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.