Transcript Chapter_10

Chapter 10
Developing Therapeutic
Relationships
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Copyright © 2002 by W. B. Saunders Company. All rights reserved.
F
Types of Relationships
Social

Primarily for friendship or task accomplishment

Needs are mutually met

Communication
- Often superficial
- Techniques: advice, meeting dependency needs
B
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F
Types of Relationships, cont.
Intimate

Between two individuals with an emotional commitment
to each other

Mutual needs met

Communication
- Personal information
- Intimate desires
- Fantasies shared
B
Copyright © 2002 by W. B. Saunders Company. All rights reserved.
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F
Types of Relationships, cont.
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
B
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F
Factors Enhancing Growth in Others

Genuineness

Empathy

Positive Regard

Helping Clients Develop Resources
Congruence
Understanding ideas expressed and feelings present in the
other
Implies respect: attitudes, actions (attending, suspending
value judgments)
Awareness, encouragement
B
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F
Boundary Blurring
Relationship slips into a social context
Nurse behavior meets personal needs at expense of client:

Underhelping

Overhelping

Controlling

Narcissism

Transference

Countertransference
B
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F
Phases of the Nurse-Client Relationship

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
B
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F
Phases of the Nurse-Client Relationship, cont.

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
B
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F
Phases of the Nurse-Client Relationship, cont.

Termination
- Deal with intense feelings regarding the experience
- Summarize goals and objectives achieved
- Review client plans for future
- Finalize termination
B
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F
Phases of therapeutic and nontherapeutic relationships
(Fig. 10-1)
Slide 10-10
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
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B
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F
Factors Beneficial to Relationships

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
B
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F
Factors Hampering Relationships

Lack of nurse availability or lack of contact

Lack of nurse self-awareness

Nurse negative feelings about client
B
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