developing a therapeutic relationship in practice

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.