8 Elements of social psychology and their role in activity of a doctor L/O/G/O Contents 1 Definition, meaning and function of dialogue, structure of dialogue 2 Communicative side 3 Interactive side 4 Perceptive side www.themegallery.com • In the professions connected to interaction "person to person", orientation to another as equal participant of interaction is important, especially the ability to humanistic, moral reaction in professional work of the doctor. As the object of research and the subject of interaction is the person, and character of knowledge is applied . • Bases of psychological knowledge are necessary for medical workers as they promote: to attentive and interested attitude of people to each other in treatmentand-prophylactic activity; to mutual trust arising on this basis; abilities to partnership, empathy, and hence, to mutual understanding. • The last is necessary because the medical worker and the patient together solve the same task preservations of health, prevention and treatment of diseases that assumes their cooperation and interaction, i.e. active dialogue. www.themegallery.com • «The doctor can seldom cure, he can facilitate more often, but he must always console», - the ancient speak. Competently established psychological contact to the patient helps to collect more precisely the anamnesis, to receive fuller and deep representation about the patient. If there is no psychological contact with the patient, probably, he will not adhere to medical recommendations and purposes. www.themegallery.com • In psychology dialogue is the process including transfer and information interchange, interaction and mutual understanding of people in developed system of public relations (G.M.Andreeva, 1975; R.K.Novikova, 1977) www.themegallery.com Dialogue is studied from three points of view: 1 Dialogue as the factor of formation of the person 2 Dialogue is studied as means of increase of efficiency of work and training 3 Dialogue is studied as the specific phenomenon www.themegallery.com Questions • • • • 1) Give a definition to the notion “dialogue” 2) From what points of view is dialogue studies? www.themegallery.com Structure of dialogue • Taking into account complexity of dialogue, it is necessary to designate its structure so that the analysis of each element was possible. G.M. Andreeva suggests to characterize structure of dialogue by allocation in it of three interconnected parties (sides): communicative, interactive and perceptive. Schematically the structure of dialogue can be presented as follows: www.themegallery.com Structure of dialogue (G.М. Andreeva) dialogue communication interaction Social perception www.themegallery.com Communicative side of dialogue • The communication in the narrow sense will consist in information interchange, in this case between the doctor and the patient. • The information is not only transferred, but also is formed, specified and develops. The special role for participants of dialogue is played with the importance of the information. • In structure of communicative process there are the following elements: • А) Communicator - the subject transmitting the information; • B) The recipient or communicant - the subject accepting the information and interpreting it; • C) A communicative field - a situation as a whole in which the information can be transferred; • D) Actually the information; • E) Channels of the communications - means of transfer of the information (verbal and nonverbal). www.themegallery.com • In conditions of human communications there can be communicative barriers because of an accessory to various social, age groups, owing to individual psychological features. • Distribution of the information occurs through the original filter of "trust" and "mistrust". Due to the filter a trustworthy information can be not accepted, and false - accepted. • Set of the means assisting to acceptance of information and weakening action of filters, name fascination (A.A.Brudniy). They are: musical, color support of speech and so forth. www.themegallery.com Nonverbal dialogue • The information can be transferred not only by means of speech, but also by means of all nonverbal behaviour including sights, a look, poses, an interpersonal distance, intonation of a voice and so forth. And visual contact and a pose frequently play more important role, than speech. • So a sight of the interlocutor expresses interest to conversation. The running sight speaks about boredom or about desire to speak (if only it does not express fear or feeling of fault). A steadfast sight, it is direct in eyes to the interlocutor, it is frequently perceived as aggression. However function of a sight depends on type of culture. www.themegallery.com Nonverbal dialogue www.themegallery.com www.themegallery.com Nonverbal communication • Feelings are expressed by body gestures. So the person shows openness if he faces with another man. Hostility is usually shown by pressure of a body, and sympathy in a relaxation of a body and an inclination forward. • The touch, voice in different cultures also are of great importance. So the quiet voice promotes removal of a pressure, and the "excited" voice is perceived as aggression. www.themegallery.com According to Mehrabian (1972) Face expression 55% 70 % 7% 38% Word meaning How words are pronounced www.themegallery.com Questions • 1) Name the structure of dialogue according to Andreeva. • 2) What do we understand under the communicative side of dialogue? • 3) What elements and structures of communicative side do you know? • 4) In what cases can a communicative barrier occur? • 5) What do we refer to non-verbal communication? www.themegallery.com Interactive side of dialogue • interaction consists in the organization of interaction between participants. • Different kinds of interaction: • - Cooperation and a competition; • - Coordinated interaction and disputed; • - « Assisting behaviour », designed to the aid of anothers and