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Therapeutic use of self
Therapeutic nurse-client relationships can occur only when each views the other as a unique human being. When this occurs, both participants have needs met by the relationship.
Therapeutic relationships are goal- oriented and directed at learning and growth promotion.
A process by which the therapist gains recognition of his/her own feelings, beliefs and attitudes and the impact these may have on therapist-client interactions
At times, therapist values may be in conflict with those held by the client
The therapist should not impose his/her values on the client
Increasing Self Awareness
- Reflection on student experiences
- Talking over events and reactions to events in post conference
Talk with friends and family as to how they see you interacting in the world
Seek alternative points of view
Be aware of frustration if or when a client is not acting in his/her own best interest
Be aware of values which you hold as “self evident truths”
Seek out and participate in values clarification workshops
Develop a conscious plan for self development
Read books, attend seminars on topics that foster your growth and self awareness
- Increase knowledge and awareness of cultures other than
- your culture of origin
The nurse-client relationship is the foundation on which psychiatric nursing is established.
The therapeutic interpersonal relationship is the process by which nurses provide care for clients in need of psychosocial intervention.
Types of Relationship
Social: involves friendship, socialization; communication meets the basic needs of both parties
Intimate: emotional commitment of two people to each other
Therapeutic: focuses on the needs, experiences, feelings, and ideas of the client, not the nurse
Conditions Essential to Development of a Therapeutic Relationship
- Genuineness - be genuine - no flippant remarks - time, verbal cues, eye contact, body language
- Empathy - relate to them w/o taking on the emotion of what they are going through
- Acceptance of person - unique human being regarless of behavior
- Unconditional Positive Regard
4 Phases of Therapeutic Relationship
- 1. Preinteraction phase
- 2. Orientation (introductory) phase
- 3. Working phase
- 4. Termination phase
- Obtain information about the client from chart, significant
- others, or other health team members.
Examine one’s own feelings, fears, and anxieties about working with a particular client.
Orientation (Introductory Phase)
nurse and client meet and roles established
purposes and parameters of future meetings established
expectations are clarified and client’s problems identified
nurse builds trust, may establish a contract, and discusses confidentiality and need to share information with the treatment team.
Gathering assessment information to build a strong client database
Formulating nursing Dx
Setting goals that are mutually agreeable to the nurse and client
developing a plan of action that is realistic for meeting the established goals
exploring feelings of both client and nurse
The Working Phase
Therapeutic work of the relationship is accomplished
Ongoing problem identification
examination of client’s feelings and responses to identified issues and problems
development of coping strategies, behavior change, increase in self esteem and independence
during this phase, may see transference and counter-transference
Termination or Resolution Phase
occurs when client’s issues are resolved or when the relationship is terminating for some other reason
New material is not raised during the termination phase
- must deal with feelings of anger and/or abandonment that
- may occur
Transference - client unconsciousley attributes (transfers) to the nurse feelings and behavioral predispositions formed toward a person from his or her past
- -client could be angry or resentful
- - client could have overwheling affection for or excessive dependency on the nurse
- - nurse's behavioral and emotional response to the
- - they may be unresolved feelings from the nurses past
- -may be in response to transference feelings from the client
Behaviors that diminish therapeutic relationships
feelings of sympathy rather than empathy
encouraging client dependency
non-acceptance of a client as person
The Impact of Preexisting Conditions
- Values, attitudes, and beliefs.
- Example: attitudes of prejudice are expressed through negative stereotyping.
- Culture or religion. Cultural mores,
- norms, ideas, and customs provide
- the basis for ways of thinking.