Relationship-centered care (RCC) is an important framework for conceptualizing . to know their patients, and RCC encourages clinicians to grow as a result. . to dictate by definition how much of a given attitude or behavior is optimal in practice. For example, in RCC, a particular physician behavior, like self- disclosure. Self-disclosure is a process of communication by which one person reveals information about Both are crucial in developing a fully intimate relationship. Most self-disclosure occurs early in relational development, but more intimate . We often perceive our own self-disclosure as higher than our partner's, which can lead. But this self-disclosure entails more than how much you are willing to tell Self- disclosure may be more limited in the early stages of a new.
Delivery systems began using patient reports of care experience as one of the parameters for characterizing the performance of clinicians, groups, and delivery system subunits. The Association of American Medical Colleges included population-based knowledge and skills among its key objectives for medical school education. Patient reports are also used as a means of evaluation in residency programs, organizational accreditation, professional certification, and re-certification in certain disciplines.
When the Pew-Fetzer Task Force set to work, it was also apparent that the philosophic framing of medical care was ripe for reconsideration. Soon after, patient-centered interviewing 9 was adopted as the standard for effective patient—physician communication, and remains so to this day.
Rhetoric aside, many social scientists had long been observing that the balance of power and discretion in medical care was precisely that—care centered on the preferences and values of the doctor. Noting patients' and clinicians' discontent with, and even alienation from, prevailing systems of care, the Task Force sought to develop a values foundation for the work of the health professions. In the current era just as in the pastthe social role and privileges of the healer seemed to be founded upon meaningful relationships in health care, not just on technically appropriate transactions within these relationships.
Principles of Relationship-Centered Care Relationships provide the context for many important functions and activities in health care.
Within relationships, we exchange information, allocate resources, arrive at diagnoses, choose treatments, and assess the outcomes of care. None of these is carried out solely by 1 party; all are mediated by the qualities of the manifold relationships that link patient, clinician, team, organizations, and community.
Relationship-centered care RCC is built upon 4 related principles that are described below. Relationships in Health Care Ought to Include Dimensions of Personhood as Well as Roles In the clinical encounter, RCC makes explicit that both the patient and the clinician are unique individuals with their own sets of experiences, values, and perspectives.
In RCC, clinicians remain aware of their own emotions, reactions, and biases, and monitor their own behavior in light of this awareness. In addition to the explicit recognition that clinicians bring their personhood into the encounter, RCC emphasizes the importance of authenticity, in the sense that clinicians should not, for example, simply act as if they have respect for someone; they must also aim actually to have internally the respect that they display externally.
Affect and Emotion Are Important Components of Relationships in Health Care Relationship-centered care recognizes the central importance of affect and emotion in developing, maintaining, and terminating relationships. In RCC, emotional support is given to patients through the emotional presence of the clinician. Relationship-centered care therefore challenges the notion of detached concern, in which stepping back to maintain affective neutrality breaks the bond that holds people together.
Rather than remaining detached or neutral, clinicians ought to be encouraged to empathize with patients, because empathy has the potential to help patients experience and express their emotions, 1213 to help the clinician understand and serve the patient's needs, 14 and to improve patients' experience of care. All Health Care Relationships Occur in the Context of Reciprocal Influence Health and health-related actions do not occur in isolation but are related to one another in time, space, and content.
As such, the smallest unit of measure in RCC is an interactional exchange. Furthermore, clinicians are undoubtedly benefited by the opportunity to know their patients, and RCC encourages clinicians to grow as a result.
While achievement of the patient's goals and the maintenance of health are the more obvious focus of any encounter, allowing a patient to have an impact on the clinician is a way to honor that patient and his or her experience.
RCC Has a Moral Foundation The formation and maintenance of relationships in health care is morally valuable for several reasons.
