Post#1: Therapeutic Communication Skills by Heather Peterson
The purpose of this discussion post is to discuss problems or barriers that can arise when patient present with resistance and how this interferes with therapeutic communication. Wheeler (2020) explains that “resistance is manifestation of anxiety” best described as “implicit memory networks created through earlier dysfunctional situations and relationship that serve a self-protective function” (pg. 223). Resistance can come in the form of failing to participate in treatment or follow treatment requirement’s, general ambivalence regarding changing behaviors or subtle forms of avoidance during therapy sessions (Liu et al, 2020). In my current role working with adolescents and young adult I encounter ambivalence for change regularly associated with substance use, medication adherence and obtaining employment. To help an individual move past their resistance it’s important to identify problems in collaboration, recognize defenses and obstacles to change and the therapist must understand ways to address patient resistance (Wheeler, 2020). Effective ways for to address resistance in a therapeutic way includes showing respect and caring, expressing empathy; attending to patient needs and strategically enhancing patients’ self-determination (Liu et al., 2020)
There were several groups identified that are more likely to struggle with resistance; adolescents, persons who are paranoid or those that have been forced to participate in treatment by the courts, spouse, family members or their job (Wheeler, 2020). On group that I chose to focus on for this discussion is the Hispanic population. Cultural values in this population often lead to resistance to engaging in mental health services in general due to reported feelings of shame and embarrassment for having a mental illness (Eghaneyan & Murphy, 2020). In the Hispanic culture cultural stigma contributes to a lack of desire to engage in mental health services, disclose mental illness or even to seek medication management to treat mental health symptoms (Eghaneyan & Murphy, 2020). In thinking about how therapeutic communication can enhance alliance building with this population best practice according to Fortuna (2021) is to use a Use a bio-psycho-social-cultural model of evaluation and treatment, take time to develop a detailed cultural formulation and be supportive of collaborative care to increase treatment retention and successful care.
Eghaneyan, B. H., & Murphy, E. R. (2020). Measuring mental illness stigma among Hispanics: A systematic review. Stigma and Health, 5(3), 351–363. https://doi.org/10.1037/sah0000207
Fortuna, L. (2021). Working with Latino/A and Hispanic patients. Working with Latino Patients. Retrieved January 28, 2022, from https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-latino-patients
Liu, L., Chui, W. H., Deng, Y., & Li, H. (2020). Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China. Australian Social Work, 73(3), 309–320
Wheeler, K. (2020). Psychotherapy for the Advanced Practice Psychiatric Nurse (Locomotive Portfolios) 3rd Edition. Springer. ISBN-13: 978-0826193797 ISBN-10: 082619379X
*Hanging indentation was not retained