Therapeutic Relationships and the Clinical Interview

Chapter 7

Nurse-patient relationship

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

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

Therapeutic vs other types of relationships

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

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

Countertransference-Tendency of nurse to displace onto patient feelings related to

people in nurse’s past

Establishing relationship boundaries

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

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

Termination Phase-Final phase of the nurse-patient relationship

-May occur when the patient is discharged

Phases of nurse-patient relationship

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

Enhancing the nurse-patient relationship

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

Factors that enhance growth

Patient leads the interview-Nurse provides opportunity for pt to reach specific

goals Preparing for Interview

-Setting-Seating

Introductions-Conveys respect-Gives pt direct control

Initiating Interview-Use open ended questions-Use statements of acceptance

The clinical interview

Key principles of counseling-Attending behaviors-Listening well

Eye contact-Variation depending on cultural background

Body Language-Kinesics: body movements and posture-Proxemics: personal space

Vocal qualities-Paralinguistics; loudness, pitch, rate, fluency

Verbal Tracking-Tracking what patient is saying

Attending behaviors: the foundation of interviewing

Clinical Supervision-Focus is on nurses behavior in the nurse-patient

relationship

-Review clinical interactions exactly as they occur 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

Clinical supervision and process recording

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

Cultural influences and the therapeutic relationship