First, unlike customer relations in which individual and organizational gain are paramount, genuine relationships are morally desirable because it is through these relationships that clinicians are capable of generating the interest and investment that one must possess in order to serve others, and to be renewed from that serving. Although one could argue that physicians have fiduciary duties to patients that arise through some sort of contract rather than through the formation of a genuine relationshipit tends to be true that, humans are more morally committed to those with whom they are in a personal relationship.
Furthermore, rather than considering this partiality to be a moral weakness, some have argued that such enhanced commitment to those with whom we have a personal relationship with is morally desirable.
This sort of honesty is morally desirable as an end in itself, and it allows the patient to assess her impact on the clinician accurately, rather than being misled by a particularly good role performance. Dimensions of RCC In suggesting that an explicit focus of care ought to be on relationships, we embrace and expand the principles of patient-centeredness within the patient-clinician relationship, and we also consider the relationships of clinician-clinician, clinician-community, and clinician-self as foundational and intrinsic to health care.
Below, we provide a general description of these dimensions of RCC. In the table, we have highlighted the areas of RCC that we also consider to be part of patient-centered care. Monitor the state of the relationship Acknowledge the importance of the relationship to one's own well-being Outcomes Patient feels honored, respected, attended to, etc.
The elements listed in Table 1 are those that we consider to be integral to RCC. There are many other variables attitudes, behaviors, personal characteristics, outcomes that might be correlated with RCC, but are not central to their definition. For example, future research might explore the question of what kinds of life experiences and educational approaches lead to the adoption of an RCC outlook, or under what circumstances RCC-related behaviors have the best impact race- or gender-concordant dyads, or routine vs emergent care, for example.
Whatever those experiences or circumstances are, they are correlates of RCC and not part of the definition. Similarly, the anticipated outcomes of RCC are not included among its defining elements.
Whether, and under what circumstances, RCC leads to favorable outcomes is an important empirical question for future investigation, but the achievement of favorable outcomes is not its defining feature. The elements described in Table 1 are also intended to be illustrative rather than comprehensive, in that there are many more attitudes and behaviors that could be added. Some omitted variables may be nested under the more general elements listed, meaning that they are not so much left out as simply embedded in the higher-order concepts listed.
While each bullet may appear to be a static category, we recognize that thinking, feeling, and action are interactive processes. For example, we value partnership with patients and we show this by reflecting on what matters most to them.
One final point is to acknowledge that it is not possible to dictate by definition how much of a given attitude or behavior is optimal in practice.
Clinician-Patient Relationship Relationship-centered care recognizes that the clinician-patient relationship is the unique product of its participants and its context. In RCC, the quality of communication between patients and clinicians is not viewed as a result or outcome of 1 single party, but as an interactive process that is dependent on the efforts of both participants. Even a particular doctor and patient who work together over a significant period of time or through changing circumstances are likely to need to adjust to the ways in which they come together and work over time.
Clinician-Clinician Relationship Relationship-centered care recognizes that the relationships that clinicians form with each other, especially within hierarchical organizations, contribute meaningfully to their own well-being as well as the health of patients. The energy and enthusiasm that a practitioner brings into the consultation with a patient is profoundly influenced by the practice and larger organization's values and integrity.
Relationship-centered care emphasizes that clinicians ought to listen, respect colleagues, appreciate the contributions that colleagues from other disciplines bring, promote sincere teamwork, bridge differences, and learn from and celebrate the accomplishments of their colleagues. Relationship-centered care emphasizes the importance of practitioners' relationships with communities of patients such that the practitioner understands the local community dynamics, appreciates the importance of the community in contributing to the health and well-being of its members, and participates in community dialogue and development.
To state the obvious, entering into any positive relationship with others first requires self-awareness and integrity. Working to improve someone else's health, furthermore, requires a resourcefulness and resilience on the part of the clinician that has its deepest roots in the practitioner's right relationship with self and self well-being. Given our frenzied lives, and the objectivist, positivist stance that pervades our scientific culture, it may be difficult to find and sustain the time and will for reflection on self and well-being.