behaviour "loosening" joint activity. • The professional - physician (as well as professional teacher) should own skills of behaviour of the leader, and be capable to dialogical, nonmanipulative dialogue. • Conflict in interactive side of dialogue occupies a special place. www.themegallery.com What is conflict - understanding conflict • There are different ways to come with a definition of conflict. When speaking of conflict, what would immediately come into mind would most likely be how differences and disagreements make such an occurrence to spring up. Having that, let us have that question again, for the purpose of a more comprehensive discussion. www.themegallery.com What is conflict - understanding conflict • Hence, what is conflict? It can be described as a disagreement among groups or individuals characterized by antagonism and hostility. This is usually fueled by the opposition of one party to another, in an attempt to reach an objective different from that of the other party. The elements involved in the conflict have varied sets of principles and values, thus allowing such a conflict to arise. www.themegallery.com Conflict Management Styles • Considering the fact that we as individuals have different points of view, there will always be instances when misunderstandings will occur among us. With the arising of these intractable conflicts comes the need for conflict management. Even in seemingly ordinary situations, conflict may be rooted by other non-apparent reasons. Understanding the other sides of the issue would allow those involved to come up with an ideal resolution to the problem. In dealing with conflict, there are conflict management styles to be followed. The Thomas-Kilmann Conflict Mode Instrument, which is an assessment used globally in conflict handling, specifies five strategies used to address conflict. They are as follows: www.themegallery.com Accommodating • Accommodation involves having to deal with the problem with an element of self-sacrifice; an individual sets aside his own concerns to maintain peace in the situation. Thus, the person yields to what the other wants, displaying a form of selflessness. It might come as an immediate solution to the issue; however it also brings about a false manner of dealing with the problem. This can be disruptive if there is a need to come up with a more sound and creative way out of the problem. This behavior will be most efficient if the individual is in the wrong as it can come as a form of conciliation. www.themegallery.com Avoiding • In this approach, there is withdrawal from the conflict. The problem is being dealt with through a passive attitude. Avoiding is mostly used when the perceived negative end outweighs the positive outcome. In employing this, individuals end up ignoring the problem, thinking that the conflict will resolve itself. It might be applicable in certain situations but not in all. Avoidance would mean that you neglect the responsibility that comes with it. The other individuals involved might think that you are neglecting the problem. Thus, it is better to confront the problem before it gets worse. www.themegallery.com Collaborating • Collaborating aims to find a solution to the conflict through cooperating with other parties involved. Hence, communication is an important part of this strategy. In this mechanism, effort is exerted in digging into the issue to identify the needs of the individuals concerned without removing their respective interests from the picture. Collaborating individuals aim to come up with a successful resolution creatively, without compromising their own satisfactions. www.themegallery.com Competing • Competition involves authoritative and assertive behaviors. In this style, the aggressive individual aims to instil pressure on the other parties to achieve a goal. It includes the use of whatever means to attain what the individual thinks is right. It may be appropriate in some situations but it shouldn’t come to a point wherein the aggressor becomes too unreasonable. Dealing with the conflict with an open mind is vital for a resolution to be met. www.themegallery.com Compromising • Compromising is about coming up with a resolution that would be acceptable to the parties involved. Thus, one party is willing to sacrifice their own sets of goals as long as the others will do the same. Hence, it can be viewed as a mutual give-and-take scenario where the parties submit the same amount of investment for the problem to be solved. A disadvantage of this strategy is the fact that since these parties find an easy way around the problem, the possibility of coming up with more creative ways for a solution would be neglected. www.themegallery.com • Given the different conflict management styles, you might be thinking of the one style that would suit you the most. It is important to note that the strategy involved in coming up with a resolution is relative to the kind of the problem. www.themegallery.com Types of interpersonal dialogue • There are three various types: an imperative, manipulation and dialogue. www.themegallery.com Imperative dialogue • – an authoritative, directive form of influence on the partner with the purpose of achievement of control over his behaviour and internal installations, compulsion to certain actions or decisions. In this case the partner on dialogue is examined as an object of influence, acts as "passive" side. Feature of an imperative is the ultimate goal of dialogue compulsion of the partner - is not veiled. Instructions and requirements are used as means of influence. www.themegallery.com Imperative • It is possible to name the whole group of social activity where use of an imperative dialogue is quite justified both with target, and with ethical points of view. In professional work of the doctor the given type of dialogue takes place when the doctor, adhering models of interaction with the patient, directively appoints the certain medicines and