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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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

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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
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Factors Enhancing Growth in Others

● Genuineness
Congruence
● Empathy
Understanding ideas expressed and feelings present
in the other
● Positive Regard
Implies respect: attitudes, actions (attending,
suspending value judgments)
● Helping Clients Develop Resources
Awareness, encouragement

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Boundary Blurring

Relationship slips into a social context

Nurse behavior meets personal needs at expense of
client:
● Underhelping
● Overhelping
● Controlling
● Narcissism
● Transference
● Countertransference

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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

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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
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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

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 Phases of therapeutic and nontherapeutic relationships

Slide 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
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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
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Factors Hampering Relationships

● Lack of nurse availability or lack of contact

● Lack of nurse self-awareness
● Nurse negative feelings about client

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