Get Real Quick Takes: Establishing supportive recovery-oriented relationships

How can a support worker establish a supportive relationship in recovery-oriented practice? In the world of mental health, there's no one-size-fits-all approach.  This conversation offers versatile strategies and insights to understand how to interact with clients for build supportive relationships.
In this episode we discuss:

• Strategies to aid the establishment of a supportive relationship 
• What do you need to know about your clients?
• Techniques for fostering a supportive relationship 
• Treating people as individuals 
• Tips for new workers 
• Framework for Recovery-oriented Practice

This episode is part of our Skills for Support Workers training podcasts, available on our website and produced as  part of the Developing the growing new NDIS (psychosocial disability) Workforce Project, supported by the Victorian Government.

Host - Ellen, Trainer and Project Manager
Guests -Dr Melissa Petrakis, Senior Lecturer of Social work, Monash University, Tamara, Trainer and Lynne, Practice Leader.

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

If you have been affected by anything discussed in this episode you can contact:
Lifeline on 13 11 14
13 YARN on 13 92 76 (24/7 crisis support for Aboriginal and Torres Strait Islander peoples)

ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.

We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

Transcript

ermha365: 0:00

Get Real is recorded on the unseeded lands of the and Wurundjeri peoples of the Kulin Nation. We acknowledge and pay our respects to their elders, past and present. We also acknowledge that the first peoples of Australia are the first storytellers, the first artists and the first creators of culture, and we celebrate their enduring connections to country, knowledge and stories.

ermha365: 0:28

Welcome to Get Real talking mental health and disability brought to you by the team at erma365.

Lynne: 0:34

Join our hosts, emily Webb and Karenza Louis- Smith, as we have frank and fearless conversations with special guests about all things mental health and complexity.

ermha365 : 0:47

We recognise people with lived experience of mental health and disability, as well as their families and carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.

Ellen: 1:10

Hello, my name is Ellen Maple. Today we're talking about recovery oriented practice. With me I've got Tamara, who I'm going to let her introduce herself. She's got a lot of really relevant experience to bring to the table Lynne from a practice leader for here at Irma365, and Dr Melissa Petrakis from Monash University. Tamara, I'd love for you to introduce yourself to our listeners because you have such a rich experience that you bring to the table.

Tamara: 1:35

I, for five years was an active person in the Victorian mental health system, so I have a lived experience. I have a trauma-based disorder, disassociated identity disorder.

Ellen: 1:46

So, from your perspective, tamara, what does a supportive relationship look like, and how do we do that? How do we create, foster support and lead a supportive relationship with someone that we're trying to help?

Tamara: 1:57

It's certainly not a simple question. A lot comes down to knowing your clients and communication skills. So the first one obviously is things like active listening, so having open-ended questions, having that respectful curiosity, allowing people to sit with the silence. So a lot of people, if you ask them a question, they might take a while to sort of gather their thinking. They might do that internally or they might have to sort of have a dialogue to sort through their thoughts. So being comfortable sitting in that silence is huge and that's often hard for a lot of us. Some people aren't great with verbal expression, so learning if our clients are more visual, can aesthetic, so being able to do things like can you mind map it, can you draw it, can you write down dot points Journally work for you? Is there something in the journaling that you choose to tell me? So giving people those options around communication, I think it's huge being aware that oftentimes people communicate best while they're doing another activity, so it might be that they're walking, that you're not sitting sort of face to face with the person where they feel like they're in the middle of an interrogation, that it's more of a natural conversation that you're having. Certainly, being conscientious about your word choices is as Melissa was saying, and even though people may use some interesting vocabulary to describe their own situation, we tend to try to model sort of positive word choices without being I know better or for writing them in that sense. So we're just very conscientious around word choices. Working with people that relate well to analogies, I find this helps a lot of people hold things in their mind.

Tamara: 3:39

I was working with a gentleman who had a mental illness. He had some addiction issues. His divorce was about eight years old. Through some of the issues he had gone through, he had lost custody of his children and this was something that was a constant theme that played in his mind his anger towards his ex-wife and the situation of losing his children. And after knowing him for a while and having a good rapport with him, I actually said to him and we'll call him Bob I said you know, bob, would you rent a room in your house to your ex-wife? And he said, oh, no way, kind of went on a bit of a thing about that and I said okay, so why are you renting her? So much space in your head? And it just sort of clicked in his mind of you know, oh my gosh, I'm allowing her to consume so much of my time and so much negative energy to him and I said what if you're able to try and every time she comes into your mind, tell her to get out of your mind and think about what skills and tools and strategies that you need to do to gain access to have custody time with your children, which was a huge goal for him and that sort of analogy of renting space in my head really stuck with him, so it gave him something to kind of hold on.