course of treatment. www.themegallery.com Manipulation • a widespread form of interpersonal dialogue supposing influence on the partner on dialogue with the purpose of achievement of the latent intentions. Manipulative dialogue assumes objective perception of the partner on dialogue which is used by the manipulator for achievement of his purposes. Also manipulative dialogue has a purpose to achieve control over behaviour and ideas of other person. Radical difference is that the partner is not informed on the true purposes of dialogue; they either simply disappear from him, or are substituted by others. www.themegallery.com Manipulation • • • • Ways of manipulative behavior: - choose the moment of giving information; - subthreshold giving of information. Concealment of manipulative influences. Manipulation can be ascertained two kinds of concealment: concealment of the fact of manipulative influences and/or concealment of intentions of the manipulator. In this case the task of concealment is solved so cardinally, that the presence of influence can be found out only with the help of the special equipment. www.themegallery.com Manipulation • Sphere of allowed manipulation is business and business relations in general, a policy(politics), advertising, sphere of ideology. A symbol of such type of relations for a long time became the concept of dialogue of D.Karnegi and his numerous followers. It is widely distributed manipulative style of influence on partners on dialogue and in the field of propagation. • At the same time possession of means of manipulative influences on other people in business sphere is known, that, as a rule, the person carries such skills to other areas of the mutual relations. The relations constructed on love, friendship and mutual attachment strongly "suffer" from manipulation. Destruction of such communications and substitution by others are inevitable. www.themegallery.com Manipulation • In manipulative process the partner is perceived not as a complete unique person, but as a carrier of the certain properties which are "necessary" to the manipulator. So, it is important, that his kindness can be used, and so on. • However, the person who has chosen as basic this type of the attitude to anothers, in result frequently becomes a victim of own manipulations. He also starts to perceive himself fragmentary, passes to stereotyped forms of behaviour, is guided by false motives and the purposes, losing a string of own life. www.themegallery.com • Comparison of imperative and manipulative forms of dialogue allows to reveal their deep internal similarity. Having united them together, it is possible to characterize them as various kinds of monologic dialogue. The person, considering another as object of the influence, as a matter of fact communicates with itself, with purposes and problems, not seeing the true interlocutor, ignoring him. • As real alternative to such type of attitudes between people the dialogical dialogue allows to proceed from the egocentric installation fixed on to installation to the interlocutor, the real partner on dialogue. www.themegallery.com Dialogue • Dialogue is equal subject subject dialogue which has as an object mutual knowledge, self-knowledge and self-development of partners on dialogue. • Dialogue forms differently than monologic dialogue. www.themegallery.com Questions • • • • 1) What do you understand under the interactive side of communication? 2) Name three main types of interpersonal dialogue. • 3) What main signs of manipulation do you know? • 4) In what spheres manipulation can be met more often? • 5) Which form of communication is the most preferable in medicine? www.themegallery.com Immutable rules of mutual relations: • Psychological adjust on an actual condition of the interlocutor and own actual psychological condition. In this case there is a principle « here and now », in view of those feelings, desires and a physical condition, which partners test at present; • · nonvalue perception a partner’s individual, aprioristic trust to his intentions (a principle of trust); www.themegallery.com Immutable rules of mutual relations: • Perception of the partner as equal, having the right on own opinion and own decision (a principle partneship); • · The maintenance of dialogue common truths and dogmas, and problems and unresolved questions (a principle problematization maintenances of dialogue) should be not; • · A principle of personification of dialogue conversation on its own behalf, without the reference to opinions and authorities, presentation of the true feelings and desires. www.themegallery.com • For social psychology next ways of influence are traditional: infection, suggestion, belief. • Support, active hearing, reflection of feelings of the partner, nonvalue judgements, understanding of nonverbal behaviour of another, "I-statements" - base communicative skills of the expert of the professional at dialogical dialogue. • The Swiss writer of XVIII century Lafater wrote: « you want to be clever - learn to ask reasonably, to listen attentively, to answer calmly and stop talking, when you have nothing to tell more ». www.themegallery.com Rules of effective understanding and studying of interlocutor • - Listen more and speak less, "do not push" him to discuss questions about which he should speak; • - Aspire to react to individual-significant information connected to needs(requirements) and interests of the partner first of all; • - Aspire to react to feelings and emotional conditions of the partner. www.themegallery.com Perceptive side of dialogue • (lat., perceptio – perception) – in dialogue as process of perception by partners each other and an establishment of a certain level of mutual understanding. • Perceptive side of dialogue means a process of perception and knowledge each other partners on dialogue and establishments on this basis of mutual understanding. A problem of therapy from the point of view of influence of the