Therapeutic Relationships and the Clinical Interview Chapter 7 Therapeutic Relationships and the Clinical Interview

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

Therapeutic vs other types of relationships 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

Establishing relationship boundaries 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

Phases of nurse-patient relationship 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

Enhancing the 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

Factors that enhance growth 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

The clinical interview 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

Attending behaviors: the foundation of interviewing 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

Clinical supervision and process recording -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

Cultural influences and the therapeutic relationship 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