Mental Health Ch 6

Therapeutic nurse-client relationships can occur only when each views the other as a unique human being. When this occurs, both participants have needs met by the relationship.

Therapeutic relationships are goal- oriented and directed at learning and growth promotion.

A process by which the therapist gains recognition of his/her own feelings, beliefs and attitudes and the impact these may have on therapist-client interactions

At times, therapist values may be in conflict with those held by the client

The therapist should not impose his/her values on the client

• Reflection on student experiences
• Journaling
• Talking over events and reactions to events in post conference

Talk with friends and family as to how they see you interacting in the world

Seek alternative points of view

Be aware of frustration if or when a client is not acting in his/her own best interest

Be aware of values which you hold as “self evident truths”

Seek out and participate in values clarification workshops

Develop a conscious plan for self development

Read books, attend seminars on topics that foster your growth and self awareness

• Increase knowledge and awareness of cultures other than
• your culture of origin

The nurse-client relationship is the foundation on which psychiatric nursing is established.

The therapeutic interpersonal relationship is the process by which nurses provide care for clients in need of psychosocial intervention.

Social: involves friendship, socialization; communication meets the basic needs of both parties

Intimate: emotional commitment of two people to each other

Therapeutic: focuses on the needs, experiences, feelings, and ideas of the client, not the nurse

• Trust
• Rapport
• Respect
• Genuineness - be genuine - no flippant remarks - time, verbal cues, eye contact, body language
• Empathy - relate to them w/o taking on the emotion of what they are going through
• Acceptance of person - unique human being regarless of behavior
• Unconditional Positive Regard

• 1. Preinteraction phase
• 2. Orientation (introductory) phase
• 3. Working phase
• 4. Termination phase

• Obtain information about the client from chart, significant
• others, or other health team members.

Examine one’s own feelings, fears, and anxieties about working with a particular client.

nurse and client meet and roles established

purposes and parameters of future meetings established

expectations are clarified and client’s problems identified

nurse builds trust, may establish a contract, and discusses confidentiality and need to share information with the treatment team.

Gathering assessment information to build a strong client database

Formulating nursing Dx

Setting goals that are mutually agreeable to the nurse and client

developing a plan of action that is realistic for meeting the established goals

exploring feelings of both client and nurse

Therapeutic work of the relationship is accomplished

Ongoing problem identification

examination of client’s feelings and responses to identified issues and problems

development of coping strategies, behavior change, increase in self esteem and independence

during this phase, may see transference and counter-transference

occurs when client’s issues are resolved or when the relationship is terminating for some other reason

New material is not raised during the termination phase

• must deal with feelings of anger and/or abandonment that
• may occur

Transference - client unconsciousley attributes (transfers) to the nurse feelings and behavioral predispositions formed toward a person from his or her past

• -client could be angry or resentful
• - client could have overwheling affection for or excessive dependency on the nurse

• - nurse's behavioral and emotional response to the
• client
• - they may be unresolved feelings from the nurses past
• -may be in response to transference feelings from the client

Inappropriate boundaries

feelings of sympathy rather than empathy

encouraging client dependency

non-acceptance of a client as person

• Values, attitudes, and beliefs.
• Example: attitudes of prejudice are expressed through negative stereotyping.

• Culture or religion. Cultural mores,
• norms, ideas, and customs provide
• the basis for ways of thinking.