Tamara: 4:53

I also like to say, to present to people this idea of the spectrum are my behaviors or what I'm thinking helping me or are they hurting me? So, again, giving somebody a very, very simple tool to decide, you know, is this helpful, is this hurtful? Sometimes people you know might need to actually chart that out as sort of you know a positive side and a negative side, allowing people to have tools in which they get to be in control of what's happening in their lives. I also think that you know a huge aspect comes around why do we want to know our clients? It's really, what do we want to know about our clients and it's those skills that we have, if that knowledge that we have on you know how do we motivate them, how do we work with them, what's important to them?

Tamara: 5:37

So we're asking questions to our clients like you know what motivates you?

Tamara: 5:40

What does your client fear or make some shut down? What are their hopes or goals for the future? So, again, looking at that sort of what does a future picture look like for you? What strengths do you possess and how do you get them? So it might be even doing a strength analysis, because I think a lot of people who have been in quite challenging situations sort of forget they have an amazing amount of strengths, even keep going.

Tamara: 6:05

What happened in the past? Tools that you have that you've used that are effective? Are they still effective? Can you reinstate those tools If you become a well? What are your concerns?

Tamara: 6:17

So we have a lot of people who are fearful of things like going back into hospital. And it might be as simple as if I go in the hospital, I live by myself and there's nobody look after my cat. So these are some reasons why we get to know people. What brings you joy and happiness? We don't often ask that question because we're also thinking about what causes them distress, but really what causes you joy and happiness? That's huge to get people to reframe things, get people in a better mindset. What are the expectations that you have of me, so you know, and what are those reasonable? Is this something you know that we can work together on? And what are the expectations that you have on yourself, so you know, when we think about that? You know communication and getting to know people. It's multi-layers and it's something that's built up over trust and time. You certainly wouldn't come in with this list of questions on your first session with your client.

Tamara: 7:11

It would be incredibly overwhelming and they would feel interrogated. So it's something that we sort of build on as we go, I think for many of our workers.

Ellen: 7:18

Some of that information would be available to them from other workers and from files, and they'll be able to do a bit of research, prepare themselves for a visit first and then continue the conversation within their own relationship as well. Because we see, you know, certainly in our more complex space here at Irma that we have teams of people working with one individual. So it's yes, there's many individual relationships, but there's also a relationship with the team and things too. But I think, having those a lot of you just named so many fantastic strategies and I want them to get lost in the volume of really great ideas that you're sharing with us. But I think, to highlight it, some of the great things that you shared against, to reiterate them for our listeners, I think being able to apply really creative and in tune ways of communicating and connecting with people.

Ellen: 8:02

So, whether it be drawing or writing, whether it be distracting and then talking while doing another activity, whether it be using some fabulous analogies, any of those things may work, or none of them may work, and that's okay, and sometimes they work on one day but not another. You might have a great experience with one person trying an analogy or and then use it for somebody else and it just falls flat. And that's actually okay as well If you can bring in a bit of self-compassion, a bit of bravery into being able to experiment and try different things with people in a, you know, in a low risk way. So there's not not with high stakes for the relationship, being able to express and try these things, you can have a lot of fun with it and you can often move things forward to strengthen the relationship. But even the trying to communicate effectively can be quite powerful too.

