This essay will assess different principles of communication, discuss barriers to communication and examine both verbal and non-verbal communication in health and social care. It will also define main counselling theories related to health and social care and evaluate Psychodynamic Theory by use of a case study.
Wilson et al (2008) defines communication as a process of conveying information from one person/organisation to another and between workers, other agencies, service users and their families in health and social care. It is a must to be empathetic, authentic, honest, and respectful for effective communication to achieve the main the objective because it determines action, reaction and feedback from the recipient. Effective communication should include the basic details such the senders name, the date, place, the topic, the recipients and deadline for response where response is needed.
Kaprowska (2006) states that communication must be clearly, empathetically courteously and comprehensively presented for effectiveness. The sender needs to know the purpose of the communication to be able include all the necessary details, to choose effective communication skills, language, time, venue, environment and mode of communication, for example if someone is preparing for a presentation for blind audience, there is no need to prepare overhead projectors or pictures as this will not mean anything to them. Knowing the recipient enables the sender to develop a useful way of getting a feedback and what kind of response to expect, which is one of the processes of communication. Having good knowledge about the topic enables the sender to meet any challenges and objections that might come from the audience, follow through what he is saying with the audience which presents a positive picture and hence gaining credibility with the audience.
Hough (1996) explains that communication can be transmitted verbally (spoken) or non-verbally (written, body language or silence). Written communication can be through letters memoranda, emails, briefing papers or reports and spoken communication includes telephone, presentations, meetings or seminars. Maggio (2005) states that written communication can take place with either only the sender or receiver present, therefore the layout and language creates an impression about the sender.
Language, punctuations, style and the words used can express the attitude, politeness and cooperation of the sender. For example words like please, kindly, please or phases such as it would be much appreciated, looking forward would give a positive impression of the sender where as words such as must, have to, want, do not care or not bothered could give a negative impression about the sender. Other forms of non-verbal communication include gesture, listening, gaze, body movements, body space, appearance, touch and facial expression, that takes 50% of communication which the recipients can use to judge the sender’s confidence, respect and knowledge.
“Non-verbal communication is also powerful medium for conveying emotions and when non-verbal linguistic messages are in conflict it is the non-verbal communication which carries greater weight” (Argyle, 1983).
Verbal communication is the interaction between people face to face. The main components of verbal communication are sound, words, speaking and language.
“Paralinguistic or paralanguage refer to the various aspects of speech which are present in addition to the actual words spoken. These extra aspects of speech can convey deep emotion and meaning much more powerfully than words. They include tone of voice, rhythm, volume, timing, accent, pitch, stressing of words and phrases, hesitation and speech errors. Someone who says ‘I am very happy’ for example, means something quite different when the word ‘am’ is stressed. This ‘I am very happy’ tends to indicate a determination to be happy, perhaps against all odds” (Hough, 1996:44).
Stewart (2005) explores the communication cycle, which involves the message conception, which is the stage when a decision to communication is identified. The next stage is the encoding when appropriate language and tone are chosen to suit the message and the sender decides whether to communication verbally or non-verbally. If decoding is inappropriately chosen, there could be communication breakdown. The third stage is the selection of the method to be used depending on the last decision which could be through letter, interview, telephone call, email, memorandum or presentation. The next stage is decoding and this when the recipient will demonstrate how the message is perceived and understood. Therefore language and knowledge should be appropriate and relevant to the receiver as wrong perception and misunderstood communication disrupts the whole process.
Depending on the understanding of the message, the receiver at this stage interprets the information. This stage will determine what is to be done in the next and final stage of communication. If the communication successfully goes through the four stages and the recipient makes correct interpretation then effective communication is achieved but if it is unsuccessful, wrong interpretation will be made leading to ineffective communication. This is the final stage when the recipient sends a feedback to the sender using the appropriate form of communication, which could have been specified by the sender at stage two (Reference? (Stewart 2005?)).
As seen above effective communication is essential in health and care setting. However, there are many factors that can cause ineffective communication. This include language, cultural beliefs, discomfort, resources, distance, time, misuse of power, negative attitude, disabilities, age, discrimination, lack of confidence, respect, trust, listening skills conflict of interest between care workers and clients.
