Developing a Therapeutic Relationship in Practice

1. Developing a Therapeutic Relationship in Practice Chris Gordon 4.1.11

2. 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

3. 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

4. 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

5. 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?

6. 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

8. 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

9. Knowledge to Establish Therapeutic Relationship • Background • Interpersonal and development theory • Diversity influence and determinants • Person/client • Health/illness • Influences of healthcare and policy • Systems

10. Capacity for establishing a Therapeutic Relationship • Self awareness • Self knowledge • Empathy • Awareness of boundaries & limits of professional role

11. Phases of a Therapeutic Relationship • Beginning/orientation phase • Working or middle phase • Ending or resolution phase

13. Establishing Boundaries Although 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

14. 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.

15. 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

16. 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

17. 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

18. 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.