Whether you are a social worker or a health care professional working with patients, the process of engagement is an essential part of connecting with people in a meaningful, therapeutic way.
Engaging with your patient allows you to understand their personal stories and struggles, and to develop a common definition of their situation and problem. Developing a common definition of the patient's problem during the engagement phase can facilitate movement toward mutual problem resolution.
While the process of engagement is ongoing, the importance of developing a therapeutic connection is most significant in the first meeting. It is during the initial connection that the basis for your ongoing work together occurs. Although the development of a strong engagement and therapeutic alliance is important for work with all patients, when working with the chronically ill, the relationship built at the beginning will set the stage for possible long-term work together during the progression of different phases of illness.
During the engagement phase, a patient will be assessing whether you are someone that they can feel safe and comfortable with to share their very personal stories and struggles, and whether they can see themselves developing a therapeutic alliance with you for ongoing work. Engagement is a multi-faceted skill involving many layers of practice. Developing successful engagement with patients is key to our success as health care professionals. The "Engagement Experiential Module" written by University of Toronto, Faculty of Social Work outlines helpful strategies to facilitate engagement.
Before meeting with a new patient, we as professionals can bring personal qualities or "attributes" to the relationship with a prospective patient which will set the stage for the engagement process. The "Engagement Experiential Module" outlines these as follows:
respectful attitude toward patient and family genuine/authentic presentation of self acceptance/non-blaming/non-judgmental approach/attitude self-awareness, especially about own emotions/discomfort and how these may impact patient engagement work together. trustworthiness (displays willingness to help) controlled emotional involvement: aware of own emotional reactions, so it does not impede the work together positive attitude warmth interest awareness of cultural/diversity issues and address them when required
The above-mentioned personal qualities or "attributes" form the foundation on which health care professionals can build engagement skills and behaviors during all phases of the therapeutic relationship with the patient
How do we engage a patient?
Clarify your role and purpose of your visit. Introduce yourself with warmth and friendliness. Present yourself in a professional manner without using technical jargon or knowledge that is difficult to understand. Obtain verbal consent from the patient to proceed with visit. Create a safe, private environment for the meeting (if possible). Start where the patient is by inquiring about the problem in a respectful manner. Maintain eye contact when talking with the patient. Employ good listening skills. Use active listening, body language which reflects openness, and calming facial expressions. Pay attention to your voice - modulate tone, rate of speech, volume. Develop a mutual understanding of the problem or issues affecting the patient by encouraging feedback.
Moving forward in the engagement process
Provide support to "help the patient verbally tell their story". Encourage the patient to “tell their story”. This involves a complex combination of skills. Use open-ended questions to engage the patient in discussing their “story”. Pay attention to verbal and non-verbal cues during communication. Support the patient in expressing his or her feelings, and validate his or her feelings and concerns by providing realistic reassurance and hope. Respect the patient’s boundaries and do not push them into disclosure. Create an environment and opportunity for patients to discuss sensitive issues. Address and be attentive to issues of culture/diversity where necessary.
Although these strategies are from engagement literature in the field of social work practice, these skills can be adapted to the practices of most health care professionals. The engagement process is the fundamental foundation on which to build a therapeutic relationship with patients and their families.
Power, R. "The Engagement Experiential Module", University of Toronto, Faculty of Social Work, 3-7, October, 2004. The material for the "Engagement Experiential Module" was a summary of a literature analysis, some of the key references for it follow:
Coady, N. (2002). The helping relationship. In F. Turner (Ed.), Social work practice: A Canadian perspective (pp. 116-130). Toronto: Prentice Hall
Marziali, E. (1988) The first session: An interpersonal encounter. Social Casework (1), 23-27.
Murphy, B. and Dillon, C. (2003) Interviewing in action: Relationship, process and change. Pacific Grove, California, Brooks/Cole ch. 10 The Clinical relationship: Issues and dynamics, p 221-246
Marziali, E. & Alexander, L. (1991) The power of the therapeutic relationship. American journal of orthopsychiatry. 61 (3), 283-391
Shulman, L. (1999) The skills of helping individuals, families, groups, and communities. Illinois: Peacock Pub Inc