Mental health articles

A therapeutic relationship is a relationship between a patient and nurse that provides the framework to help the patient resolve clinical problems using interpersonal communication techniques. The psychiatric nurse must establish the therapeutic relationship as a clinical relationship and not friendship. At times there can be a blur in the relationship, especially in an inpatient unit where the patient and the psychiatric nurse may develop a friendlier-thanclinical rapport. There is a fine but definite line between a clinical rapport and friendship. It is the psychiatric nurse who must clearly define the difference and maintain the clinical rapport. A therapeutic relationship also provides the foundation for the psychiatric nurse to help the patients cope with situations that confront the patients. Processing is thinking logically through a situation to reach an appropriate response to the situation. The psychiatric nurse should not tell the patient what to do.

Instead, the psychiatric nurse should ask questions that lead the patient through

the process of logical thinking, enabling the patient to reach their own decision.

The therapeutic relationship framework consists of four phases:

• Preinteraction Phase: The nurse assesses unresolved problems presented by the patient with or without the patient’s active participation.
• Orientations Phase: The nurse is introduced to the patient and defines the nurse’s role and the patient’s role in the therapeutic relationship. The nurse is working with the patient—not for the patient. The objective is to develop trust and set mutually agreed upon goals for addressing the patient’s unresolved problems based on the results of the preinteraction phase. It is important to tell the patient the rules of confidentiality; what information will be shared and with whom; and what information will not be shared.
• Working Phase: The nurse helps the patient examine unresolved problems and helps the patient achieve goals defined during the orientations phase. A goal is to develop the patient’s problem-solving ability to change resistance behaviors and embrace adaptive behaviors.
• Termination Phase: The nurse ends the therapeutic relationship by summarizing

accomplishments and unachieved goals of the working phase and exploring why any goal was not met. Particular care must be given to recognize that the patient may not want to terminate the therapeutic relationship.

The nurse focuses on accomplishments made during the therapeutic relationship

and encourages the patient to go forward with follow-up care.

Tags: psychiatric nurse