In the words of the Pew-Fetzer Task Force report: Thus, self-disclosure breeds intimacy. It is hard for humans to accurately judge how fully another is disclosing to them. Although self-monitoring is measured on a continuous scale, researchers often group individuals into two types: Someone who is a high self-monitor tends to examine a situation more closely and adjusts their behavior in order "fit in" with others in the scenario. High self-monitors tend to behave in a friendlier and extroverted manner in order to be well liked by peers.
A low self-monitor does not do this and tends to follow their own emotions and thoughts when behaving in public. By noticing these cues, high self-monitors tend to reciprocate equally in their self-disclosures.
It can also be explained by social exchange theory. Research shows that high self-monitors are more uncomfortable when paired with a low self-monitor because low self-monitors do not tend to disclose intimate details so the balance in the conversation is uneven. High self-monitors are also shown to be the "pace-setters" of the conversation and generally initiate and maintain the flow of a conversation. This may be because of informational effects whereby happy people tend to access more positive information which leads them to behave in a more optimistic and confident manner.
Unhappy people tend to access more negative information which increases the likelihood of cautious, pessimistic and restrained communications. Assimilation effects rely on an individual's prior knowledge to guide their behavior in a situation and accommodation effects rely on careful monitoring of a situation and a greater attention to concrete information. Assimilative processing is ideal for safe, routine situations while accommodative processing is for problematic situations.
Happy people tend to use assimilative processing, which leads to more daring and direct disclosures, while unhappy people use accommodative processing, which leads them to be more cautious in their disclosures. These accommodating effects for unhappy people tend to increase reciprocity because these individuals will match the level of disclosure from their partner but will not go beyond that.
The exception to this is lonelinessfor lonely individuals have shown decreased rates of self-disclosure. Androgynous people disclose more intimately across contexts than do notably masculine and feminine people. Women self-disclose to enhance a relationship, while men self-disclose relative to their control and vulnerabilities.
Men initially disclose more in heterosexual relationships. Women tend to put more emphasis on intimate communication with same-sex friends than men do. While people with high self-esteem tend to reveal themselves more, the reverse is also true, where self-esteem is enhanced by a partner's disclosures. For both genders, the state of a relationship and the feelings associated with it are major contributors to how much each spouse reveals himself or herself. Husbands and wives in a relationship marked with satisfaction, love, and commitment rate their own levels of disclosure highly as well as their perceptions of their spouses' disclosures.
Among men, those who are or appear more "tough" are less likely to disclose and express themselves. We like to present ourselves in ways that we feel are congruent with our own self-conceptsand what we tell others about ourselves often becomes how we actually are.
This allows an even deeper level of understanding between two people and fosters even more intimacy as a result of the disclosures. Likewise, relationship satisfaction was found to correlate with sexual disclosures. For men, high levels of sexual self-disclosure predicted higher relationship satisfaction, though this was not found to be true for women. But, sexual satisfaction was linked to higher levels of sexual self-disclosure for both men and women. Further, those who disclose more sexually have been found to have less sexual dysfunction.
Partners learn a shared communication system, and disclosures are a large part of building that system, which has been found to be very beneficial in highly satisfying relationships. Surveys done by a variety of researchers have found that people list marriage as the ultimate form of intimacy. Spouses feel responsible, in that they need to be responsive to their partners' self-disclosures, more so than they feel obligated to respond to the disclosures of people in their other relationships.
The results show that the actual disclosures in the process of self-disclosure may not be the only factors that facilitate intimacy in relationships. Husbands' intimacy was most strongly predicted by self-disclosure, while perceived responsiveness to disclosure was the stronger predictor for wives' feelings of intimacy with their husbands.
Those who think their husbands are not sharing enough are likely to break up sooner. This finding links to the idea of positive illusions in relationship studies. On the other hand, wives are thought to value more the feelings of being understood and validated by their husbands' responsiveness to their disclosures, and this is the more important factor in their feelings of intimacy in their marriages.
