Chapter 7
Therapeutic Relationships and the Clinical
Interview
Nurse-patient relationship
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Basis of all psychiatric treatment
Establish an understanding that the nurse is
safe, confidential, reliable, consistent, and the
relationship is conducted within appropriate and
clear boundaries
Creative process unique to each nurse
Therapeutic use of self
-Scientifically substantiated as an evidence –based
intervention
-Takes time
Therapeutic vs other types of
relationships
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Goals of therapeutic relationship
-Facilitating
-Assisting
-Helping
-Promoting
Relationship
-Interpersonal process that involves 2 or more people
-Types
 Social
 Therapeutic Accountability, focus on patient’s
needs, clinical competence, delaying judgment,
supervision
Establishing relationship
boundaries
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Allows the establishment of clear patient boundaries that
provide safe space through which the patient can
explore feelings and treatment issues
Warning signals of blurred boundaries
-Overhelping, controlling, narcissism
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Transference
-When a person unconsciously displaces (transfers) onto
individuals in their current life, those patterns of behavior that
originated in relation to significant figures in childhood
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Countertransference
-Tendency of nurse to displace onto patient feelings related to
people in nurse’s past
Phases of nurse-patient
relationship
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Preorientation Phase
-Prior to 1st meeting, the nurse may have thoughts and
feelings related to the 1st clinical session
Orientation Phase
-1st time that nurse and patient meet
-Initial interview occurs
-Establish rapport
-Parameters of the relationship
-Formal or informal contract
-Confidentiality
-Termination
Phases of nurse-patient
relationship
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Working Phase
-Allows patient to experience increased levels
of anxiety and demonstrate dysfunctional
behaviors in safe setting while trying out new
and more adaptive coping behaviors
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Termination Phase
-Final phase of the nurse-patient relationship
-May occur when the patient is discharged
Enhancing the nurse-patient
relationship
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Consistency
-Same pt assignment
Pacing
-Let pt set pace
Listening
-Let the pt talk when needed
Initial Impressions
-Positive initial attitudes and preconceptions
Comfort and control
-Promoting pt comfort and balance
Patient factors
-Establishing trust and pts active participation
Factors that enhance growth
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Genuiness
-Self awareness of ones feelings as they arise within
relationship and ability to communicate
Empathy
-Understanding the feelings of others
Sympathy
-Feeling the feelings of others
Positive Regard
-Attitudes
-Actions
The clinical interview
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Patient leads the interview
-Nurse provides opportunity for pt to reach specific
goals
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Preparing for Interview
-Setting
-Seating
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Introductions
-Conveys respect
-Gives pt direct control
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Initiating Interview
-Use open ended questions
-Use statements of acceptance
Attending behaviors: the foundation
of interviewing
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Key principles of counseling
-Attending behaviors
-Listening well
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Eye contact
-Variation depending on cultural background
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Body Language
-Kinesics: body movements and posture
-Proxemics: personal space
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Vocal qualities
-Paralinguistics; loudness, pitch, rate, fluency
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Verbal Tracking
-Tracking what patient is saying
Clinical supervision and process
recording
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Clinical Supervision
-Focus is on nurses behavior in the nursepatient relationship
-Review clinical interactions exactly as they
occur
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Process Recordings
-Written record of segment of nurse-patient
session that reflect as closely as possible the
verbal and nonverbal behaviors of the nurse
and the patient
Cultural influences and the
therapeutic relationship
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Cultural background has a great deal to do with
what nonverbal behavior means to different
individuals
Degree of eye contact and use of touch are two
nonverbal aspects that can be misunderstood by
individuals of different cultures
A meaningful therapeutic relationship is
facilitated when values and cultural influences
are considered.
Necessary to understand the patients
perceptions