Chapter 10 Developing Therapeutic Relationships

1. Chapter 10Developing Therapeutic Relationships F Menu

2. Types of Relationships Social • Primarily for friendship or task accomplishment • Needs are mutually met • Communication - Often superficial - Techniques: advice, meeting dependency needs B F Menu

3. Types of Relationships, cont. Intimate • Between two individuals with an emotional commitment to each other • Mutual needs met • Communication - Personal information - Intimate desires - Fantasies shared B F Menu

4. Types of Relationships, cont. Therapeutic • Between nurse and client to enhance client growth • Focus on client issues, problems, and concerns • Communication - Therapeutic techniques used to identify and explore needs, set goals, assist in development of new coping skills, encourage behavioral change B F Menu

5. Factors Enhancing Growth in Others • Genuineness Congruence • Empathy Understanding ideas expressed and feelings present in the other • Positive Regard Implies respect: attitudes, actions (attending, suspending value judgments) • Helping Clients Develop Resources Awareness, encouragement B F Menu

6. Boundary Blurring Relationship slips into a social context Nurse behavior meets personal needs at expense of client: • Underhelping • Overhelping • Controlling • Narcissism • Transference • Countertransference B F Menu

7. Phases of the Nurse-Client Relationship • Preorientation - Planning for the first interaction with client - Identifying nurse concerns • Orientation - Compressed due to short hospitalizations; longer in community-based care - Issues: trust, parameters of relationship, contract, confidentiality, termination B F Menu

8. Phases of the Nurse-Client Relationship, cont. • Working - Tasks: • Maintain relationship • Gather further data • Promote client problem-solving skills, self-esteem and communication • Facilitate behavioral change • Overcome resistance behaviors • Evaluate problems and goals and redefine prn • Practice and express alternative adaptive behaviors B F Menu

9. Phases of the Nurse-Client Relationship, cont. • Termination - Deal with intense feelings regarding the experience - Summarize goals and objectives achieved - Review client plans for future - Finalize termination B F Menu

10. Phases of therapeutic and nontherapeutic relationships (Fig. 10-1) 10-10 From Forchuk C. et al [2000]. The developing nurse-client relationship: Nurse’s Perspectives. Journal of The American Psychiatric Nurse’s Association, 6(1):3-10 B F Menu

11. Factors Beneficial to Relationships • Consistent, regular, and private interactions with client - Consistency in assigned nurse - Regular routine of activities • Being honest and congruent • Letting client set the pace • Listening to client concerns • Positive initial attitudes and preconceptions • Promoting client comfort and balancing control • Client demonstrating trust and actively participating in relationship B F Menu

12. Factors Hampering Relationships • Lack of nurse availability or lack of contact • Lack of nurse self-awareness • Nurse negative feelings about client B Menu