DEVELOPING A THERAPEUTIC RELATIONSHIP IN PRACTICE
Chris Gordon4.1.11
The aims of the session: To improve the understanding of the
therapeutic relationship
To increase awareness of the boundaries and limits of the professional role
To aid recognition of the effective development of the therapeutic relationship
The Therapeutic Relationship It could be in the background, the intervention through
which comfort, support, and provision of care are facilitated
It could be the primary intervention to promote awareness and growth and/or to work through difficulties
Therefore the therapeutic relationship is central to
Community Nursing and important to establish on first meeting with a client
Therapeutic versus other types of relationship Taking into account that a relationship is an
interpersonal process that involves two or more people
Discuss with your neighbours the types of relationships you have in your life and how these differ to the therapeutic relationship you have with a client
Feedback
Your own Relationship as a Patient!
Think about your own relationship with your general practitioner (GP) or another health professional
What would you score that relationship on a scale of one to ten, and why?
Therapeutic Relationship A therapeutic relationship is a
purposeful, goal directed relationship that is aimed at advancing the best interest and outcome of the client
It is consistently focused on the client’s problems and needs
Essential Qualities of the Therapeutic Relationship Active listening Respect Trust Genuineness Empathy Validation
Consider these qualities in groups of 5-6 and feedback via visualiser
Knowledge to Establish Therapeutic Relationship Background Interpersonal and development theory Diversity influence and determinants Person/client Health/illness Influences of healthcare and policy Systems
Capacity for establishing a Therapeutic Relationship
Self awareness Self knowledgeEmpathyAwareness of boundaries &
limits of professional role
Phases of a Therapeutic Relationship
Beginning/orientation phaseWorking or middle phaseEnding or resolution phase
Establishing BoundariesAlthough theoretically well stated they are at risk
of blurring leading to non therapeutic dynamics
Relationships can slip into a social context
The nurse’s needs are met at the expense of the client’s
This is often a result of unrecognised transference or counter-transference
Transference and Counter-transference Transference; the client unconsciously/
inappropriately displaces onto individuals patterns of behaviour/emotional reactions that originated in previous relationships
Counter-transference; the nurse displaces onto the client feelings related to people in their past
Consider both of these in the health visitor/ school nurse therapeutic relationship with the client. Provide examples to illustrate.
Recognising Over Involvement Frequent demands by client causing increased
dependency
Unwillingness of client to progress
Colleagues disagree with the nurse’s interventions/perceptions of the client
Keeping of secrets about nurse-client relationship
Recognising Under Involvement
Client withdrawal Lack of mutually agreed goals Lack of progress Nurse avoidance of spending time with
client Failure to follow through on agreed
interventions
Clinical Supervision The importance of supervision can not be
over emphasised.
It aids in promoting professional growth as well as safeguarding the integrity of the nurse-client relationship
It should be factored into the health visitor/ school nurse schedule on a regular basis
References Department of Health (2007). Facing the Future: a review of the
role of health visitors. DH, The Stationary Office.
Greenhalgh, T. and Heath, I. (2008). Measuring Quality in the Therapeutic Relationship. London, King’s Fund.
Registered Nurses’ Association of Ontario, (2006). Establishing Therapeutic Relationships. Canada, RNAO.
Varcarolis, E. M. (2009). Developing Therapeutic Relationships. In Varcarolis E.M. & Jordan Halter, M. Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, Ed6. Oxford, Elsevier.