Chapter 8
Therapeutic Relationships
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Compare and contrast a social relationship and a therapeutic relationship
Explore qualities that foster a therapeutic nurse-patient relationship and qualities that
contribute to a nontherapeutic nursing interactive process
Patient centered care is the gold standard and is one of the QSEN qualities
Nurse-patient relationship is the basis of all psychiatric mental health treatment
First to establish a repour and understanding you must exhibit as
 Safe
 Confidential
 Reliable
 Consistent
Establishes CLEAR boundaries
Relationship doesn’t have clear boundaries when becomes
 Social
 Nurses needs for attention, affection and emotional become met at the expense of
the patients’ needs
Therapeutic relationships have
 Needs of patient identified and explored
 Clear boundaries established
 Problem-solving approaches taken
 New coping skills developed
 Behavioral change encouraged
To achieve a therapeutic relationship nurse uses self as a tool
 Use personality consciously and in full awareness
 Attempt to establish relatedness
 Structure nursing interventions
Positive therapeutic alliance is one of the best tools in mental health
Necessary behaviors to build therapeutic relationships
 Accountability
 Suspending judgement
 Building repour
 Focusing on patients’ needs
 Supervision
 Clinical competence – knowing the why of what you’re doing
Goals and functions occur better when therapeutic relationships are established
 Facilitate communication of distressing thoughts and feelings
 Assist patient with problem solving
 Help patients examine self-defeating behaviors and test alternatives
 Promote self-care and independence
Boundaries
 Transference and counter-transference – boundary blurring – Freud
 Know how different values impact decisions
 Four phases of the nurse patient relationship – Hildegard Peplau pg 130-132
 Pre-orientation
 Orientation
 Working
 Termination
Transference – patient unconsciously inappropriately displaces onto nurse feelings and
behaviors related to significant figures in the patients past. Such as saying you remind me of….
Can be negative or positive
Positive doesn’t have to be addressed necessarily
Negative that threatens the relationship DOES need to be addressed
 Hostility
 Jealousy
 Competitiveness
To solve focus back on the patient, don’t react negatively
Counter transference – nurse displaces feelings related to people in a nurses’ past onto patient
 Patients’ transference often leads to nurse transference
 Common sign – over identifying with the patient – relating too much to the patient
 Wanting to “rescue” the patient – ex. bringing money to help
Factors that promote patient growth
 Genuineness
 Empathy (not sympathy) – empathy focuses back on patient, sympathy focuses
back on yourself, has a lot of “I” statements
 Positive regard
 Attitudes – positive respect and willingness to work with the patient
 Actions – attending, suspending judgement, helping patient develop own
resources