and the London School of Medicine and Dentistry, Queen Mary, University of London, UK Correspondence: Dr Rose McCabe, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. Email: [email protected] First received 11 Dec 2007, final revision 11 Dec 2007, accepted 14 Feb 2008 For [email protected] Property of Bookemon, do NOT distribute 28