In forming teams around clients, we focus much more now on interdisciplinary ways of working. The qualities of a therapeutic alliance can be a valuable tool in creating relationships which underpin a shared vision and goals.
Here, Dr Shabnam Berry-Khan, MD, clinical psychologist, Advanced BABICM case manager and founding director of PsychWorks Associates, broadens the lens of therapeutic relationships beyond the initial scope of practitioner-client to facilitate collaboration and reflection with the wider network to deliver high quality rehabilitation for our clients
When we talk about the therapeutic alliance, generally we would refer to it in terms of a positive relationship between a client and practitioner to facilitate connection, trust, respect, warmth and maximised outcomes. And why wouldn’t we when person-centred care is at the heart of our health and social care models.
But, why is it that we stop there? If we know how beneficial a positive relationship is from one human to another, why don’t we also explicitly apply the same concept with team members working around our clients?
Perhaps we do already! Of course, I am not saying that we need to be therapists with our colleagues, but I certainly believe that respectful, warm and trustworthy relationships – therapeutic relationships, if you will – have purpose beyond the direct focus of the client, and is in fact an important part of improving interdisciplinarity within rehabilitation teams around the client. After all, if you enjoy working with your colleagues, you will naturally want to communicate and collaborate with them more.
Interdisciplinary working is a big topic in the personal injury space at the moment. For me, interdisciplinary working comes because a strong and supportive relationship within the team I am working in has been formed, whether I am the case manager or psychologist within that team, although I feel this approach is particularly pertinent to case management because case managers can envisage team cultures.
What does having a therapeutic relationship look like in an IDT?
The therapeutic alliance is a concept that came from psychotherapy research while trying to understand why an evidence-based therapeutic approach works better for some clients than others.
While we don’t have a definitive answer to this through research, through our ability to interact as humans we can point to the fact that it’s about connecting with people compassionately, respectfully and acceptingly. Because the environment feels safe, the connection opens up all kinds of possibilities and ideas.
And while this is true within a client-practitioner relationship, it is absolutely true within a team where shared goals and shared vision are vital in creating a productive relationship which will deliver the best outcomes for the client.
In order to be able to communicate well and collaborate with our fellow professionals, to hold them in mind while we are all doing our own specialist work, to see things from their perspective, we do need to have that relationship or alliance in place so we feel comfortable alongside each other and able to work together. I’m sure we can all relate to being in a workspace in which we did not enjoy the company of one or two individuals. The impact that has on our work and team workability can be huge and impeding. Our clients deserve better – and we have a right to feel like we belong to the team we have joined.
Whether socially or professionally, we don’t form relationships unless we feel some form of commonality or connection. The common factor may well be the client, but that does not automatically mean that those working with the client will align in values, visions and approaches. That relationship will need to be built on and a sense of safety developed,.
To not have safe professional relationships in place can almost be a barrier to us being able to achieve what we want to including interdisciplinarity and it is for this reason that I think case managers need to consider mechanisms and strategies to develop good working relationships when forming a team around a client
Fostering a culture of collaboration and shared visions
While the development of a positive rapport within teams can be very empowering for those within it, it is not always easy to achieve.
For those working within a team, we don’t choose to work together. We all have our own ways of working, our own approaches. Usually these days, we’re all working remotely too. And we appreciate that anyone working in a therapeutic role is likely to be massively overwhelmed that the capacity to invest time in building relationships with colleagues is limited.
But nevertheless, we must all appreciate that working in collaboration is a huge part of what we do – at PsychWorks Associates, we make that explicitly clear to our associates, it is built into the way we work. By not working in this way, we may not be doing quite the best job we can for ourselves, the team, or crucially for the client.
At PsychWorks Associates, our case managers adopt a few ways to promote strong, professional relationships amongst the team around a client:
- Recruitment of an IDT – if you can put a team together with the qualities you need, where everyone is aligned and able to deliver that, then that’s fantastic. But this is a hard feat to achieve, and without the opportunity to essentially ‘team build’ – a concept so well-used in the corporate world, but rarely, if ever, in rehab or case management – we need to give permission and make time for the ‘softer parts’ of working together, as well as focusing on our roles individually as therapists. Findings ways to do that creatively eg starting an IDT meeting with ice-breakers or ending meetings with positive reflections or appreciations are some ideas.
- Informal sharing – by encouraging regular, open and positive communication, our clinicians are more likely to learn about one another professionally and possibly personally (in a boundaried way!) to allow some kind of appropriate friendliness to develop which fosters a positive environment. A strong sense of who you are, your values, boundaries and good supervision help manage that line well.
- Keeping the client’s story at the centre of everything – indeed, we at PsychWorks Associates are so committed to our clients’ voices that we have devised a case conceptualisation model around it – it does not work unless everyone is very clear about what they are doing individually and together through that shared vision.
- Addressing outliers – While it’s fine to have different perspectives, what is very unhelpful is for someone to essentially ignore the main thrust of the consensually agreed direction. When one member of the team is not joining the current plan, it does need to be called out. That is a difficult thing for a case manager to do, but this can sometimes be vital to the success of the team.
- Reflective supervision – this is where the value of reflective practice comes to the fore. It has a real role in promoting healthy relationships with and around the client, to help create a reflective interdisciplinary team. We are all working on clinical needs that are really complex, and you do need to build in the time to be able to reflect on how you are positioned, to process the role you are playing and step back and consider that the effectiveness of your actions and clinical decisions.
- Capacity to take on relationship building – in a busy world that is health and social care, it can be the intention to connect with others beyond the client and family. But when caseloads get busy and hard to manage for a prolonged period of time, relationship building tends to be the first thing to drop. This is why at PsychWorks Associates, we encourage a 80/20 split of work-thinking time for our team, where 20 per cent is assigned to essential parts of their role other than fee earning, such as allowing the time and space for reflection.
- Open and safe culture – To have a team with a case manager as a reflective practitioner can have a powerful impact, supporting the team itself to be reflective and supporting those little sparks of team building opportunities wherever possible. By creating a safe space every time you have a meeting for those working within the team to say ‘I don’t understand that, I don’t see how I can support that’, you are creating a much better way of moving forward than someone feeling alienated within the team and finding it hard to join and belong.
When you create a team culture which allows clinicians to feel professionally safe, they soar, which can only be a positive thing for the individual, the team and the client.
The ‘take home’
In order to offer our clients the best support possible, we also need to ensure we are working optimally with their professional network.
For that to be the case, relationships need to be built within the team and those relationships help facilitate the work we are collectively doing, whether with our colleagues in law, therapy, care or statutory services.
Through enabling those relationships to be built and developed within teams, and giving the safety and opportunity for reflection, therapists are empowered to be at their best individually as well as when working together in an interdisciplinary way.
- PsychWorks Associates works with seriously and catastrophically injured clients, their families and their professional networks. We have qualified and skilled clinicians keen to work in an interdisciplinary way, with the capacity to lead a team well towards client goals. If you feel that our case management team (or even our treating psychologists) could effectively support your client as well as their system, please be in touch via on admin@psychworks.org.uk or via our referral form.
