Developing the Therapeutic
Developing Therapeutic Relationships
At the completion of this session students will:
Formulate a list of therapeutic techniques
Have reviewed the phases of a therapeutic one-to-
Compare and contrast social and therapeutic
Be aware of the potential boundary violations that
may occur during a therapeutic relationship
Define self-awareness and describe a strategy for
Discuss within groups these following
What is a relationship?
What does it mean to be therapeutic?
How does the therapeutic relationship differ
from other relationships?
The Therapeutic relationship is a
concept that is fundamental to the
identity of mental health nurses
Characteristics of a therapeutic
Nurse takes responsibility for the conduct of the
Relationship has a specific purpose and a health
Relationship terminates when the identified goal is met
Focus of the relationship is on the client
Relationship is entered through necessity
Choice of whom to be in the relationship is not
available to either the nurse or the client
Self-disclosure is limited for the nurse but encouraged
for the client
Understanding should always be put into words
The Mental Health Nurse role within
Route to understanding
Finding meaning to the experience
Creating opportunities for change to occur
Being a resource for clients
Peplau’s six nursing roles
Active leadership role
Enhancing growth in others
– Understanding ideas expressed and feelings present in
– Some actions manifest an attitude of respect
(attending, suspending value judgments)
Exercise: Recognising role
limitations in self-disclosure
1. Make a list of phrases that describe your
own personality, such as:
I am shy
I get angry when criticised
I find conflicts hard to handle
I am sexy
2. Mark each descriptive phase with one of
A. Too embarrassing or intimate to discuss in a group
B. Could discuss in a group of peers
C. This behaviour characteristic might affect my ability to
function in a therapeutic manner if disclosed 10
Discuss in groups:
1. What criteria were used to determine the
appropriateness of self-disclosure?
2. How much variation is there in what each of you
would share with others in a group or clinical
3. Were there any behaviours commonly agreed on
that would never be shared with a client?
4. What interpersonal factors about the client would
facilitate or impede self-disclosure by the nurse?
5. What have you learnt from this exercise that
could be useful in future encounters with clients?
Phases of the Nurse-Client
– Planning for the first interaction with client
– Identifying nurse concerns
– Compressed due to short hospitalisations;
longer in community-based care
– Issues: trust, parameters of relationship,
contract, confidentiality, termination
Phases of the Nurse-Client
Working – Tasks:
– Maintain relationship
– Gather further information
– Promote client problem-solving skills, self-esteem and
– Facilitate behavioural change
– Overcome resistance behaviours
– Evaluate problems and goals and redefine them as
– Practice and express alternative adaptive behaviours
Phases of the Nurse-Client
– Deal with intense feelings regarding the
– Summarise goals and objectives
– Review client plans for the future
– Finalise termination
Relationship slips into a social context
Nurse behaviour meets personal needs at
expense of client
– the unconscious emotional reaction patients
have in a current situation that is really based
on previous relationships and experiences
– Main Issue – the wish to be taken care of and to
have needs met
– Forms may be severe or subtle
– Can be positive and negative
– Reactions based on the nurses past experience
– May lead the nurse to have inappropriate
responses to a patients action
Transference – Interventions
– Recognise the transference or counter-
– Examine gently but directly
– Limit setting
Factors beneficial to relationships
Consistent regular and private interactions with
– 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
Factors hampering relationship
Lack of nurse availability
Lack of nurse self-awareness
Nurse negative feelings about client
Recognising the nature of ones own
attitude, emotions and behaviour
a keen sense of self awareness acts as a
barometer of the relationship process
Exercise – Developing self-
An effective way of raising self-awareness is
the use of questioning.
In order to raise your awareness of some
important issues ask yourself the following
questions then discuss your responses in
1. What kinds of values do I hold as a important framework
2. Where do these values come from?
3. How do they inform my understanding of what it is to be
a person in this world?
4. How has my family of origin influenced how I view the
5. What values did my family hold as important?
6. What do I see as important in family life?
7. What do I know about why I choose to be a nurse?
8. What are the pervading social attitudes towards people
in mental distress?
9. What are my beliefs about people in mental distress or
with mental illness?
10. What experiences have I had that influence how I feel
about people with mental illness?
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