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Chapter 10

Developing Therapeutic Relationships

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Types of Relationships

Social Primarily for friendship or task accomplishment Needs are mutually met Communication

- Often superficial- Techniques: advice, meeting dependency

needs

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Intimate Between two individuals with an emotional

commitment to each other Mutual needs met Communication

- Personal information- Intimate desires- Fantasies shared

Types of Relationships, cont.

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Therapeutic Between nurse and client to enhance client

growth Focus on client issues, problems, and concerns Communication

- Therapeutic techniques used to identify and explore

needs, set goals, assist in development of new coping skills, encourage behavioral change

Types of Relationships, cont.

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GenuinenessCongruence

EmpathyUnderstanding ideas expressed and feelings present in the other

Positive RegardImplies respect: attitudes, actions (attending, suspending value judgments)

Helping Clients Develop ResourcesAwareness, encouragement

Factors Enhancing Growth in Others

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Relationship slips into a social contextNurse behavior meets personal needs at expense of

client: Underhelping Overhelping Controlling Narcissism Transference Countertransference

Boundary Blurring

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Preorientation - Planning for the first interaction with client - Identifying nurse concerns Orientation - Compressed due to short hospitalizations; longer

in community-based care - Issues: trust, parameters of relationship, contract,

confidentiality, termination

Phases of the Nurse-Client Relationship

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Working- Tasks:

Maintain relationship Gather further data Promote client problem-solving skills, self-esteem and

communication Facilitate behavioral change Overcome resistance behaviors Evaluate problems and goals and redefine prn Practice and express alternative adaptive behaviors

Phases of the Nurse-Client Relationship, cont.

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Termination- Deal with intense feelings regarding the experience- Summarize goals and objectives achieved- Review client plans for future- Finalize termination

Phases of the Nurse-Client Relationship, cont.

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Phases of therapeutic and nontherapeutic relationships

10-10 (Fig. 10-1)From Forchuk C. et al [2000]. The developing nurse-client relationship: Nurse’s Perspectives. Journal of The American Psychiatric Nurse’s Association, 6(1):3-10 Menu FB

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Consistent, regular, and private interactions with client- Consistency in assigned nurse- Regular routine of activities

Being honest and congruent Letting client set the pace Listening to client concerns Positive initial attitudes and preconceptions Promoting client comfort and balancing control Client demonstrating trust and actively participating in

relationship

Factors Beneficial to Relationships

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Lack of nurse availability or lack of contact Lack of nurse self-awareness Nurse negative feelings about client

Factors Hampering Relationships

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