Therapeutic

Relationships

 Components include:
Genuine interest
Acceptance of person, not necessarily his
or her behavior
Unconditional positive regard
Trust
Empathy (not sympathy)
Self-awareness and therapeutic use of self

Trust
Congruence occurs when the word and action matches
Nurse Behaviors:
- caring

- treating the client as a human being

- openness

- suggesting without telling

- objectivity

- approachability

- respect

- listening

- understanding - keeping promises

- consistency

- honesty

What is the difference between sympathy and

empathy?
To express sympathy is to make it known that
you are aware of anothers distress and that
you have compassion for them.
To express empathy takes things a step further
by not only expressing compassion but also
showing a deeper level of understanding by
entering into the other persons experience.

Empathy vs Sympathy

Self-Awareness and
Therapeutic Use of Self
Self-awareness: process of understanding ones
own values, beliefs, thoughts, feelings, attitudes,
motivations, strengths, and limitations and how
ones thoughts and behaviors affect others
Therapeutic use of self: the nurse uses aspects of
his or her personality, experience, values,
feelings, intelligence, needs, coping skills, and
perceptions to establish relationships with clients
that are beneficial to clients

Self-Awareness Issues
Self-awareness on the nurses part is crucial to
developing therapeutic relationships
Values clarification, journaling, group discussions,
and reading will assist with this process
Developing self-awareness is a continual, ongoing
process; the nurse needs to plan for self-growth

Therapeutic Use of Self

The Johari window is a

selfawareness tool that
categorizes
qualities
of self as:
Open/public
Blind/unaware
Hidden/private
Unknown

The Johari Window

To better understand yourself; who you are
The exercise allows you to understand how
other people view you
In this way, youre forced to think about
your behavior, about yourself, about
who you are.

Assignment
Now
Having thought about yourself (hopefully) in a new
way
How does this exercise in personal reflection relate
to college essay
writing?

Types of Relationship
1. Social Relationship is primarily initiated for the
purpose of
friendship
2. Intimate relationship involves to people who are
emotionally c
committed to each other
3. Therapeutic Relationship focus on the needs,
experiences,
feelings and ideas of the client only

Establishing the
Therapeutic Relationship
Therapeutic relationships are
focused on the needs,
experiences, feelings, and ideas
of the client, not the nurse
The therapeutic relationship
consists
of three phases:
Orientation
Working
Termination

Establishing the Therapeutic Relationship

(contd)
In the orientation phase:
The nurse and client meet
Roles are established
Purposes and parameters of future meetings
are discussed
Expectations are clarified
Clients problems are identified

Orientation Phase
T trust and rapport
E environment (Therapeutic)
A assess clients strengths and weaknesses
C contract (Therapeutic)
H help Communicate

Contracts

Should include the following:

1. Time, place and length of sessions
2. When session will terminate
3. Who will be include in the
treatment plan

Confidentiality
Respecting the clients right to keep
private any information about his or
her mental and physical health and
related care.

Establishing the Therapeutic

Relationship (contd)
The working phase involves:
Problem identification
o The client identifies the issues or concerns
causing problems
o Examination of the clients feelings and
responses
Exploitation:
Development of better coping skills and a
more positive self-image, behavior change,
and independence

Tasks of the Working Phase

Maintaining the relationship
Gathering more data
Exploring perceptions of reality
Developing positive coping mechanisms
Promoting a positive self concept
Encouraging verbalization of feelings
Facilitating behavior change
Working through resistance
Evaluating progress and redefining goals
Promoting independence

Mandatory Reporting- Duty

to Warn
Sexual Abuse
Child Abuse
Elder Abuse

Establishing the Therapeutic

Relationship (contd)

In the working phase, the nurse must be

acutely aware of 2 common elements can
arise:

Transference: when clients unconsciously

transfer feelings they have for significant
persons in their life onto the nurse
Countertransference: when the nurse
responds to the client based on his or her
own unconscious needs and conflicts

Establishing the Therapeutic

Relationship (contd)
The termination or resolution phase:
Begins when the clients problems
are resolved
Ends when the relationship is ended
Deals with feelings of anger or
abandonment that may occur

Termination Phase
P Promote self care
R Recognize increasing anxiety
I
Increase Independence
D demonstrate emotional stability
E Environmental Support

Behaviors That Diminish

Therapeutic Relationships
Inappropriate boundaries (relationship becomes
social or intimate)

Feelings of sympathy and encouraging

dependency
Non acceptance of the client as a person
because of his or her behaviors, leading to
avoidance of the client
Nurse self-awareness is the way to avoid such
problems

Therapeutic Roles of the Nurse in a

Relationship

Teacher
Caregiver
Advocate
Parent surrogate

Self-Awareness Issues

Self-awareness on the nurses part is

crucial to developing therapeutic
relationships
Values clarification, journaling, group
discussions, and reading will assist with
this process
Developing self-awareness is a
continual, ongoing process; the nurse
needs to plan for self-growth