Similarly, the wives who rated their global satisfaction highest also had higher levels of daily intimacy. Greater marital satisfaction was found among those who had the higher ratings of intimacy.
Further, couples with high levels of demand-withdraw communication rated their average daily intimacy as much lower. This suggests a relationship between one's overall marital satisfaction and the amount of intimacy in a relationship, though no causation can be proven with the present research.
Likewise, less intimacy leads to more negative disclosures between partners. The breadth of disclosure decreases with decreasing intimacy as originally predicted, but couples actually disclose more deeply. It is speculated that these results come about because a strained relationship causes spouses to restrict their topics of communication breadthbut that they are also more willing to discuss deeply intimate subjects: Thus, while they are sharing more deeply, it is mostly in a negative light.
The researchers then speculated that people might actually avoid disclosing very personal facts in the most satisfying relationships because they are fearful that their positive relationships will be negatively affected.
It is suggested that at this stage partners know each other quite well and are very satisfied with what they communicate already. Some speculate that disclosures and their respective responses from a spouse lead to intimacy between the partners, and these exchanges accumulate into global and positive evaluations of the relationship by the couple. In support, studies show that couples who report greater levels of intimacy in self-reports of their daily interactions are also those who report increased global relationship functioning in their marriages.
As a group gets larger, people become less willing to disclose. Research has shown that individuals are more willing to disclose in groups of two than in larger groups and are more willing to disclose in a group of three rather than four. The actual disclosures mimic the willingness to disclose as individuals disclose more in pairs than they do in the larger groups. There are also gender differences in disclosure depending on group size.
Men feel more inhibited in dyads, match the intimacy of the disclosure from their partner, and do not offer more information. Women, on the other hand, feel more inhibited in larger groups and disclose more personal information in dyads.
Self-disclosure by the therapist is often thought to facilitate increased disclosure by the client, which should result in increased understanding of the problem at hand. It helps to acknowledge the therapeutic relationship as a fundamental healing source,  as an alliance between client and therapist is founded on self-disclosure from both parties. In some respects it is similar to modeling appropriate social behavior.
Establishing common interests between therapists and clients is useful to maintain a degree of reality. Immediate disclosure shows positive views of the therapeutic process in which the two are engaging and communicates self-involving feelings and information about the therapist's professional background. Many see the benefits of this type of disclosure. Non-immediate disclosure, however, is the revealing of more about the therapist than his or her professional background and includes personal insight.
This type is rather controversial to psychologists in the present day; many feel it may be more detrimental than it is beneficial in the long-run, but there are significant findings that contradict this claim as well. Direct disclosures grant the client information about personal feelings, background, and professional issues. Indirect disclosures are those not explicitly granted, such as pictures on the therapist's desk and walls or wearing his or her wedding band.
The most common reasons are: The preferred therapeutic approach and the effectiveness of treatments are two of the most common. Many also reveal their views of raising children, stress-coping methods, items that convey respect for the client, and emotions that will validate those the client has expressed. Anecdotes about sexual attraction, dreams, and personal problems seem to be disclosed to subjects with the least frequency by therapists.
Early psychodynamic theorists strongly disagreed with the incorporation of therapist self-disclosure in the client-therapist relationship. Ferenczi notably maintained his belief that self-disclosure was of the utmost importance in children's therapy for traumas in that a neutral, flat therapist would only cause the child to relive the trauma.
Self-theorists believe much the same as object-relations theorists. Intersubjective and relational schools of thought encourage disclosure due to its ability to bring subjectivity into therapy, which they deem a necessary element to real healing.
They maintain that therapeutic relationships cannot be initiated and changed without intentional disclosures from both therapist and client. Humanistic theorists want to trigger personal growth in clients and feel that a strong relationship with a therapist is a good facilitator of such, so long as the therapist's disclosures are genuine.
