Interpersonal Relationships and Communication

Chapter 3


Interpersonal Relationships and Communication





Chapter Objectives



1 Identify components of communication.


2 Define groups and components of group structure.


3 Identify and give examples of different group models.


4 Identify the stages of group development.


5 Discuss methods of establishing rapport within a group.


6 Explain how to plan and lead an effective occupational therapy group.



Key Terms



The interpersonal relationship and the communication between an occupational therapy practitioner and client are important factors for satisfactory intervention outcomes. Knowing how to treat a client requires more than knowledge of the client’s medical diagnosis and treatment protocols; an understanding of personal psychosocial, environmental, cultural, socioeconomic, and occupational factors affecting the client’s level of function is also required. The practitioner must be able to communicate effectively to gather this information and a positive interpersonal relationship facilitates the therapeutic process. Good communication is a key factor in establishing the interpersonal relationship. Therapeutic use of self is also an essential element in the interpersonal relationship and will be addressed in Chapter 4.


Increased awareness of the interpersonal communication of the health care provider–client relationship has evolved in recent years. Mutual respect, trust, and collaborative decision-making will result in positive outcomes for the client. Respect, or regard for the client, can be demonstrated to the client through communication that is caring and compassionate; in doing so, trust develops and collaborative decision-making is encouraged. The client needs to know that the health care provider cares and is committed to his or her well-being. Whether providing services individually or within a group context, the occupational therapy practitioner needs to have excellent communication skills for this to occur. Communication can be described by verbal components, nonverbal components, and the use of skills such as active listening. For many clients, just having the opportunity to express their concerns and state their goals in a supportive environment is the most important to them.



Components of Communication


Components of verbal communication include written and spoken words. In both instances, the practitioner considers the characteristics of the audience. For written communication, the reading and comprehension levels of the reader should be assessed. Plain-language literature suggests that verbal communication be written at a sixth-grade comprehension level. Some clients may be embarrassed at their inability to read and may not wish to disclose this to the practitioner. Careful observation of the client’s skills is necessary to ensure that any written information provided to the client is appropriate. Practitioners should consider the use of simple explanations of health information versus medical jargon to ensure understanding in both written and verbal communication. They must be aware of the client’s environment and influence of culture, spiritual beliefs, and socioeconomic status. These influences may affect the ways health information and treatment are perceived by the client.


Verbal communication includes formality and complexity of language used, content of the message, tone and volume of voice, and speed and length of presentation. It is generally respectful to initially refer to an adult by his or her last name or professional title unless otherwise instructed by the client. Following the lead of the client in regard to how he or she prefers to be addressed is best in most situations. Assumptions should not be made regarding the level of complexity in verbal communication. When communicating, the language should be simple and direct. Observing the client to assess level of understanding and asking if the client needs clarification can allow for assessment of the level of understanding. Care should be taken to avoid talking down to the client or making the client feel uncomfortable. Content should be concise and clearly express the message that the practitioner is conveying. Providing the client with large amounts of information at one time can be overwhelming. Providing information in short and direct messages increases the likelihood that the client will understand and retain the information. Tone of voice should match the content of the message and be appropriate to the person. Talking to an older adult in a childlike voice is never appropriate. Likewise, talking in a loud voice when not required for the client to hear you can be over stimulating and distressing to clients. Most times, individuals who are hard of hearing do better with a moderate tone of voice and the opportunity to look directly at the practitioner to read lips and nonverbal cues to understand what is being said. The speed of the verbal message is also important. Care should be taken to speak at an average rate. In a busy health care setting it can be easy to speak quickly to move the therapy session along at a faster rate; however, this can result in the client misunderstanding the intended message.


Components of nonverbal communication include eye contact, facial expression, and body language such as positioning of self and use of gestures. Looking the client in the eye conveys interest and attention to the conversation. Consistently looking away from the client and demonstrating behaviors such as frequently checking the time indicate a lack of interest and caring. Facial expression should be consistent with the verbal message being provided. Smiling when talking about a serious topic is not appropriate and it does not portray compassion. Body language should be appropriate to the situation as well. Placing your hand on the client’s arm when he or she is speaking or providing a hug can be comforting to a client coping with the stress of illness or injury (Table 3-1).



Active listening is another essential component of effective communication. It is through listening to the client that the practitioner becomes aware of the client’s goals and concerns. Critical information for effective intervention may be missed if the practitioner fails to engage in active listening. The practitioner must convey to the client a willingness to listen to what the client has to say and allow the client adequate time to express his or her needs and concerns. Strategies for active listening include maintaining eye contact with the other person, use of nonverbal gestures such as nodding your head and smiling appropriately to indicate you are listening, actively avoid distractions, concentrating on what the person is saying instead of other aspects of the person such as appearance or gestures, and avoiding thinking ahead or trying to finish the other person’s statements. Asking questions to clarify what the person is saying can be useful as well.



image Clinical Pearl


Paraphrasing is an effective way to ensure that active listening has occurred and that an understanding of what the client has said is accurate. The practitioner can summarize the content of the client’s message and ask the client if this summary is an accurate understanding of what was said to validate that active listening has occurred.


There are many techniques for improving communication skills. By carefully evaluating one’s verbal and nonverbal communication skills and one’s ability to engage in active listening, areas for improvement can be identified. Self-evaluation along with objective feedback from peers can provide insight into communication strengths and weaknesses and how one is perceived by others. The best way to improve communication skills is to practice. Identifying a specific technique and establishing a plan for practicing this skill are suggested. Specific skills for nonverbal communication may include use of appropriate eye contact and facial expressions, whereas skills for verbal communication may include use of language that is appropriate for the client and awareness of speed and tone of voice. Feedback from others is essential in evaluating improvement in skills.


