Leadership in Psychiatry

Dinesh Bhugra, Pedro Ruiz, Susham Gupta, Dinesh Bhugra, Pedro Ruiz, Susham Gupta

• Publisher: Wiley-Blackwell
• Year: 2013
• Print ISBN: 9781119952916
• eBook ISBN: 9781118570036
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

The psychiatric profession must ensure that its next generation of leaders has the appropriate skills to provide mental health services in the face of globalization and urbanization, new technologies, and competing demands for shrinking resources. Developing leadership skills and leaders is critical in order to optimise the use of resources, their application, service planning and delivery of services for patients and their families.

This is the first book on leadership (rather than management skills) to focus on psychiatry and mental health care. Contributions from international experts with clinical and non-clinical backgrounds pull together the theories and practical skills required to be a successful leader. The aim is to guide mental health professionals in general and psychiatrists in particular on how to gain the relevant skills and on how to utilise these skills and training to take on leadership roles in clinical and organisational settings.

The book covers the role of the leader and the skills required for leadership, including chapters on communication, decision-making, team development, mentoring, gender issues in leadership, burnout and more. It includes a section on assessment tools and learning material. Essential reading for all those who aspire to lead in psychiatry!

Part B

Skills Required for Leadership

Chapter 7

Communication

Levent Küey

Introduction

Among the various fundamental assets of good leadership, the quality of communication seems to be the most emphasized. Thus, effective communication could be considered as a primary attribute for good leadership; conversely, the quality of leadership depends on the quality of communication.

This chapter will mainly focus on the communication skills of a psychiatrist in the contexts of his/her work roles and environment and leadership skills.

What is communication?

Communication is defined as ‘a process by which information is exchanged between individuals through a common system of symbols, signs, or behaviour’.1 So, it is an exchange and sharing of a common system or set of symbols (e.g. language) or behaviour aiming to construct meaning. Communication is the process of interchanging such symbols between the sender(s) and receiver(s) by a wide range of means and modes in a milieu; thus the information-loaded messages are shared by the parties involved. In fact, the Latin origin of the word (communis) meaning ‘to share’, implies that the communication is completed only when the messages are perceived by the receiver. A social setting provides the context or the milieu for this social interaction, namely communication, for which at least two interacting agents are needed.

A complete communication cycle embraces, at least, the sender, the message and the receiver. Furthermore, any communication also holds certain basic elements, namely:

1. who – the person conveying the message;

2. what – the message itself;

3. to whom – the person(s) receiving the message;

4. how – the medium and the means by which the message is conveyed;

5. when – the timing of the message;

6. why – the aims of the message;

7. outcome – the effects of the message.

Communication as a scientific discipline

Communication as a scientific discipline and communication studies as an academic field are institutionalized across the world in many universities. The field covers a range of topics also reflecting the taxonomy of communication. Various types of communication can be classified from different standpoints, including:

• verbal and non-verbal communication;
• interpersonal, intrapersonal or organizational communication;
• intercultural and international communication;
• written, mass- or computer-mediated communication;
• face-to-face or long-distance communication.

The interpretations of communication in its context of political, cultural, economic, semiotic, hermeneutic and social dimensions are also the focus of many researches in this field. Different scientific disciplines prefer to use different classifications according to their aims and scopes.

The importance of communication for a psychiatrist

A psychiatrist can attain different professional roles for which communication skills are profoundly important to fulfil his or her aims. Working as a clinician, as a group leader of the mental health team or an interdisciplinary health team, as a researcher, as an educator, as a mentor, or as a leader in departments and organizations – all these different roles and service settings require successful communication. Yet, very few studies have been published specifically on the leadership roles of psychiatrists and the role of communication in improving their professional leadership qualities.2

In the field of mental health and psychiatry, verbal and non-verbal communication in an interpersonal face-to-face context becomes a priority. However, different modes of communication are used in modern psychiatric practice, besides face to face, including telephone, hands-free telephone, videoconferencing, and internet-based or tele-psychiatry.3, 4

In clinical settings, the main mode of communication is an interpersonal, face-to-face type involving the exchange of verbal and non-verbal messages, and influenced by various confounding factors. Hence, discussion of the features of communication taking place in the clinical setting will be presented under the following subheadings: interpersonal communication in the clinical setting; verbal and non-verbal communication in the clinical setting; and communication turning into therapeutic alliance in the clinical setting; in the last section, the communication skills for effective leadership of a psychiatrist will be deliberated.

Interpersonal communication in the clinical setting

The relation between the psychiatrist and the patient is a human interpersonal interaction set by the demands of the patient for a specific reason, namely to diminish the suffering of the patient. This aim shapes the rules and the forms of communication between the two paties. It is mainly a verbal and non-verbal communication relying on the impact of exchange of words and signs or behaviour. Some of the basic characteristics of psychiatrist-patient communication in the clinical setting can be discussed as below, also taking into consideration the general rules of basic interpersonal communication.