doctor on consciousness of the patient is to improve of his ability to conscious purposeful management of mental self-control, to active counteraction of illness. www.themegallery.com • Mutual understanding can be interpreted as: а) understanding of the purposes, motives, installations of the partner, б) acceptance, division of these purposes and installations that lead to an establishment of special relations: the affinity expressed in feelings of sympathy, friendship. • In dialogue it is necessary to take into account, as the partner understands your needs(requirements), motives, installations. www.themegallery.com Techniques of social perception • • Identification - likening of to another. It is one of the simplest ways of understanding of other person. • Identification is closely connected to empathy which also is defined as a special way of understanding of a person. Thus the empathy assumes not rational judgement of a problem of other person, and the aspiration and ability emotionally to respond to his problems. • Reflection - comprehension by the individual of how he perceives the partner on dialogue. www.themegallery.com • The perception of other people depends on how we "classify" them therefore stereotypes of perception are formed. Stereotypes generate a conditional and simplified representation about other people. They are formed depending on what group we belong, generated by mastering of stereotypes of parents, teachers, friends, introduced by mass media. Education, mutual contacts, approachement of groups - promotes change of stereotypes. • The stereotype arises on a basis enough the limited last experience, as a result of aspiration to build conclusions on the basis of the limited information. However the main problem is made not with the stereotype, but with installation forcing us to adhere this or that behaviour. www.themegallery.com Installation • Installation has three measurements: cognitive, affective and behavioural. Cognitive includes opinions and the belief allowing us to judge that is true, plausible or possible. Affective measurement makes positive or negative emotions connected to these belief and which focus our actions. Behavioural measurement of installation assumes a reaction of a person corresponding to his belief and experiences. • Installations get its final form between 12 and 30 years of a life. After that installations vary hardly. It is necessary to distinguish the central installations which form a nucleus of system of belief, and installations peripheral, playing a smaller role in social adaptation. www.themegallery.com At perception people of each other there are a number of effects: • effect of an aura ("haloeffect"), effect of novelty and primacy, effect or the phenomenon of stereotypification. • effect of an aura - the information on the person is imposed for that image which already has been created beforehand. This aura prevents to see the valid features for the present moment and display of object of perception. • effect of primacy and novelty concerns the importance of a certain order of presentation of information on the person for drawing up of representation about him. At perception of the stranger we trust the primary information on him more. At perception of the familiar person the effect of novelty passes, that is newer information is more significant. www.themegallery.com Attraction • is a process of formation of appeal of any person for perceiving, and a product of this process, that is some quality of attitudes. • Process of formation of attraction is influenced with similarity of characteristics of the subject and object of perception, "ecological" characteristics of process of dialogue (affinity of partners on dialogue, frequency of meetings, etc.), type of interaction of partners on dialogue, character of "reinforcement" and other factors. • www.themegallery.com Effects of interconnections • During dialogue there can be a number of the effects influencing on specificity of interaction of partners. It is possible to attribute to such effects: projective identification, a transfer, a countertransfer. www.themegallery.com Projective identification • –introduction of feelings of the partner to other partner on dialogue. If it occurs between the doctor and the patient, the doctor can be dangerous to both as at the doctor as a result of it will be internal psychological misbalance, and he will need psychological help. www.themegallery.com Transfer – • the tendency in the present to see the past, to resort to use of old ways of perception and reaction, including any new information. • In clinical practice in case of presence of transfer the client begins interaction with the doctor as with someone another (mother, the father, etc.). www.themegallery.com Coutertransfer • And the doctor can test any feelings in relation to the patient, starting with his past. This phenomenon refers to a countertransfer. The countertransfer amplifies in experience of stressful events and non-authorized conflicts in a life of the doctor. The countertransfer can be considered as reaction on internal disbalance which is shown as anger to the client, irritations, fear of the client and so forth. www.themegallery.com Communicative competence • It is possible to speak about the importance for effective and on-conflict interactions between the patient and doctors such concept, as communicative competence, i.e. abilities to establish and support necessary contacts to other people. This process means an achievement of mutual understanding between partners on dialogue, best understanding of a situation and a subject of dialogue. It is necessary to note, that communicative competence is professionally significant characteristic of the doctor and the nurse. However, in spite of the fact in conditions of clinic the patient is compelled to address for help to the doctor, communicative competence is important and for the patient. www.themegallery.com L/O/G/O