When considering the factors that can inhibit a therapeutic relationship, it is firstly important to establish what a therapeutic relationship is, or what it should be like. According to Philip Burnard, “the main point of working in the health care field is to communicate” (Burnard, 1992, p.1). The realm of communication in general is vast, with countless models and theories. As discussed extensively by Burgoon et al, the communication process very much depends on the purpose of the communication (Burgoon et al, 1994). Opinions on the form that the communication between practitioner and client should take are probably as varied as the individuals involved in therapeutic relationships. A general definition is given by Kagan and Evans, “Professional interpersonal skills require flexible adaptation to changing circumstances and different people in a range of different situations, in pursuit of clear nursing (therapeutic) goals” (Kagan and Evans, 1995, p.1). The goal may take many forms; the important point is that both practitioner and client are clear of the goal from the start and constantly aim for it in the development of the therapeutic relat

Much of the therapeutic relationship revolves around the practitioner’s use of questioning and listening skills, which are the subject of this section of the essay. A useful approach to take is that of ‘client-centred counselling’, as founded by Carl Rogers, an American psychotherapist. This approach involves the practitioner helping the client to ‘find’ her own solutions to problems without the practitioner giving direct advice (Morrison and Burnard, 1997). This very much places the focus on the client, allowing the practitioner to use minimal prompts (e.g. “umm”, “yes”, nodding of the head, “I am with you” etc.) to facilitate the conversation. Generally, the literature on therapeutic relationships does not focus on questioning. It appears that using too many closed questions – or indeed too many questions at all! – is an inhibitory factor in the relationship (Bolstad et al, 1992).. In order to provide the best service to the client, the practitioner must focus on her listening skills One aspect of listening is known as “attending”, which involves using the non-verbal methods of communication (such as ‘SOLER’ mentioned above), and also giving full attention and interest to the client (Bolstad et al, 1992). A client would soon lose faith in a practitioner who stares out of the window or fiddles with her hair or a pen: “Listening and attending are by far the most important aspects involved in the counselling process” (Morrison and Burnard, 1997).

With regard to the environment, Burgoon (1994) discusses many aspects in detail. He states that attractive rooms create feelings of well-being, which may be conducive to good communication. Also mentioned is the use of furniture as barriers: this is the cliché of the doctor who sits distant and aloof behind his enormous desk, making the patient feel “small” and unimportant. In accordance with the SOLER strategy above, this is not an “open” position

Some topics in this essay:
Morrison Burnard, Davis Fallowfield, Kagan Evans, Relax Burnard, Philip Burnard, Sit Squarely, Rogers American, Therapeutic Relationship, therapeutic relationship, et al, LEVENSTEIN JH, morrison burnard, burnard 1997, kagan evans, interpersonal skills, morrison burnard 1997, Skills Nurses, practitioner client, bolstad et al, health care, al 1992, bolstad et, london chapman hall, kagan evans 1995, et al 1992,