When therapy is provided in the context of a group format, the occupational therapy practitioner must be aware of the interpersonal relationships with all group members individually and as a whole, and be aware of the interpersonal relationships that exist among group members. An understanding of the interpersonal communication that is needed within the context of the group dynamics is necessary for a therapeutic group process to occur. People are instinctively social beings. They naturally form relationships with other people and are part of groups through these relationships or as part of their work, family, or leisure pursuits. Interpersonal communication as related to group processes is discussed in this chapter.



Definition of a Group


A group can be defined as individuals who share a common purpose that can be attained only by group members interacting and working together.4 All occupational therapy groups can be described as consisting of content and process. The content of a group includes the occupational activity that the group completes during the group time and includes what is said, written, or produced during the course of the group. The process of a group refers to the manner in which the occupational activity is conducted and the emotional tone of the verbal and nonverbal content that occurs during the group. Although the occupational activity content of a group may remain constant for a series of groups, the process may vary greatly, depending on the interpersonal communication that occurs and the facilitation skills of the group leader during the group process.



Group Structure


Many elements describe group structure. The organization and procedures of the group may be well developed and formal or may be loosely developed with no specific format. The setting of the group refers to the environment in which the group is conducted. The type of facility and the type of room can influence the group process in many ways. Elements of the environment include aesthetic properties such as color scheme and use of art and decoration in the meeting space, comfort of the environment such as type of seating provided and temperature, and ability to attend well by minimizing auditory and visual distractions. Attention to the environment can have a significant effect on the ability of the group to attend to the activity and engage in interpersonal communication.


Logistical factors can also affect the group. Factors include time of day, length of group, frequency of group meetings, and number of participants per group. Whether the group is open or closed can significantly affect participation. If group membership remains the same over time for groups that meet regularly, then the group is considered a closed group. Open groups allow for new participants to join the group so the membership changes over time. With closed groups there is more opportunity to establish interpersonal relationships with other group members and greater rapport with the group leader as opposed to open groups.


Group participation may also be voluntary or involuntary. If members are attending based solely on their personal desire to attend the group, they will be more invested in engaging in the group process. Some group members may be participating at the advice of their physician or because of pressure from family and friends. Group participation may even be court ordered or required for obtaining other services. In these cases, the participant may not be as invested in the group process.


Group size can influence the amount of interpersonal interactions that occur during the process of the group; the larger the number of participants, the less opportunity there will be for interactions. Up to 10 members will allow for members to participate and interact as desired or as facilitated by the group leader. More than 10 members can impede the opportunity for participation of all members. The frequency of group meetings can increase the comfort levels of participants and increase participation as well, particularly for groups that have more consistent membership and attendance.


Time of day and length of groups can also affect participation. Some members may have more difficulty concentrating and participating later in the day. Planning groups with awareness of the participants’ schedules can facilitate greater attentiveness and involvement. The length of the group should be appropriate for the type of group. Groups that are enjoyable and relaxing can be implemented for longer periods, whereas groups that are more cognitively intense or physically or emotionally stressful may need to be limited to what the clients are able to tolerate.



image Clinical Pearl


When planning for a stress-management group designed to increase the group members’ ability to relax, the setting should be conducive to enabling relaxation. Elements to consider include providing comfortable seating, using soft colors and calming visual stimuli, eliminating outside or distracting noises, providing background music or sounds that are pleasing to the group members, and other elements such as room temperature and tone of voice of the group leader.



Group Models


Occupational therapy practitioners have the opportunity to engage clients in a variety of different groups based on purpose, group goals, and setting. The theoretical basis for group design and the purpose of the group dictates how the group is structured and implemented. Occupational therapy groups may be classified into different categories: activity groups, psychoanalytic or intrapsychic, social systems, and growth groups.6



Activity Groups


Schwartzberg, Howe, and Barnes write, “Activity groups are small, primary groups in which members are engaged in a common activity or task that is directed toward learning and maintaining occupational performance.”6 Activity groups can be further classified into six different types of groups as described by Mosey.5 These include evaluation, task-oriented, developmental, thematic, topical, and instrumental groups. Evaluation groups allow for assessment of both interpersonal and activity skills. Task-oriented groups allow for the focus to be on both self-awareness and interactions with other group members through the activity process. Developmental groups focus on teaching group interaction skills that are considered developmental stage–specific. There are five stages, ranging from parallel groups in which clients work on individual projects in shared space to mature groups in which the group’s needs take priority over the individual’s needs. Thematic groups focus on the clients learning the knowledge, skills, and activities for a specific activity. Topical groups are similar to thematic groups, with the difference being the focus of implementing the group activity in the community. Instrumental groups focus on clients maintaining their current level of function and meeting health needs.5



Psychoanalytic Groups


Psychoanalytic or intrapsychic groups are focused on increasing insight into the self and increasing understanding of personal behavior. These groups can be thought of as traditional group therapy sessions led by a trained psychiatric professional in which the primary means of accomplishing the goal is talking about personal issues and sharing these with the group. Occupational therapy groups may have the same outcome, but are structured with the focus on occupation to achieve insight into the self and to increase understanding of personal behavior. Projective occupational therapy groups and groups that use therapeutic media as a means to understanding behavior are examples of psychoanalytic groups. Therapeutic media may include any form of art such as painting or working with clay, other forms of media such as wood or leather, or creative media such as music or dance.


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Related posts:

  1. Occupational and Group Analysis: Children
  2. Emerging Occupational Therapy Practice Areas
  3. Activity Analysis
  4. Therapeutic Use of Self: Applying the Intentional Relationship Model in Group Therapy

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Apr 12, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Interpersonal Relationships and Communication

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