The therapeutic relationship is especially crucial to psychiatric care, beyond its normal importance in all fields of nursing. It is a helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to the self and others, and assisting with the gratification of the patient’s physical, emotional, and spiritual needs through adequate knowledge and skill. It starts when the nurse and patient come together in the moment, resulting in harmony and healing through effective communication. Helping relationships are:
- Patient-Centered
- Professional
- Goal-Directed
- Time-Bound
- Structured (planned, follows the phases of a nurse-patient relationship)
| Therapeutic Relationship | Social/Intimate Relationship | |
|---|---|---|
| Characteristics | Personal but not intimate | Personal or intimate |
| Identification of Needs | Present | May not occur |
| Resources Used | Specialized professional skills for intervention | Variety during interaction |
| Goal | Meet the client’s needs | Conducts favors for mutual benefit |
| Termination | With limitations as defined during initiation | Not defined |
Phases of Therapeutic Relationships
Pre-Interaction Phase
The phase before first contact with the patient. The nurse gathers relevant information such as the client’s name, address, age, and medical/social history. With the data gathered, the nurse can consider their own strengths and limitations when working with the patient in any area that may signal difficulty.
Introductory Phase
First contact with the patient. A relationships is established, trust and respect is developed, goals are set, and security is felt within the relationship.
- Establish Boundaries and Acceptance
- Establish Trust
- Establish Contract and Boundaries: purpose, time, place, and length of the session; persons involved; client and nurse responsibilities.
- Nurse responsibilities: punctuality, confidentiality, assessment of anxiety levels, preparation for termination and separation.
- Establishing Relationships: gain trust, establish boundaries and expectations, and goals to be met.
Working Phase
The nurse works with the client for the resolution of the patient’s identified problems and to meet goals. Evaluation and redefinition of goals is done as necessary.
Termination Phase
The nurse summarizes the relationship and assessment of the client’s self-sufficiency. Progress of the relationship is discussed, and potential separation issues are identified and dealt with; emotional stability is assessed.
- Do not promise that relationships with clients are going to continue.
- Refer and transfer the client to other support systems.
Key Components of Therapeutic Relationships
- Trust
- Genuine Interest: the client perceives a genuine person if the nurse is comfortable, aware, and focused. This can build trust as the patient sees the nurse is not sending false signals or hiding things from them.
- Empathy: the ability to perceive the meaning and feelings of the client and to communicate that understanding to the client. It has emotional, cognitive, and behavioral implications.
- Accepting Behavior: A caring action for the client’s well being; sensitivity, comfort, attentive listening, honesty, and being non-judgmental.
- Positive Regard: appreciation of the client as a unique worthwhile human being regardless of behavior, background, or lifestyle.
- Using the client’s preferred name
- Spending time with the client
- Listening and responding openly
- Considering the client’s ideas and preferences while planning care
- Therapeutic Use of Self: self-awareness and the use of effective communication techniques to aid in comfort, safety, and non-judgmental acceptance of clients.
- Uses “EARS”: empathy, awareness of self, respect, and self-disclosure.
Barriers to Therapeutic Relationships
- Countertransference: the nurse transfers their feelings to the client.
- Transference: clients transfer their feelings to the nurse.
- Resistance and Avoidance: these result in the development of ambivalent feelings for self-exploration or self-disclosure.
- Inappropriate Boundaries: maintain a professional boundaries.
- Encouraging Dependency: the nurse should develop the patient’s functional independency.
- Sympathy: the nurse should develop empathy.