DEVELOPING A
THERAPEUTIC
RELATIONSHIP
IN PRACTICE
Chris Gordon
4.1.11
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 knowledge
Empathy
Awareness of boundaries &
limits of professional role
Phases of a Therapeutic
Relationship
Beginning/orientation
phase
Working or middle phase
Ending or resolution phase
Establishing Boundaries
Although 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.