Engagement and Therapeutic Communication in Mental Health Nursing


Sandra Walker

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  • Back Matter
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    One thing that can never be overlooked in mental healthcare is the complexity of human beings. Unfailingly individual, we all operate from a comprehensive array of cultural backgrounds and beliefs; various levels of knowledge and understanding; differing likes and dislikes; diverse life experiences and multiple behaviours. Learning to navigate these differences and managing to connect with others despite them, is one of the hardest tasks ahead of us in our quest for high quality care for those in mental distress. Research has consistently shown that it is the human relationships we develop that have the biggest impact on recovery in mental healthcare; successful engagement and therapeutic communication are essential in order to help people find their way out of the maze of problems that may have beset them.

    This book offers many practical suggestions as to how to ensure we successfully engage with those in our care, underpinned by a broad base of theory and evidence. The principles of person-centred recovery, validation, respect and dignity are themes that are interwoven throughout the chapters. The book provides practical exercises that will help the reader to develop a stronger sense of self both as a person and a professional while at the same time learning to put themselves in the shoes of the person they are caring for and always remembering that it is their values, not ours, that must direct our action.

    There are two outstanding themes, however, that bear further consideration as you embark on reading this text. The importance of self-awareness is a recurring theme throughout the chapters. It is essential that we are aware of our own cultural background, our own values, beliefs and attitudes, our non-verbal body language, our limitations and when we need to ask for help. The importance of supervision and reflective practice support this and are repeatedly highlighted as hallmarks of best practice. Additionally, curiosity is another, often reoccurring, theme. It is the way to ensure we are not hijacked by our own standpoint. To ask gentle probing questions of the position of the person in distress, to maintain a respectful curiosity in the face of behaviour we find difficult to understand, is key in helping us to work collaboratively with people to help them recover. The importance of these two themes cannot be underestimated.

    If you are a student nurse, a newly qualified nurse or even a nurse of some years’ standing looking for tips to update your portfolio of skills, this book will stand you in good stead for practice. It can be read as a whole but can also be dipped into section by section as you come across situations in practice, perhaps, that warrant further exploration of that particular subject. Engaging with this book will help you to become a more effective practitioner of the art of mental health nursing, enhancing your ability to connect with people of diverse backgrounds and needs.

    Sandra WalkerApril 2014


    The authors and publisher wish to thank the following for permission to reproduce copyright material.

    Open University Press for the nursing qualities displayed in Figure 1.1, from Megan Ellis and Crispen Day (2013) The therapeutic relationship: engaging clients in their care and treatment, Chapter 12 in Norman, IJ and Ryrie, I (eds) The Art and Science of Mental Health Nursing: Principles and practice, pp172 and 174.

    David A Richards and Mark Whyte (2011) for Figures 4.1 and 4.2, Funnelling, reproduced with kind permission from Reach Out: National Programme Student Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions (3rd Edition). London: Rethink.

    About the Authors

    Peter Bullard is the Accredited Psychological Wellbeing Practitioner (PWP) Quality Lead for the Isle of Wight Primary Care Mental Health service. He works with individuals suffering from anxiety and depression, and delivers low-intensity CBT interventions through different modalities. He graduated from Southampton University in 2010 and has worked on the course as a clinical educator since that year. He has an MSc in Transcultural Mental Health and Psychological Therapies. Before working in mental health services he had a background in physical fitness, completing his degree in Health and Fitness management, and working as an instructor and trainer in many different healthcare settings. He strongly believes in the value of combining therapeutic approaches with the application of improving well-being for individuals experiencing mental health problems.

    Simon Grist is a Lecturer in Mental Health and Programme Lead for the Improving Access to Psychological Therapies Psychological Wellbeing Practitioner programme at the University of Southampton. A qualified mental health nurse and CBT therapist, prior to working at the university he was a CMHT manager, working extensively in crisis and home treatment teams and in substance misuse services.

    Yvonne Middlewick has been a mental health lecturer within the University of Southampton for six years. A dual registered nurse, RGN and RMN, she has had a varied career working with people of different ages. She started her career in a gynaecology and breast surgery unit, where she cared for people with complex psychological as well as physiological needs, rekindling her interest in mental health. As a result, she completed a post-qualifying mental health course at Bournemouth University, and later worked with older adults in a mental health setting before returning to an adult nursing environment to work with older people. Experience from both settings has helped Yvonne to holistically care for older people with complex needs.

    Dorothy Neal is a pseudonym used, at her request, to protect the identity of the service user who co-wrote her chapter. She has a long history of mental health problems as well as a full and active family life plus a love of dancing.

    Julia Pelle is a Senior Lecturer in Mental Health Nursing at Kingston University and St George's University London. She currently teaches on culture, ethnicity and diversity in mental health and social care to pre- and post-registration students. Julia maintains a research interest in family carers from Black and Ethnic Minority communities who care for relatives with an enduring mental health problem. She also worked as a Senior Nurse in an acute inpatient mental health setting before moving into health and social care education.

    Wendy Turton (RMN, MSc, BABCP Accred. Cognitive Therapist) is currently a Lecturer in Mental Health within the Faculty of Health Sciences at the University of Southampton and the Senior Psychological Therapist with a Mental Health Recovery Team in Portsmouth. Wendy trained in Leicestershire on an integrated Mental Health and Learning Disability nursing programme, choosing to focus her career on mental health, and in recent years on severe and enduring mental health problems, in particular the experience of psychosis. In 2004 Wendy set up the Psychosocial Interventions for Psychosis Service (PSIPS) within South East Hampshire, which she led for nine years. During this time Wendy was involved in clinical research, exploring the efficacy of Person-based Cognitive Therapy for Distressing Psychosis (Chadwick, 2006) and co-authored two award-winning short books on the experience of living with psychosis with MH service users; her ongoing research continues to focus on the lived experience of psychosis. Wendy also works with the CBT Programme Team at the University of Southampton.

    Sandra Walker is a Senior Teaching Fellow in Mental Health at Southampton University, where she is also a doctorate student researching the patient experience of the mental health assessment in the Emergency Department. She is a Qualified Mental Health Nurse with a wide range of clinical experience spanning more than 20 years. In addition to her university work, she is a professional musician and does voluntary work for various mental health organisations, including being the coordinator for the Hampshire Human Library – an international initiative aimed at reducing stigma through interaction and education of the public. She is the creative director of The Sanity Company, which publishes books aimed at helping children and young people develop good mental health and problem-solving skills.

    Janine Ward is an accredited Psychological Wellbeing Practitioner (PWP) and Mental Health Practitioner by background and has worked within forensic mental health, learning difficulties, community mental health and substance abuse teams. Janine currently leads the Southampton Improving Access to Psychological Therapies Low Intensity and Assessment Team and provides some clinical leadership across her employing Trust. She is seconded as a PWP educator at the University of Southampton and has worked within the Health Sciences Faculty for the last three years. Janine is currently studying for her PhD at Southampton.

    Andy Williams joined the Royal Navy at 18 and served for 22 years, during which time he trained as a Registered General Nurse and later a Registered Mental Nurse. Andy is a Master of Arts in Mental Health and a Bachelor of Nursing with Education in order to register for the education of nurses. On leaving the service, Andy secured a senior lecturer post with the MOD before accepting a post at Southampton University.

    Andy's teaching interests are in interpersonal and communication skills, bereavement and loss, post-traumatic stress disorder, spirituality, adult mental health, particularly around anxiety and depression, suicide and self-harm. He is involved in nurse education in pre- and post-qualifying programmes and IAPT education.

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