Effective people
The way that practitioners behave makes a difference to treatment outcomes - for good or bad. The research evidence is consistent and well developed. We know that practitioners with certain qualities are able to build positive relationships; some people naturally display these qualities and others need to learn to adopt them. People with lived experience may fall into either category. Similar experiences can engender a natural affinity and the basis for mutual trust. Mutual aid groups such as SMART, AA and NA depend on this kind of supportive relationship.
The characteristics of effective practitioners…
The story starts back in the 1960s when humanist approaches to treatment emerged. Around the same time a group of researchers led by Morris Chafetz in Massachusetts set out to understand the nature of ‘alcoholism’ and improve the treatment available. They conducted studies in a general hospital and came up with a similar message to Carl Rogers, namely that the way you speak to people makes a difference to what happens next and in the longer term. It is worth reading the detail of this and the study by Luborsky because of their contemporary relevance (see below).
Empathy
Carl Rogers was at the forefront of the humanist psychotherapies. What have become known as client-centered therapy and Rogerian psychotherapy were based on the premise that personal growth and fulfillment would occur in the setting of a genuine therapeutic relationship delivered with unconditional positive regard and empathic understanding.
Empathy is repeatedly found to be an important characteristic of effective therapy and the key ingredient for all practitioners to absorb into their practice.
In this video Carl Rogers talks about the centrality of empathy in talking therapies ➜
Carl Rogers, Humanist and influential American psychologist 1902-1987
Some researchers will say that what the practitioner does is the most crucial factor in the outcome of treatment - the particular intervention is of less importance. The model below shows the elements of the practitioner’s interaction that are thought to be significant.
Creating a working alliance
The better the working alliance between service user and therapist the more likely that good outcomes will follow. Martha Sanchez-Craig talks about effective therapists ➜
Martha Sanchez-Craig, Senior Researcher formerly of The Addiction Research Foundation, Toronto
Effective therapists are:
✔︎ Empathic
✔︎ Experienced from years helping people
✔︎ Authoritative in their sphere of knowledge
✔︎ Psychologically stable
✔︎ Interested in learning - disinterested in personal gain
and their behaviours are..
✔︎ Active listening and reflection
✔︎ Showing genuineness, respect and direction
✔︎ Adherent to a therapeutic approach (flexible use of a manual)
So far on this page the ideas of empathy and a working alliance have been applied to treatment, but not all practitioners will be involved in direct treatment roles. Often the first people service users have contact with at an agency are reception staff or triage practitioners. The same general principles are important. Effective practitioners tend to use a motivational style of talking: they ask open questions rather than questions expecting a yes/no answer, (which would be a response to a closed question), or questions with such intonation that the preferred answer is implicit. In the next video you can check out how welcoming open, rather than closed questions might be…
Engaging people
Dr Gillian Tober demonstrates ways of starting to build a positive relationship with service users. She poses a number of questions and statements some of which are open ended and some are not.
The video pauses after each question or statement so that the viewer has time to think about whether it was open and welcoming, and likely to engage a service user or whether the opposite was the case.
If you have a public facing role why not ask a colleague or friend to help you practise open and welcoming questions. Questions that start with words like, where, when, how and who are unlikely to have implied responses, but work on your own style of motivational dialogue.