Language could include sign language, use of charts, body language or any form that shares common understanding between the sender and the recipient within health and social workers without altering the meaning. Lack of common language affects communication. Cultural differences can be a barrier in communication as some expressions, words or acts in one culture could mean totally different to a different culture or may be acceptable in one culture but totally unacceptable in another, which could lead to information being misinterpreted (Reference?). .
Respect and trust must be observed during communication for effectiveness. Lack of resources could be a barrier because workers may not have access to facilities to communicate effectively with clients with more complex needs or disability. Discrimination, negative attitude and conflict of interest could be a barrier from both the workers and service users and is therefore essential that both observe to eliminate them. Listening skills from both the workers and service users are important as very little can be passed or received when there is lack of attention, which can be due to discomfort, pain, temperature, facilities, lack of interest or age from either side (Reference?).
Communication is essential between counsellors and clients in counselling because both rely on effective communication for positive outcome.
Counselling is a process that provides direction or advice as to a decision or course of action which takes place when a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having, distress they may be experiencing, perhaps their dissatisfaction with life, or loss of a sense of direction and purpose. It is always at the request of the client as no one can properly be ‘sent’ for counselling. (British Association for Counselling and Psychotherapy, 2005) cited in Hough (2006).
Hough (2006) explains that there are three main counseling theories related to health and social care. These include psychodynamic approach, the behavioural/cognitive behavioural approach and the humanistic/person-centred approach. All these approaches are used to help clients identify unknown factors that can influence behaviour; childhood and present experience are explored when and if, clients request assistance in relationship issues.
The behavioural and cognitive behavioural approach is based on the work of behavioural psychologists who are Palvol (849-1946), Watson (1878-1958) and Skinner (1904-1990). These psychologists did experiments on animals to validate their theories, which are concerned with actual, observable behaviour. This approach sees human problems as learned behaviours such as phobias or obsessions, which are often problematic, but can be unlearned through behaviour modification therapy. In this theory, techniques are identified to focus and change the problematic stimulus-response pattern for example reinforcement in maladaptive behaviour. This approach is concerned with the way an individual think and how this affects individual’s observable behaviour, which is highly valued and supported by many psychiatrists as a most effective form of talking therapy. (Reference?).
Humanistic approach, the second theory, puts emphasis on individual’s personality, which can be seen as unique to every individual and this is associated with individual’s problems. In this theory the central focus is on subjective and individuals experiences and therapy to help clients grow towards self-actualization, integration and wholeness. The main theorists behind this theory are Carl Rogers (1902), Abraham Maslow (1908-1970) and Fritz Perls (1983-1970). Gerald Egan’s structural model has been influenced by this theory. (Reference?).
Finally there is Psychodynamic theory, based on the works of Sigmund Freud (1856-1939) and Freud’s (what year?), focuses on unconscious motivation, psychosexual stages of development, aggressive sexual drives, transference and nature of the therapeutic relationship. Significance of dreams, talking cure, and current behaviour and forms of defence mechanisms and why they are applied and interpreted by connecting what happened in childhood or past and what is happening currently. Id (unconscious), ego (conscious) and superego (personality that detects right from wrong) are personality models that were Freud’s mind description in 1920s. (Don’t understand what you mean by this sentence). (Reference?).
“Psychodynamic approach to understanding people takes account of the significance of unconscious thoughts perceptions, and feelings. These may be met negatively as hostility, resistance and defensiveness or positively as expectation and attachment, as significant feelings from the past appear in current relationships and situations. The technical term for this is ‘transference’. If this relationship develops from worker to the service user this is known as ‘counter-transference’. This unconscious repetition of earlier experience into a current relationship is viewed as useful to the therapeutic work in Psychodynamic counselling. It is a ‘way of seeing old relationships come to life in the present’ and might be a ‘vital clue to insight and to reworking what has gone wrong in the past’ (Seden, 2005:62).
In attached case study, Appendix A, Jerry opted for Psychodynamic theory to help Velma because she does not really seem to know why she is experiencing these difficulties. “Get in touch with her unconscious and bring what is unconscious into the conscious” (Stewart, 2005:384). During this session careful listening, reflection (saying what Velma has said) with an aim of focusing more on her feelings related to her words, paraphrasing, (re-warding what she has said) to ensure that correct information is gathered and summarising to ensure that all the necessary information has been gathered.