Seeing that weakness and struggle are common among all people, even therapists, is useful to clients in the humanistic therapy setting. In order for existential psychologists to help clients, they try to disclose their own coping methods to serve as sources of inspiration to find one's own answers to questions of life.
For therapists who value feminismit is important to disclose personal feelings so that their clients have total freedom to choose the correct therapist and to eliminate power fights within the therapeutic setting.
The ever-popular cognitive-behavioral approach also encourages disclosure in therapy so that clients can normalize their own thoughts with someone else's, have their thoughts challenged, and reinforce positive expectations and behaviors.
Clearly, today's therapists are mostly supportive of disclosure in therapy, as the early psychoanalytic taboo of such is slowly being overridden through the recognition of many schools of thought. Most identify the benefit of self-disclosures in facilitating rewarding relationships and helping to reach therapeutic goals.
Certain types of disclosures are almost universally recognized as necessary in the early stages of therapy, such as an explanation of the therapeutic approach to be used and particular characteristics of the therapist.
It is thought that disclosing the details of a traumatic experience can greatly help with the organization of related thoughts, and the process of retelling is itself a method of healing. An understanding between therapist and client is achieved when the client can share his or her perceptions without feeling threatened by judgments or unwanted advice.
Further, expressing emotions lessens the toll of the autonomic nervous system and has been shown in several studies to improve overall physical health in this way.
The Pennebaker Writing Disclosure Paradigm is a method commonly used in therapy settings to facilitate writing about one's experiences. Exposure theory also offers support in that reliving and talking about a negative event should help the negative affect to be more accepted by the individual overtime through extinction.
Supported heavily is the idea of mutuality: The modeling hypothesis suggests that the client will model the disclosures of the therapist, thereby learning expression and gaining skills in communication.Dating Disclosure
Some argue for the reinforcement model, saying that the use of self-disclosure by therapists is purely to reinforce self-disclosure in their clients. Lastly, the social exchange hypothesis sees the relationship between client and therapist as an interaction that requires a guide: Studies have also shown the disadvantageous effects of keeping secretsfor they serve as stressors over time.
Concealing one's thoughts, actions, or ailments does not allow a therapist to examine and work through the client's problem. Unwanted, recurrent thoughts, feelings of anxiousness and depressionsleeping problems, and many other physiological, psychological, and physical issues have been seen as the results of withholding important information from others. Therapy sessions for personality disordersbehavior disordersimpulse control disordersand psychotic disorders seem to use therapist self-disclosure far less often.
Their likability was increased by their willingness to disclose to their clients. The three dimensions mentioned have been said to be of utmost importance when determining one's likability.
Additionally, a therapist who discloses too frequently risks losing focus in the session, talking too much about himself or herself and not allowing the client to actually harvest the benefits of the disclosures in the session through client-focused reflection.
Research shows that "soft" architecture and decor in a room promotes disclosure from clients. This is achieved with rugs, framed photos, and mellow lighting. It is thought that this environment more closely imitates the setting in which friends would share feelings, and so the same might be facilitated between counselor and client. Further, a room should not be too crowded nor too small in order to foster good disclosures from the client  Effectiveness[ edit ] The efficacy of self-disclosure is widely debated by researchers, and findings have yielded a variety of results, both positive and negative.
A typical method of researching such ideas involves self-reports of both therapists and clients. The evaluations of therapists on the positive effects of their own disclosures is far less positive than that of clients' self-reports.
Clients are especially likely to assert that the disclosures of their therapists help in their recovery if the disclosures are perceived as more intimate in content. Much of these results, however, are linked to how skilled the therapist is in disclosing. Therapists must choose wisely in what they disclose and when. A client who is suffering greatly or facing a horrific crisis is not likely to benefit much from therapist self-disclosures. If a client at any point feels he or she, should be acting as a source of support to the therapist, disclosure is only hindering the healing process.
