Dec 27 2008
Barriers to the therapeutic relationship in hospital social work…
This is something I’ve been thinking about the past few days. It is somewhat surprising that I am able to establish any kind of therapeutic relationship with patients or their families. There are so many barriers to establishing that relationship in a hospital setting. Some of these barriers may be specific to our hospital setting but I’m sure some exist in any hospital setting.
I think the first barrier, and this one may be specific to our hospital, is the fact that most of our patient rooms are shared. There are only a handful that are private. Those tend to be reserved for folks who have an infection disease or who are in the process of actively dying. And, also patients with dementia and/or delirium. So, of course, I can understand why people would not want to open up about all of their personal problems and private issues when they know their roommate is just on the other side of the curtain and potentially listening in.
Another barrier is the brief relationship we have with people. Generally speaking, patients are in the hospital on average only about 72 hours. Sometimes it is even less than that. They may not see any point on developing any kind of relationship with a social worker when they know they are going to be on their way in such a short time.
The next barrier could also be a potential factor in actually establishing the therapeutic relationship. I think that being admitted to the hospital is a very traumatic experience for people. They are very ill and basically they have to give up most of the control over their own life to hospital staff upon entering the hospital. I think that is very difficult for people. So, I think sometimes people do really want to talk to me, the hospital social worker, because they feel it’s another thing they HAVE to do. On the other hand, some people are traumatized and want to talk about their experience with someone and process those feelings. So, I think this factor is a toss up.
Contact precautions can be a really huge factor, for me personally. I have to be completely honest about this one. For me it is very difficult knowing that I’m going in to talk with someone who has C. Diff or MRSA. I realize that the gowns and gloves and masks should protect me and washing my hands and all of that. But, I just really worry that I may be bringing something really bad home with me. I worry that it could infect my children or husband or even myself. I do my best but I wonder how much of that comes off to the patient. I know many patients on contact precautions feel isolated and ostracized. It’s difficult for me to imagine that I may be making it worse.
So, these are just a few barriers to the therapeutic relationship in the hospital setting. I hope there are other hospital social workers out there that can comment on it and add to it…maybe even have some solutions!
