Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5: Therapeutic Relationships.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 5: Therapeutic Relationships

Chapter 5: Therapeutic Relationships


Therapeutic RelationshipTherapeutic Relationship

• One of the most important skills a nurse can develop

• Crucial to success of interventions with clients requiring psychiatric care


Components of Therapeutic RelationshipComponents of Therapeutic Relationship

• Trust – Behaviors such as caring, interest,

understanding, consistency, honesty, promise keeping, listening (Box 5.1)

– Congruence is essential

• Genuine interest – Self-comfort, self-awareness of strengths and

limitations, clear focus


Components of Therapeutic Relationship (cont’d)Components of Therapeutic Relationship (cont’d)

• Empathy– Putting oneself in client’s shoes

• Client and nurse giving “gift of self”

– Different from sympathy (feelings of concern or compassion; focus shifting to nurse’s feelings)

• Acceptance (no judgments; set boundaries)• Positive regard (unconditional nonjudgmental

attitude)


Self-AwarenessSelf-Awareness

• Know self– Values (sense of right and wrong, code of

conduct for living)• Values clarification

• Choosing• Prizing• Acting

– Beliefs– Attitudes (Box 5.2 and Box 5.3)


QuestionQuestion

• Tell whether the following statement is true or false:

• A nurse displays empathy by showing feelings of concern and compassion.


AnswerAnswer

• False• Empathy is putting one’s self into the client’s

shoes. – Sympathy is showing feelings of concern and

compassion.


Therapeutic Use of SelfTherapeutic Use of Self

• Use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships beneficial to clients– Concept developed by H. Peplau


Therapeutic Use of Self (cont’d)Therapeutic Use of Self (cont’d)

• Johari window: tool to learn about oneself– 4 quadrants: open/public self; blind/unaware

self; hidden/private self; unknown– Goal: move qualities from quadrants 2, 3, 4 into

quadrant 1


Therapeutic Use of Self (cont’d)Therapeutic Use of Self (cont’d)


Patterns of KnowingPatterns of Knowing

• Ways of observing, understanding client interactions

• Four patterns (Carper, 1978; Table 5.1)– Empirical (derived from nursing science)– Personal (from life experiences)– Ethical (from moral nursing knowledge)– Aesthetic (from art of nursing)


Patterns of Knowing (cont’d)Patterns of Knowing (cont’d)

• Fifth pattern (Munhall, 1993): unknowing – Nurse admits lack of knowledge of client or

understanding of client’s subjective world


Types of RelationshipsTypes of Relationships

• Social– Purpose of friendship, socialization,

companionship, or task accomplishment– Superficial communication; shifting roles;

outcomes rarely assessed

• Intimate– Emotional commitment of two persons– Individual needs met; assistance with helping

each other meet needs


Types of Relationships (cont’d)Types of Relationships (cont’d)

• Therapeutic– Focus on needs, experiences, feelings, ideas of

client only– Use of communication skills, personal strengths,

understanding of human behavior by nurse – Joint agreement on areas to work on; outcome

evaluation


QuestionQuestion

• Tell whether the following statement is true or false:

• A social relationship involves superficial communication for the purposes of friendship or task accomplishment.


AnswerAnswer

• True• A social relationship occurs for friendship,

socialization, companionship or task achievement. It involves superficial communication with shifting roles.


Establishing a Therapeutic RelationshipEstablishing a Therapeutic Relationship

• Peplau’s model of three phases– Orientation– Working– Termination (Table 5.3)

• Overlapping, interlocking of phases


Establishing a Therapeutic Relationship: Orientation PhaseEstablishing a Therapeutic Relationship: Orientation Phase

• Meeting nurse, client• Establishment of roles• Discussion of purposes, parameters of future

meetings • Clarification of expectations• Identification of client’s problems • Nurse-client contracts/confidentiality, duty to

warn/self-disclosure


Establishing the Therapeutic Relationship: Working PhaseEstablishing the Therapeutic Relationship: Working Phase

• Problem identification: issues or concerns identified by client; examination of client’s feelings and responses

• Exploitation: examination of feelings and responses; development of better coping skills, more positive self-image, behavior change, independence

• Possible transference/countertransference


Establishing the Therapeutic Relationship: Termination PhaseEstablishing the Therapeutic Relationship: Termination Phase

• Begins when client’s problems are resolved• Ends when relationship is ended• Deals with feelings of anger or abandonment

that may occur; client may feel termination as impending loss


Behaviors Diminishing Therapeutic RelationshipsBehaviors Diminishing Therapeutic Relationships

• Inappropriate boundaries (relationship becomes social or intimate)

• Feelings of sympathy, encouraging client dependency

• Nonacceptance of client, avoidance (Box 5.4)


QuestionQuestion

• During the working phase of a nurse-client relationship, which of the following would occur?

A.Expectations are clarifiedB.Nurse-client contracts are establishedC.Feelings of loss are addressedD.Client feelings are examined


AnswerAnswer

D. Client’s feelings are examined• During the working phase, the client

identifies issues or concerns and his or her feelings and responses are examined. – Expectations are clarified and contracts are

established during the orientation phase. Feelings of loss are addressed during the termination phase.


Therapeutic Roles of the Nurse in a RelationshipTherapeutic Roles of the Nurse in a Relationship

• Teacher (coping, problem solving, medication regimen, community resources)

• Caregiver (therapeutic relationship, physical care)

• Advocate (ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation)

• Parent surrogate (Box 5.5)


Self-Awareness IssuesSelf-Awareness Issues

• Nurse’s self-awareness: crucial to developing therapeutic relationships

• Helpful activities: values clarification, journaling, group discussions, reading

• Development of self-awareness: continual, ongoing process

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5: Therapeutic Relationships.

Documents

needs slide

phases slide

peplau slide

art of nursing slide

clear focus slide

therapeutic relationships

psychiatric care slide

warnselfdisclosure slide