It is very necessary to establish basic trust and tacit understanding with patients when contacting them for the first time. Active treatment alliance is significantly related to active treatment results.
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In order to develop a positive therapeutic relationship (therapeutic alliance), it is necessary to:
1. Prove to patients that you have good consulting skills and accurate understanding. You can constantly show your devotion and understanding to patients through reasonable feelings, words, pronunciation and intonation, facial expressions and body language. Try to convey the following implied information to the patient:
I care about you and value you; I want to know what you are going through and help you. I am confident that we can cooperate well and cognitive behavioral therapy will be useful to us. I am not overwhelmed by your question, although you may be a little overwhelmed; I have helped many patients like you.
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Through this therapeutic relationship, patients with depression can be indirectly helped to do:
When you are warm, friendly and interested in him, the patient will think he is cute; When you describe the cooperative treatment process as a team working towards the goal in order to solve the problem, patients will feel that they are not alone; When you show hope for the treatment results, patients will become more optimistic; When you help them realize that they have the ability to solve problems, complete homework and participate in other productive activities, patients will gain a great sense of self-efficacy.
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2. Share your conceptualization and treatment plan with patients. Keep sharing your conceptualization with patients and ask them if it is true and accurate. If accurate, the patient will say "yes, I think so"; If it is wrong, the patient will say "not exactly, more like ...". Inducing patients' feedback can not only consolidate the treatment alliance, but also enable you to conceptualize individuals more accurately and implement effective treatment.
3. Make decisions with patients. Give suggestions and induce patients to respond. You and the patient are moving forward as a whole.
4. Ask the patient for feedback.
You can be alert to patients' emotional reactions during the conversation, and observe their facial expressions, body language, words and intonation. For example, when the patient is experiencing increasing pain, it is usually possible to change the subject at this time. "You look very upset. Can you tell me what you were thinking just now? " It is very important to give positive reinforcement when patients provide negative thinking feedback, and then conceptualize the problem and plan corresponding strategies to solve it. Failure to identify patients' negative feedback in time will reduce patients' ability to focus on solving real-life problems and help them feel good.
Even if you are sure that your treatment alliance with patients is solid, you still need to seek feedback from patients at the end of the meeting. For example, "What do you think of this meeting? What do you think I misunderstood "and so on. Asking these questions can significantly strengthen the therapeutic alliance between you and patients, because you really care about them, so they usually feel respected.
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5. Change your style and use different methods. Observing the patient's emotional reaction during the conversation can remind you to ask questions to the patient, so as to discover and change your image in front of the patient and make the patient more comfortable.
6. Help patients relieve their pain. A good way to consolidate the therapeutic relationship is to become an effective and capable cognitive behavioral therapist. Studies have proved that when patients' symptoms are relieved, the treatment alliance will be consolidated.
Second, make a treatment plan and talk structure.
One of the main goals of treatment is to make you and the patient understand the treatment process. You will promote the treatment as efficiently as possible, so that the patient's pain can be alleviated as soon as possible. Treatment according to standardized procedures can promote the realization of these goals.
When patients know what they can expect from the treatment, know clearly what you want them to do, feel that you are a team with them, and know clearly how the treatment will go on, most patients will feel very comfortable, whether during the talks or during the whole treatment.
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Third, recognize cognitive dysfunction and respond to it.
An important part of every treatment meeting is to help patients respond to their incorrect or useless ideas. These thoughts include their automatic thinking, images (mental images) or potential beliefs. You can identify important automatic thinking in many ways, but when patients report their own pain or mood swings, or dysfunctional behavior, you should ask a basic question, that is, "What were you thinking just now?" .
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1. Guide discovery
During the treatment, you will induce the patient's cognition (automatic thinking, images or beliefs). Usually, we can ask a series of questions to understand what kind of cognition bothers patients the most, help them keep a distance from wrong cognition, evaluate the effectiveness and usefulness of cognition, or turn fear into disaster.
Is there any evidence to prove that your idea is correct? What are the negative evidences?
Is there any other way to look at this problem? What's the worst result? If it does happen, what should you do? What will be the best result? What is the most likely outcome of this scenario?