Jerry’s attention and interest encouraged Velma to continue exploring and clarifying her feelings during which Velma became very tearful, felt guilty, angry, depressed and admits that she blamed and condemned herself for arguing with her mother on the day of the accident. She also blames her doctor for not referring her for psychological help despite being given medication for Post Traumatic Stress Disorder, which she does not want to continue taking anymore. Velma also shows an interest in wanting to understand her reaction to the accident by asked Jerry if they could arrange to meet for sometime to enable her talk through her issues.
As it is supported by Nelson-Jones(2006), Velma used projection and regression defence mechanisms by trying to blame her doctor for failing to refer her for psychological help through professional attention from Jerry’s warmth, empathy, genuineness and support. She gradually developed psychological strength to be more aware and deal with her problems that been revealed, enabling her to explore more on solutions to deal with her situation by incorporated all the id, ego and superego areas of personality.
“Many problems relating to Post Traumatic Stress Disorder are alleviated through adequate expression of painful emotions and through the support of friends and professional help (Lowe, 1994).
Hough (2006) argues that although Psychodynamic theory is a very effective in counselling there are times when the relationship between and client and counsellor become unfriendly.
“The Psychodynamic counsellor can appear distant and detached, possibly even lacking in warmth, but this is because of the belief that the personal qualities of the counsellor should not intrude into the counselling relationship.” (Stewart, 2005:385).
This theory is not suitable for people in crisis or have recently been bereaved because these people would suit crisis intervention or support group. It is also not suitable for who are more anxious like drug and alcohol addicts and people with severe mental illness who are not within security of hospital, as they need extra support and back up services.
In summary, to achieve effective communication, principles have to be considered and elimination of potential barriers to communication, which is vital in health and social care settings. It is through effective communication that information is conveyed, right course of action is taken and a decision arrived at, as demonstrated in the counselling stages in this essay.
Argyle, M. (1983) The Psychology of Interpersonal Behaviour. London, Penguin.
Koprowska, J. (2006) Communication and Interpersonal Skills in Social Work. Exeter, Learning Matters.
Lowe, F. (1994) Post Traumatic Stress Disorder. Dublin, Mercier.
Maggio, R. (2005) The Art of Talking to Anyone: Essential People of Skills for Success in Any Situation. London, McGraw Hill Professional.
Margaret, H. (1996) Counselling Skills. Essex, Addison Wesley Longman Limited.
Margaret, Hough (2006) Counselling Skills and Theory. 2nd ed. London, Hodder Arnold Education.
Nelson-Jones, R. (2006) Theory and Practice of Counselling and Therapy. 4th ed. London, Sage Publications Limited.
Seden, J. (2005) Counselling Skills in Social work Practice. 2nd ed. Berkshire, Open University Press.
Stewart, W. (2005) An A-Z of Counselling Theory and Practice. 4th ed. Cheltenham, Nelson Thornes Limited.
Wilson, K., Ruch, G., Lymbery, M. & Cooper, A. (2008). Social Work: An Introduction to Contemporary Practice. Essex. Pearson Education Limited.
Egan, G. (1994) The Skilled Helper: A problem-Management Approach to Helping. 5th ed. California, Brooks/Cole Publishing Company.
APPENDIX A – CASE STUDY
Velma was involved in a motor accident with her mother and two elder brothers at the age of eighteen for which she received medical attention for Post Traumatic Stress Disorder and discharged. She did not wish to discuss anything related to this accident with anybody outside her family as she argued that it gave her bad memories, especially when she remembered about an quarrel she had picked up with her mother the morning they had an accident. The rest of her family members with whom she received severe injuries which led to complex deformities that she did not wish to talk about it with them.
Recently Velma has been experiencing severe difficulty in concentrating and vague anxious feelings which has led to loss of confidence in herself and this prompted her to seek help in counselling. She made an appointment with Jerry who is one of the counsellors at a counselling centre.
When Velma arrived she received very warm welcome with self introduction from Jerry who informed her that they had fifty minutes to talk about the issues that had brought her. Jerry took Velma into a very comfortable room where he assured her that every detail would be kept confidential although he could use his work in general with his supervisor. Jerry’s openness seemed to reassure Velma and this, unlike most service users who found it difficult to absorb information on the first visit caused by emotional stress.
Velma described her current difficulties without any problems but she became very anxious and stressed out when she started talking about her accident which was expressed in change of tone, facial expressions, silence and became very tearful. Jerry gave her full attention and only spoke when she realised that he wanted to say something.