Dr Melissa Petrakis: 8:46

I wanted to almost repeat a couple of things that Tamara said, because there's this science that shows that anytime we're exposed to a new idea, we have to hear it multiple times to be able to take it on board, like to have it be our own. Not just for adult listeners or adult learners, but like for everybody. We have to be exposed to something repeatedly if it might contradict or be new to what we intuitively already do. And so it's worth, I think, just again highlighting for the listeners a couple of things in particular that were quite sophisticated, that Tamara was talking about, and what Tamara was doing was letting people take the conversation how they wanted or where they wanted. So just the open-ended questions is super important. And another thing that Tamara was talking about that's just mega beautiful is this idea that a sophisticated approach doesn't have to be done in a fancy pants way. So we call it the Decisional Balance Sheet, where you work out the pros and cons of something, or we often talk about Decisional Balance Sheets. As soon as you do that, it becomes fancy, and then it's a disempowering or expert versus client almost dynamic you set up, which is the opposite of what Tamara's talking about. So it's just to make sure that the listeners get that. You can do it as simply as on the back of an envelope or on a post-it note. You draw a line down the middle of the sheet and you put a plus sign on one side and a negative on the other and you just ask the person like with regard to this thing, or when you're talking about this thing, and you feel a bit like you're not sure which way to go. What are the pluses and what are the negatives if you do that behavior? Or what about another one? If you do this other behavior, what are the pluses and what are the like? What's to gain, what's to lose? There's always gonna be both.

Dr Melissa Petrakis: 10:26

I'm always struck that when people tell us things, whenever we're assessing people, we're only usually doing that with what they tell us. So they already know the consumer, the service user already knows their needs. We only know through what they tell us. So it's actually profoundly arrogant without realizing we're doing it. It's profoundly arrogant when we then tell someone and try and convince them and they're being resistant to it what their needs might be. You know, because, like we know, we're just picking and choosing which bits of their story we're hearing and feeding that back to them. Often, especially in inpatient settings where I've worked sometimes, as soon as we've seen a lot of people with a similar presentation, we think, like the next one through the door is the same, or the next one through the door, as if it's a production line, the next one, you know the next person through the door will have. If they present a certain way, we'll want to need the same thing. So I'm going to roll that out and they'll be efficient, and I just think at every point you can don't do that.

Lynne: 11:25

I was just talking about that the other day. We you start referring to someone as a diagnosis instead of it, and it can be, it can be really in the certain saddle diagnosis that end up getting a bad rap more than others. And I was saying to someone think about it this way. A few years back now, I was at the hairdressers. I had two hairdressers for some reason Don't know what I was doing, but they started moving me around like to do whatever, and the other one got my head and sort of pushed it to the side and said to the other hairdresser you moved the head. Now they forgot I was under there.

Lynne: 12:00

Because this is what and I think of that often when I think my son goes ah, here's another BPD or here's another, and you sit there thinking you know, and it gets easy to do it when people have seen it. But it's remembering it's a person that has been given this diagnosis, often wrongly so as well. It depends. Things have changed. Even our determination of someone with autism has changed in the last few years. It's remembering that there's actually a person who has been given this label, but there's a person. Everyone is different. Not every single person is going to have the same thing. Not every person with brown hair likes dogs.

Ellen: 12:36

You know, when we're talking about recovery oriented relationships, you know there's really three things in the room with us, we've got the person, and where they're there to support We've got ourselves, and then the relationship is almost like a third person and we're talking about the skills and techniques and things that people can use to build relationships, where they're the things that we're working on constantly.

Ellen: 12:54

We never seem to. We talk about this bag of tools that the workers need to have in order to go out on their job, but these are tools for life. You know, we have relationships in every stage of our life with a whole range of different people, and those relationship skills that we're learning about we're also teaching to the people that we're supporting. For our listeners, just to try and give some people some really nice takeaways, what would be? I'd love it if we could just share maybe a top one to, maybe even three tips for new workers to consider when we're thinking about building those recovery-oriented, supportive relationships. Well, the top two or three things that people could you know to try and to do when they're first meeting people or in maintaining those relationships.

Lynne: 13:32

I would firstly say ask for an invitation to do so and I would assume, because you are there to work and the person you support knows that I'm here for you. You let me know I'm not the professional or the expert in your life. You are, you know, open in the invitation and give them the strength from the very start and be genuine. Be genuine. Like you know it sounds silly, maybe cliche, and people go. Of course we'll be genuine, but sometimes people aren't a view, talk a certain way. That's how you talk and you know, like, quite often, say with some people that mainly people with the disability that may have a different, you know verbal cues, I'll say, oh, sometimes I sound a bit funny with this accent and you know, move on, just add something like that so that if there's something you're not understanding, it'll, it's most likely from my end. So again, just the invite and giving them that power that they can ask questions and that it's not on them if they don't understand something. It's a shared responsibility.

