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Therapeutic alliance

At its core, therapeutic alliance is the relationship between health professionals and their patients. In other words, professionals treating your loved one must establish a trusting relationship with them to ensure effective treatment. These professionals have a wide variety of expertise and may include psychiatrists, general practitioners, nurses, social workers, psychologists, occupational therapists, special educators and others. All of these professionals work to assess, treat and track the progress of your loved one. What about your role as an assistant, as mentioned in the CAP Model? What expectations do you have of these professionals? What obstacles will you encounter? What approach should you adopt? These are all extremely important questions, as the answers affect how well you can participate in your loved one’s recovery process.


How can I help?

Always remember, you have control over your involvement. No one can force you to take on a role you don’t want to play. However, if you wish, you can provide emotional and/or material support to your loved one as an assistant. To do this, it is important to establish contact with the care team.
The help you provide can take many forms. Family members often provide support in meeting their loved one’s primary needs for food, shelter, safety and love. In this regard, your knowledge of your loved one’s daily life and routines can provide significant support to the professional care team since they did not know your loved one prior to the onset of their illness. Their academic background allows them to recognize and understand the illness, but they do not know your loved one as a person. It is a good idea to team up with the professionals, but remain vigilant about your boundaries, because all assistants run the risk of becoming exhausted and isolated. If you try to meet all your loved one’s needs, you will quickly run out of steam. It’s a risk that should be taken seriously from the very beginning. Assisting your loved one means you are providing support to promote their recovery. Be careful not to fall into the trap of taking charge of your loved one’s life, because it can interfere with their recovery and affect your own physical and/or mental health.


How do I get involved in my loved one’s treatment?

One of your strengths is the quality bond you have with your loved one. It is a personal relationship that no one can match since it is based on family ties and friendships. In your own way, depending on the bond that unites you and your commitment to them, you become a beacon, or an essential, reassuring reference to them. In this regard, your involvement with the health care team is desirable but will need to adhere to the following realities :

  • Professionals and families come from two different worlds
  • Unless they are found to be unfit (unable to care for themselves), your loved one has the right to make decisions that affect them
  • Professionals will always work in the interest of their patients
  • Professionals have little time to devote to you

These facts allow you to gain a better understanding of the challenges you will encounter and, more importantly, the approach you will need to use to make yourself heard. Here are some steps you can explore :

  1. When you find the right time, converse with your loved one. Let them know what help you can offer to support them in their recovery. Let them know the role you want to play as an assistant. If they agree, ask them to notify members of their treatment team. Then, when you meet with your loved one’s care team, explain the reasons why you are interested in obtaining information about their progress.

Here are some convincing arguments for why you want to be involved :

  • You can help maintain the therapeutic relationship
  • You can be a source of information on your loved one’s progress and their daily habits, attitudes and behaviours
  • You are able to recognize the warning signs of a relapse
  • You are a positive source of motivation
  • You acknowledge your loved one’s right to confidentiality regarding aspects of their personal and emotional life

To make it easier to collect, keep a list of the information you want to share during your meeting with the professional and decide which questions you want to ask based on the time available.

  1. If your loved one refuses your involvement with the care team, there is no point in insisting. You must respect their reasons, comfort level and decisions. However, you may wish to involve their psychiatrist or caretaker. Depending on the circumstances, one of them may have the power to influence your loved one’s decision.
  2. Regardless of your loved one’s permission, you can always pass on information about their attitudes and behaviours that you consider relevant. In addition, you can ask non-confidential questions about the services provided by the facility and the symptoms of mental illness.


What are my biggest obstacles?

Confidentiality measures, professional secrecy and obtaining your loved one’s permission to be involved in their recovery are the biggest obstacles you will encounter when it comes to gaining access to information about them.

  1. Confidentiality. This refers to an individual’s right to privacy. Without your loved one’s permission, employees or professionals working in a facility or community organization may not disclose confidential information to you about your loved one, whether it is on file or not.
  2. Professional secrecy. This is required for all members of a professional organization, except in the case of an emergency, such as preventing an act of violence, or if the person is deemed incompetent. Professional secrecy means that professionals are obliged to withhold all information relating to your loved one’s diagnosis, test results, treatment, evaluation, etc.
  3. Obtaining your loved one’s permission. For many reasons, regardless of whether you think they are good or bad, your loved one may refuse your involvement in their care. Despite the pain and inconvenience caused by this decision, you must respect their choices.


Things to remember

Although this legislation exists to protect everyone, you may be particularly affected by not being able to access information about your loved one. It may seem as if you are unimportant or not being recognized for the support you provide. Don’t take things personally, and never doubt your role as an assistant in your loved one’s recovery. You are an important person. However, you must be patient, respect professional boundaries and accept that the care team will not want to break the bond of trust they have with their patient. Always remember that you have the right to provide information about your loved one and receive information on topics that are not confidential.

Source : CAP santé mentale and UNAFAM. L’Indispensable.

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