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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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