Ellen: 14:36

The checking of it and giving people say, and that's a bit of saving face going on there to for people.

Lynne: 14:42

Oh, that's exactly, and we do that, and I believe we do that with staff. People coming into infuse always ask. If you don't understand something, just please let me know so that I can ask you. There's nothing worse than feeling stuck because if you can carry on talking the rest of the day, if they don't know what you were saying at the very first place, you've just wasted everyone's time. Yeah absolutely.

Ellen: 15:05

Thank you, Melissa. Did you have anything you wanted to add?

Dr Melissa Petrakis: 15:08

Yeah, yeah, I would say that you know there are guides and tools to help us and that in Victoria we have this framework for recovery oriented practice from August 2011. It's not new. We're actually all supposed to be implementing it. And around page 13, there's really a really clear box around the key capabilities for mental health professionals and I like it. It breaks down behaviors, attitudes, skills and knowledge, and I think sometimes it's part of such a big document. People sometimes get lost in the whole document. But just that that's that little table is probably a good starting point, and I like the advice to work with people to identify, utilize and build on their strengths, resources and resilience. I really like that. I like work with people to support and sustain their existing resources, assets, networks and relationships, and I really like facilitate people's self-management of their mental health. So it's that our behaviors should be values based and should support the person in their own like we were talking about before goal setting, but their goals, yeah, and just swing right back around to our earlier conversation.

Ellen: 16:09

We were saying, you know, holding around non-judgmental practice, and that we have values, and I think one of the things I wanted to add to that was that it's okay to you know, to be motivated by social justice, to be motivated because of your values and your experience, and that's what draws us in.

Ellen: 16:24

You know, linear allude to that, that it draws us into the field of practice often, that we want to do this, Sometimes really challenging work that makes us do quite a bit of soul searching. Sometimes, too, that's uncomfortable, it's hard work in that way, but that we're driven to do that because of our values and that we can use those positively. We might need to set them aside in our relationships and not use them to make the choices and that we make with people, but we don't have to let go of our judgments completely. We can be driven by them and they can support us effectively if we do a good amount of self-reflection and, knowing myself as well, that probably would be my takeaway. You know it's a big thing. That we've seen through these discussions too is the importance of understanding yourself first in the relationship. Tamara, I'd love to give you the final word Look.

Tamara: 17:05

I agree with everything that Ellen and Melissa said, and I think there's so many skills it's hard to break them down into a few. But I think what wasn't stated was to remain as adaptable as you can as a worker, that everybody is an individual. And again, you know you have that tools, but you're going to modify even the tools that you use to the individual and allow the individual to modify it. So again, you know, going back to the Lego aspect, is you know, say, look, here's an idea, how would you do it? How would you like to use it? I think you know the transparency is huge and this isn't. You know that you have to tell them everything about your life no, you have professional boundaries but that you're transparent about the process. And in that it's like you know, not using jargon, as Melissa sort of alluded, we have this sort of academic vocabulary that we use to bring it down to layman terms, so that it puts us on equal groundings, so people don't feel like, oh, you're the expert and I'm you know nothing, I'm just the person in need of help here.

Tamara: 18:11

And patience, I think patience is huge. I know working with a lot of clients. I had one client that you know, it took about a year working with him to motivate him and there was lots of challenges there. But once we actually started making a little chip into sort of moving forward, things started to flow and then it was like a river. It just kind of kept gaining momentum from a trickling stream into a river. So I think you know a lot of us get really frustrated in the sense that we think, oh my God, this is so simple. If you just do this in this, you know you'll make progress and forward. But for a lot of people it feels unsafe, it feels unnatural, it goes against the habits that they've formed for years. So patience is you know, really, really valuable, amazing.

Ellen: 18:57

Thank you all so much for your time. It's been great having you.

ermha365: 19:02

You've been listening to Get Real Talking Mental Health and Disability, brought to you by the team at erma365. Get Real is produced and presented by Emily Webb, with Karenza Louis Smith and special guests. Thanks for listening and we'll see you next time.

Ellen: 19:19

erma365 provides special support for people with complex mental ill health and disability.

ermha365 : 19:26

Established by consumers in 1982, today, erma365 is proud to deliver services across Victoria and in the Northern Territory. Find out more at Irmaorg. That's E-R-M-H-A dot org.