As a social worker, one of the important elements of developing the therapeutic relationship remains in establishing rapport with the pt (patient). Initially, the pt will be someone who is a complete stranger to you and you need to create a sense of trust with this person. Many clinicians will take a client-oriented approach and we with a method we call "meeting the pt where the pt is". In order to do this, we do a quick mental status assessment and often look at some of the basic available theories in order to determine and approach.
Sometimes using tools that are a bit creative and taking that client centered approach will not only make the client more comfortable - and yourself as well - but will provide you with information that can be used to determine other clinical approaches with your pt. By that I mean when you offer a pt an activity important elements might be brought to your attention that could be addressed further.
For example, you could start off with an open ended ice breaker:
Clinician: "What is your favorite food?"
Pt. "My mother's chicken pasta?"
C: Tell me about that
Pt. She would make it for us whenever we won a game..,
C: Who is us?
Pt. My team and I. My friends. We played softball for City High. I was the catcher. I was hoping for a baseball scholarship.....
The above is an example of what I'm trying to get at. You start off with a favorite food and then you find out about growing up, possible dreams. You can probe for strengths here and discover triggers just by finding a creative way to open a dialog. (Of course the above is very brief and just an example to illustrate my point. I don't think a dialogue like the above would suffice as a complete talk).
Rapport is important because it allows you both to become more comfortable with the pt (or them if you are in a group). Remember the pt is coming to you as a stranger and may even be mandated and therefore a bit reluctant to talk to anyone at all. Finding a creative and enthusiastic approach will give the pt a chance to relax and they may let any walls they have put up down, and feel comfortable opening up.
A Little About Narrative Theory
Narrative theory is an approach that is based upon the idea that as humans, we all have stories that reflect our lives. We go through experiences and think about them and process those people, places, events, ideas - everything - and have a way of sharing them with others through dialogues or examining those things that are part of our being, ourselves. We are all basically stories. And of course the level of internal dialogue, self-narratives, create our identity.
One of the aspects of the narrative theory approach that I would like to use when I talk about ACROSTICS is that the dialogue isn't necessarily written in permanent ink. We have the ability to rewrite some of those things we have experienced and create a new dialogue with a fresher perspective. In short, we don't change the events themselves, but the way we look at them. Basically, we take editorial liberties with own thinking.
In many ways, it can lead into a cognitive approach such as described by CBT. By rewriting our internal voice, we can improve our emotional level and find ourselves going through behavior changes compatible with the more favorable emotions and actions.
If this interests you I would suggest some more research on the topic. I only mention narrative theory because the ACROSTIC is a "poem", You will be asking pts to seek out words or sentences which are relevant to subject of the ACROSTIC. I'll get to defining what an ACROSTIC is in the next section.
What Is Your Story?
What is an Acrostic
An ACROSTIC, is a poem that uses the first letter of a name or other word, as the first letter of a line in the poem. Often I will pick a name - the name of the pt - and have them write it vertically. For example, Elizabeth would be:
Then I ask the patient to look at each line and write something positive (or meaningful - it might not always seem upbeat) on that line. It could be a word or a phrase. Such that:
L oves Life
T ruthful to people
You can see how this works out. I'll show some examples of other types of acrostics at the end. But basically the gist is the same when considering whether the person uses their name or the city in which they live or something they might be thinking about such as GAS PRICES. It can be a phrase even. The main goal is to get the pt thinking and active and give you an idea of what is on their mind so you can take an approach.
Words and Self-Image
One of the concerns I've found in using this approach to build rapport, is that the pt is initially reluctant. They have come in expecting to talk about their problems and giving them this activity sometimes puts them in a place where they feel uncomfortable. You are asking them to think and be creative. This approach might not work with all clients. I've discovered however, that by giving them a direct request to write a positive word - start out with words, they may even want to include phrases themselves - they soon find it hard to stop and sometimes want to do another.
You can switch this up a bit by having them write about someone important to them. For example, I was working with a man who was depressed and he was having difficulty communicating with his wife. She felt ignored he though. I asked him to write her name down, with each letter saying something positive about her. I asked him to present it to her as a gift and talk to her about it. He had to think awhile about what to write, but when he did he was pleased. After he shared it with her, things opened up and they were able to talk and laugh.
The main idea is to get the pt to elevate the way they are looking at something using a language that is productive and beneficial. Using words to create a story that will inspire healthier thinking or even rewrite, for example, cognitive distortions, that are holding them back. Instead of saying I cannot, they write I can and I will.
Finding Useful Connections
This could work to allow you to see certain strengths or risk factors that are maintained in the pt system. For example, I worked with a client who sang karaoke and that was mentioned in the poem they wrote. From there I found out about the pt's support system which consisted of friends at the bar they sung with. And from that, I found out about some triggers which led to more drinking than necessary. I discovered self-esteem concerns which led to social anxieties and fears about the college class.
The possibilities are actually endless. I have found this to be a great introductory activity that will allow you to comfortably strengthen the therapeutic bond and even give the client an opportunity to see attributes they never realized they possessed or realize areas that need to be examined closer.
Keep in mind that we all move about through different systems that are defined by ourselves and the environment we are in. I am writing this on the assumptions that those who are reading this understand the basics of systems theory. We use words and thoughts to interpret our relationship to the world around us. One of the easy tools in the narrative approach is the ACROSTIC.
The Power of Positive Thinking
Well I hope I didn't deviate too much from the intended topic of this piece. I wanted to provide a useful tool for helping along the relationship when you are trying to engage with the pt.
When you think about it, many of the theories are connected and ultimately we are all trying to find stability within our system, homeostasis. And the premise on which I believe the ACROSTIC works can be found in the connection between thinking, feeling and behavior found in CBT (Cognitive Behavior Theory). Good thinking can lead to desired outcomes. There are numerous ways in which this has been described in popular culture.
Too many to mention here, and that is a different topic altogether.
But by using this approach and encouraging the positive with your pt, I am certain that some of the results you notice will be preferable ones.
In short, don't ever underestimate the potential of a good thought.
Please see below for some examples of more ACROSTICS that use words and other phrases besides names.
Some Other Examples of the ACROSTIC
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