Therapeutic Relationships


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Therapeutic Relationships

  1. 1. Therapeutic Relationships •Genuine interest •Empathy •Acceptance •Positive regard –respect, using client’s name, considering pt’s ideas. •Self-awareness & therapeutic use of self •Self-awareness –understanding own values, beliefs, feelings, prejudices & how these affect others. •Values-abstract standards (sense of right & wrong, hard work, honesty, sincerity, cleanliness & orderliness). •Exercise •Beliefs – ideas one hold to be true. Ex all old people are heard of hearing, peas should be planted on St Pat’s Day. Some beliefs are irrational. •What are your beliefs about the chemically dependent? •Attitudes – general feelings – hopeful, optimistic, optimistic, or pessimistic •It’s the journey, not the destination that’s important. Relationships •Social vs. Therapeutic •Social relationship Initiated for the purpose of friendship Mutual needs are met Communications includes giving advice & meeting basic needs such as lending money
  2. 2.  Goals of a therapeutic relationship communication of distressing thoughts & feelings •Facilitate •Assist client with problem solving to help daily living •Help clients examine self-defeating behaviors & test alternatives •Promote self-care and independence Therapeutic Counselor-client Relationship 3 Phases Beginning - orientation •Middle - working •End - termination Therapeutic Relationship: Phase One Orientation •Assessment and analysis •Communications •Assessing pt’s reason for seeking help •Developing trust •Establishing mutually agreed-upon goals •Developing a therapeutic contract •Formulating nursing diagnosis
  3. 3. What are your responsibilities? Therapeutic Relationship: Phase One Orientation Responsibilities •State your name and role •Establish time and place for interactions •Define expected duration of your work with client •Begin to establish trust immediately •Begin client assessment and data collection Working- Planning & Implementation Phase •Use communication skills to help client: learn about him/her self •Explore feelings and problems •Begin work on behavioral changes •Interventions are planned to meet client goals •Expression of thought and feelings is facilitated •Constructive coping mechanisms are encouraged Working Phase •Alternative, more adaptive behaviors by the client are practiced and evaluated •Resistance and testing behavior are worked through Termination (Evaluation) Phase •Termination date is stated in the 1st or 2nd client/nurse meeting •Remind client periodically through out sessions of termination date •Inform client of other sources of help available now and in future •Evaluate therapeutic outcome •Express feelings about termination
  4. 4. •Observe for regressive behavior •Evaluate the counselor-client relationship Counselor may have mixed feelings: happy with progress, sad to leave a rewarding relationship Transference The process whereby a person (patient) unconsciously displaces (transfers) onto individuals (nurse) in his current life those patterns of behaviors that originated with significant figures from childhood. Counter transference •The tendency of the nurse to displace onto the client feelings caused by people in the therapist’s past. Behaviors that diminish therapeutic relationships Inappropriate boundaries •Client attracted to nurse or vice versa •Accepting gifts or giving gifts •Giving out home address or phone # to patient •Boundary Behaviors that diminish therapeutic relationships •Sympathy •Encouraging client dependency •Non acceptance or avoidance