Establishing a Collaborative Relationship

A collaborative relationship between the patient and therapist is necessary because the clinical management of most sleep disorders depends on the patient's willingness to carry out the clinician's recommendations.

Although the therapist's role and the level of required clinical skills will vary according to the specific sleep disorder and the selected modality of therapy, basic psychotherapeutic skills such as empathy and support are essential in all cases. Once those skills are mastered, the management of sleep disorders should be sleep focused, goal directed, and problem solving in orientation. The clinician is a facilitator and a problem solver, not someone who will provide a magical cure. The underlying message is that the patient must take an active role in his or her own care.

Within this self-management framework, the therapist provides guidance and recommendations, but the patient is responsible for their implementation. An important objective of therapy is to foster a sense of control so that patients no longer feel that they are victims of a sleep problem. This is best accomplished by educating patients about controlling variables and teaching them how to alter those circumstances. Ongoing monitoring of treatment progress is also an essential element of any therapeutic relationship. A common mistake is to expect that the prescription of a drug or of behavioral changes will suffice to eliminate sleep complaints. Regular follow-up evaluations must be scheduled to monitor treatment progress and compliance.