1. The Therapeutic Relationship
Chapter 11
The Therapeutic Relationship
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Dynamics of the Therapeutic Relationship (p. 117)
Directed energy exchange between two people
A flow that moves clients toward constructive ways of thinking and effective ways of coping
Dynamics
Interactions that occur among various forces
Three types:
Social relationship
Work relationship
List and describe the differences between a social relationship and a therapeutic relationship.
Copyright © 2013 by Elsevier Inc. All rights reserved.

3. Dynamics of the Therapeutic Relationship cont’d. (p. 117)
The five dynamic components of the therapeutic relationship include the following:
Trust
Assured belief that others are capable of assisting in times of distress and will probably do so
An important part of any therapeutic relationship
Empathy
Ability to walk a mile in another person’s shoes
Autonomy
Ability to direct and control one’s activities and destiny
Clients are often in vulnerable positions. They must share very personal information in therapy. Trust is crucial for the therapeutic relationship to work.
What are two important parts of forming trust?
Clients may feel frightened, angry, or ashamed. In order for the therapeutic process to work, clients must feel they will be understood. Health care providers must show empathy.
How should the health care provider adjust if he or she feels more empathy toward one client and not another?
Clients are often looking for autonomy, but must depend on a health care provider to help them gain it. The health care provider must know when to intercede and when not to.
How can a health care provider gauge when she is not giving a client enough autonomy?

4. Dynamics of the Therapeutic Relationship cont’d. (p. 118)
The five dynamic components of the therapeutic relationship also include:
Caring
Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable
Hope
Expectation of achieving a future good
Consists of six dimensions—affective, affiliative, behavioral, cognitive, temporal, and contextual (know the definition)
The client is asking for emotional and psychological help. The health care provider must care in order to help someone in this situation; there are no concrete physical actions that can take the place of caring.
How should the health care provider adjust if she feels that she doesn’t care enough about a client?
Explain each of the six dimensions of hope, and provide an example for each.
Copyright © 2013 by Elsevier Inc. All rights reserved.

5. Characteristics of the Therapeutic Relationship (p. 119-120)
Acceptance
To receive what is being offered
Remember that it is the person who must be accepted, not the behaviors or the attitudes.
Rapport
Ability to establish a meaningful connection with clients
Genuineness
To be open, honest, and sincere in the relationship
While being genuine, remember that the client is the primary focus.
Describe the four characteristics of the therapeutic relationship.
List three ways to establish therapeutic rapport.
Copyright © 2013 by Elsevier Inc. All rights reserved.

6. Characteristics of the Therapeutic Relationship cont’d. (p. 121)
Therapeutic use of self
The most therapeutic tool of any care provider is the self.
Caregivers are role models.
Caregivers direct themselves therapeutically by focusing energies on the client.
Skills in using “self”
Feel good about yourself.
Develop an awareness of how your actions, gestures, and expressions affect other people.
Define the meaning of “therapeutic use of self.”

7. Phases of the Therapeutic Relationship (p. 120-122)
The four stages or phases of the therapeutic relationship are as follows:
Preparation phase: The caregiver gathers data and prepares for the relationship.
Orientation phase: The caregiver and the client become acquainted, agree to work with each other, and establish the purpose for the relationship.
Working phase: The client and caregiver work toward the goals in the client-caregiver agreement.
Termination phase: Should begin before last meeting; Goals are completed, and the client and caregiver share a sense of accomplishment. Sometimes client gets nervous or scared. ***Table 11-3***
The orientation phase is critical. The client is seeking emotional and psychological support, so feelings about the health care provider and their reactions to him or her are very important. Health care providers must strive to make a good first impression.
How should a health care provider explain his or her role to the client?
During the working phase, the client will sometimes seem to progress and sometimes seem like he or she is resisting therapy.
How should a health care provider respond to a client who feels anxious about the termination? How should a health care provider respond to a client who is concerned he won’t be able to apply his new skills? (The health care provider should make sure that the client agrees that the therapeutic goals have been met, and the health care provider should stress that the termination of the therapeutic relationship can be a happy and prideful occasion. It represents progress, accomplishment, and new possibilities.)

8. Roles of the Caregiver (p. 122-123)
Caregivers play several roles for their clients
Change agents
Teacher
Technician
Therapist
The orientation phase is critical. The client is seeking emotional and psychological support, so feelings about the health care provider and their reactions to him or her are very important. Health care providers must strive to make a good first impression.
How should a health care provider explain his or her role to the client?
During the working phase, the client will sometimes seem to progress and sometimes seem like he or she is resisting therapy.
How should a health care provider respond to a client who feels anxious about the termination? How should a health care provider respond to a client who is concerned he won’t be able to apply his new skills? (The health care provider should make sure that the client agrees that the therapeutic goals have been met, and the health care provider should stress that the termination of the therapeutic relationship can be a happy and prideful occasion. It represents progress, accomplishment, and new possibilities.)

9. Problems Encountered in the Therapeutic Relationship (p. 124)
Environmental problems
Lack of privacy
An inappropriate meeting place
Uncomfortable furniture
Lighting
Temperature
Noise and frequent interruptions
What problems may be encountered in the therapeutic relationship?
With careful planning, environmental problems can be eliminated or minimized.
Not all clients will be bothered by the same environmental problems.

10. Problems Encountered in the Therapeutic Relationship cont’d. (p. 125)
Problems with care providers
Barriers related to care providers in the therapeutic relationship include the following:
Difficulties with attitude
Compassion
Congruence
Counter-transference
Setting of helping boundaries
The health care provider must be sure he or she can deliver the appropriate levels of interest, compassion, understanding, and objectivity.
What are some signs that personal problems are interfering with the therapeutic relationship? When the health care provider’s personal feelings affect the therapeutic relationship, this is called countertransference.
How should a health care provider adapt if he believes his client cannot accomplish his or her goals?

11. Problems Encountered in the Therapeutic Relationship cont’d. (p. 124)
Problems with clients
Clients can engage in various behaviors to stall the effectiveness of therapeutic actions.
Client behaviors that block progress fall into three basic categories:
Resistance-secondary resistance
Secondary gain
Transference
Noncompliance
Clients often have resistance to therapy. The health care provider has been trained and is motivated to help people, and client resistance can be confusing and frustrating for the nurse.
A health care provider and his client have decided on some goals, but the client begins to refuse to work on them. What should the health care provider do?

12. Question 1
To establish a therapeutic relationship, three qualities must be present. Which of the following is not one of the three qualities?
Confidentiality
Acceptance
Rapport
Genuineness
Correct Answer: 1
Copyright © 2013 by Elsevier Inc. All rights reserved.

13. Question 2
During which phase of the therapeutic relationship do the caregiver and the client identify themselves by introducing themselves to one another?
Preparation phase
Orientation phase
Working phase
Termination phase
Correct Answer: 2
Copyright © 2013 by Elsevier Inc. All rights reserved.

14. Question 3
Care providers who work with mental health clients assume many different roles. Which of the following is not one of the roles that care providers assume when dealing with mental health clients?
Therapeutic change agent
Student
Technician
Therapist
Correct Answer: 2
Copyright © 2013 by Elsevier Inc. All rights reserved.

15. Question 4
The mental health team member focuses on the holistic care of the client in which role?
Therapeutic change agent
Teacher
Technician
Therapist
Correct Answer: 3
Copyright © 2013 by Elsevier Inc. All rights reserved.

16. Question 5
Common problems in a therapeutic relationship include all of the following except:
The environment
The caregiver
The client
Financial resources
Correct Answer: 4
Copyright © 2013 by Elsevier Inc. All rights reserved.