Psychiatrist-patient communication in the clinical setting has a clear predetermined aim, namely a therapeutic outcome for the benefit of the patient. Hence, communication turns into a therapeutic alliance in the clinical setting. Further, communication between psychiatrist and patient in this setting is inevitable. Once the interview or the clinical encounter between the psychiatrist and the patient starts both parties send and receive verbal and non-verbal messages and interpret what they have been exchanging.

The communication is an interactional joint process. Although the basic principles and framework of this communication are determined by the theoretical orientations and practice of psychiatry, it is constructed and reconstructed by both sides in the interchanging roles of sender and receiver.

Communication in this setting is also a continuous and irreversible process. The exchange of messages is a continuous flow of profoundly mingled verbal and non-verbal symbols and signs. The psychiatrist and the patient constantly express messages, and once expressed, no words or behavioural signs can be reversed. Every expression by the sender in this communication creates an impression on the receiver in a dialectical manner. None of these expressions or impressions can be deleted afterwards.

Communication in this context is a multifaceted process. The psychiatrist and the patient, although interacting as two real persons, are also both acting and reacting to each other via the imagined and internalized other. On both sides, there is a self, as well as a perceived self and an expressed self. In this sense, the interview room is quite crowded.

Psychiatrist-patient communication in a clinical setting is open to misunderstandings. Each verbal or non-verbal symbol used in communication is loaded with different meaning by either party. Interpretation and reinterpretation of the messages exchanged are inevitable components of communication in clinical settings, and it is the responsibility of the clinician to decode and clarify the conveyed meanings as much as possible.

The characteristics of the clinical setting provide the context of the interpersonal communication between the patient and the psychiatrist. The physical design of the interview room, and the psychological and cultural milieu provide the foundations of the communication, to be built on accordingly. The placement of chairs and the distance between them; the attitude of the clinician – whether authoritarian or liberal – or his/her cultural sensitivity and compatibility will lead to different styles of communication. Patient and psychiatrist sitting knee-to-knee in a small room, or the psychiatrist sitting in an armchair behind a walnut antique table and the patient sitting on a plain chair in front, would each create different interactional dynamics and communication styles.

The therapeutic outcome of the clinical encounter depends on the clarity of the communication, which is primarily the duty of the clinician. At times, this clarity can be hard to establish due to the psychopathology of the patient, besides the factors related to the communication skills and competency of the clinician.

Verbal and non-verbal communication in the clinical setting

The clinical setting is full of verbal and non-verbal messages, just as the sky is full of sparrows in a clear Mediterranean summer daybreak. Words and behaviours as the main means of exchanging messages between patient and clinician fill up the clinical milieu. The clinician's task is to distinguish and guide these little birds. For early career professionals this might seem like an impossible task. The clinician facing this challenge tries to identify, interpret and redirect these flying messages. The words, the conceptual constructs, loaded with overt and implied meanings, and the expressed behaviours on both sides need to be perceived and utilized for therapeutic purposes.

In a real-life situation the verbal and non-verbal communications are not two separate and independent processes; this division is made for the sake of analysis and improving our understanding from a methodological perspective. They are in fact contradictory and complementary means of message exchange. In a clinical setting, it is vital for the clinician to understand and explain the interaction of the verbal and non-verbal messages conveyed by the patient. Harmony or disharmony among the verbal and non-verbal messages can provide valuable clues. It is an important element of the psychiatric examination in assessing the mood and affective responses of the patient, which are mostly reflected by the non-verbal expressions.

On the other hand, verbal messages or the speech of the patient express the flow and content of thoughts. Here, it is not our aim to further discuss the steps and rules of psychiatric assessment, but it should be noted that a thorough understanding of the verbal and non-verbal messages expressed by the patient is crucial for a complete assessment of the mental status and emotional life of the patient. Furthermore, when it comes to the task of improving the efficiency of therapeutic interventions, the quality of the communication and the evaluation of the verbal and non-verbal messages of both sides should be followed and managed very closely by the clinician. Psychotherapy is a process of working through the meanings of communicated and even non-communicated messages. It is widely accepted that in a clinical encounter in psychiatry, considerable emphasis is placed not only on the content of the patient's verbal messages but also on observing the patient's interactions with the environment and the psychiatrist.5 On the other hand, clinicians themselves must also be aware of their own non-verbal communications, since these can either enhance or harm the therapeutic quality of the relation.

Verbal communication

Verbal communication uses language, as an ever-evolving human-made tool, that is learned, accepted and shared by a specific group of people. It is a system of vocal and written symbols and the primary vehicle for the conveyance of meaning. Humans are not born with knowledge of a language but with the mental capacity to learn a language, by which we are socialized in a specific cultural context.

Language not only reflects what is in our minds but also reconstructs our way of mental being. As Souba says:

This idea that reality is constituted in language is core to an ontological approach to leadership. Language reframes our ...

Table of contents

• Cover
• Title Page
• Copyright Page
• List of Contributors
• Preface
• Part A: The Role of the Leader
• Part B: Skills Required for Leadership
• Part C: Learning Materials
• Index