Further, clients might become overwhelmed if their initial ideas of therapy do not include any degree of self-disclosure from their counselor, and this will not lead to successful therapy sessions either. It is also a risk to reveal too much about a therapist because the client may begin to see the healer as flawed and untrustworthy. Clients should not feel like they are in competition for time to speak and express themselves during therapy sessions. The American Psychological Association supports the technique, calling it "promising and probably effective".
Using "I" statementsa therapist emits a certain level of care not otherwise felt by many clients, and they are likely to benefit from this feeling of being cared for. In cases of a therapist needing to provide feedback, self-involving statements are nearly inevitable, for he or she must state a true opinion of what the client has disclosed.
These sorts of "I" statements, when used correctly and professionally, are usually seen as especially validating by clients. Largely, the use of self-involving statements by therapists is seen as a way of making the interaction more authentic for the client, and such exchanges can have a great impact on the success of the treatment at hand.
Spouses are encouraged, or even required, to disclose unexpressed emotions and feelings to their partners. The partners' responses are practiced to be nonjudgmental and accepting. Therapists utilize techniques like rehearsal and the teaching of listening skills. Some fear that this is of little long-term help to the couple because in their real lives, there is no mediator or guiding therapist's hand when one is disclosing to another.
Goals like these, as reported by young people fairly universally, can affect how they disclose to their parents to a large degree.
Some go so far as to use the rate of self-disclosure between parents and children as a dominant measure of the strength of their relationship and its health.
When information is withheld, distance is created and closeness is nearly impossible to facilitate. Teens pick and choose what to tell their parents, thus limiting their control over the teens' daily activities. Adolescents' unique preferences and interests are expressed.
If these vary from their parents', they establish an identity of their own. Thus, they moderate their parents' potential reactions. Because of this, it is important for parents to be aware of how they react to their children's disclosures, for these reactions will be used as judgment calls for the children's' future sharing.
Other times a reason is that the children do not want their parents to worry about them, and this is called parent-centered disclosures. Disclosing in order to make oneself feel better or to ensure protection from parents is considered to be another reason for youth to disclose, and it is called self-oriented disclosure.
On a more manipulative level, some adolescents report telling their parents things based solely on gaining an advantage of some sort, whether this is the right to reveal less or the fact that being more open tends to result in more adolescent privileges. Sometimes children qualify their disclosures by merely stating that they only disclose what they feel they want to their parents. Thus, some information is kept secret.
This is dubbed selective self-disclosure. In sum, adolescents feel different pulls that make them self-disclose to their parents that can be based on the parents' needs and the children's needs. There has not been a distinct pattern found to predict which reasons will be utilized to explain disclosures by different children. For this reason it is widely believed that the reason for disclosure is largely situation- and context- dependent.
Self-disclosure - Wikipedia
Parental knowledge of their children's whereabouts and daily lives has been linked to several positive outcomes. The more parents know about their kids, the lower the rate of behavior problems among children, and the higher the children's well-being. Adolescents who disclose have been found to have lower rates of substance abuselower rates of risky sexual behaviors, lower anxiety levels, and lower rates of depression. It has been shown that children's understanding of friendship involves sharing secrets with another person.
This mutual exchange of sharing secrets could be the norm of reciprocity, in which individuals disclose because it is a social norm. This norm of reciprocity is shown to begin occurring for children in sixth grade.
Sixth graders are able to understand the norm of reciprocity because they realize that relationships require both partners to cooperate and to mutually exchange secrets.
They realize this because they possess the cognitive ability to take another person's perspective into account and are able to understand a third person's views which allows them to view friendships as an ongoing systematic relationship.
Equivalent reciprocity requires matching the level of intimacy a partner discloses, therefore, a high-intimacy disclosure would be matched with an equally revealing disclosure while a low-intimacy disclosure would be matched with little information revealed.