Therapeutic Relationship

INTRODUCTION
DEFINITION OF THERAPEUTIC
RELATIONSHIP
“ The relationship between a healthcare

professional and a client (patient). It is a mean
by which the Therapist and a client hope to
engage with each other and effect beneficial
change in the client”
DEFINITION OF THERAPEUTIC NURSE PATIENT
RELATIONSHIP
“ The interaction process in which the

Nurse fulfills her role by using her
professional knowledge and skill in such
a way that she is able to help the patient
physically, socially and emotionally”
1. Social Relationships
2. Intimate Relationships
3. Therapeutic Relationships
SOCIAL RELATIONSHIP
1. Social Relationships
relationship that is primarily initiated with the
purpose of friendship, socialization and
enjoyment.
For example, participants share ideas, feelings

& experiences.
INTIMATE RELATIONSHIP
2. Intimate Relationships
An intimate relationship occurs between two

individuals who have an emotional commitment to
each other.
Often the relationship is a partnership wherein each

member cares about the other’s need for growth &
satisfaction.
THERAPEUTIC RELATIONSHIP
3. Therapeutic Relationships
 The therapeutic relationship between nurse & the patient.
 differs from both a social & an intimate relationship
 In therapeutic relationship nurse maximizes communication

skills, understanding of human behavior & personal strengths,
in order to enhance the patient’s growth.
 The focus of the relationship is on the patient’s ideas,

experiences & feelings.
Facilitating communication of distressing thoughts &
feelings.
Assisting the client with problem solving
Helping the client examine self-defeating behaviors &

test-alternatives.
Promoting self-care & independence.

 Communicate of ideas and felling
 Teach new patterns of behaviour
 Socialize
FACTORS DETERMINING EFFECTIVE
NURSE PATIENT RELATIONSHIP
1. Self Awareness
2. Attitude towards the patient
3. Ability of developing the rapport

Self Awareness
Self awareness includes self concept, beliefs and values.
If a nurse has a positive self concept about herself she

will be confident in caring for the patient.
But if she has developed a negative self concept, she will

not be able to help the patient
Attitude towards the patient
Nurse must develop an attitude of acceptance of

the patient, tolerance of his/her disturbed
behaviour and helping the patient
She should avoid passing the judgement on the

patient
Ability of developing the rapport
It is defined as a relationship of mutual sympathy and
understanding especially between patient and therapist.
The essential qualities for developing rapport are warmth,

genuineness and empathy
QUALITIES OF THERAPEUTIC NURSE
PATIENT RELATIONSHIP
1. Genuineness (real and honest)
2. Sincerity
3. Respect
4. Love and affection
5. Concern
6. Good Listener
7. Empathy
8. Good communication skills
9. Exploration of problems
10. Self discipline
1. Pre-interaction phase
2. Introductory or Orientation phase
3. Working phase
4. Termination phase
This phase begins when the nurse is assigned to
initiate a therapeutic relationship
 included all that the nurse thinks, feels or does

immediately prior to the first interaction with
the patient.
Count…
Nurse’s tasks in the pre-interaction phase:
Explore own feelings, fantasies & fears
Analyze own professional strengths &

limitations.
Gather data about patient whenever possible.
Plan for first meeting with patient.

Count…
Help from peers and supervisor in self
analysis & facing reality.
Analyze herself & recognize her asset &

limitation.
It is during the introductory phase that the nurse &
patient meet for the first time.
One of the nurse’s primary concerns is to find out

why the patient sought help.
Nurse’s tasks in the Orientation phase:
 Establish rapport, trust & acceptance.
 Establish communication.
 Gather data, including the client’s feelings, strengths &

weaknesses.
 Define client’s problems; set priorities for nursing intervention.
 Mutually set goals

• Nurse must be willing to relate honestly to her feeling & share it
with supervisor.
• Nurse must feel free to reveal self without fear of criticism.
• Difficulty may be faced in assisting a nurse with

countertransference since most of this behavior is unconsciously
determined.
• A alert supervisor can detect this & guide the nurse appropriately.
Most of the therapeutic work is carried out during
the working phase.
The nurse & the patient explore relevant stressors

& promote the development of insight in the
patient.
Nurse’s tasks in the working phase:
• Gather further data; explore relevant stressors.
• Promote patient’s development of insight & use of constructive

coping mechanism.
• Facilitate behavioral change; encourage him to evaluate the

results of his behavior.
• Provide him with opportunities for independent functioning.
• Evaluate problems & goals & redefine as necessary.

Count…
This is the most difficult, but most important
phase of the therapeutic nurse-patient
relationship.
The goal of this phase is to bring a therapeutic

end to the relationship.
Count…
Nurse’s tasks in the Termination Phase:
Establish reality of separation
Mutually explore feelings of loss, sadness, anger &

related behavior.
Review progress of therapy & attainment of goals
Formulate plans for meeting future therapy needs.

Count…
Nurse should be aware of patients feeling & be able to
deal with them appropriately.
Assist the patient by openly eliciting his thoughts &

feelings about termination.
Supervisor can assist the nurse in preparing patient for

discharge.
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• It’s a natural learned
reluctance to avoidance of
verbalizing or even
experiencing troubled
aspects of self.
• It is an unconscious response of the patient in
which he experiences feeling & attitudes
towards the nurse that were originally
associated with significant figures in his early
life.
• Transference reactions are harmful to the

therapeutic process only if they remain ignored
& unexamined.
• It’s a therapeutic impasse created by
the nurse.
• It refers to nurse’s specific emotional
response generated by the qualities
of the patient.
• In this case the nurse identifies the
patient with individuals from her
past & personal needs will interfere
with therapeutic effectiveness.
Receiving a gift from patient make the nurse
to inhibit independent decision making &
create a feeling of anxiety or guilt.
Gift is something of value is voluntarily

offered to another person, usually to convey
a gratitude.
It occurs when nurse goes outside the
boundaries of therapeutic relationship
& establishes a social, economic or
personal relationship with the patient.

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INTRODUCTION

“ The relationship between a healthcare

“ The interaction process in which the

For example, participants share ideas, feelings

An intimate relationship occurs between two

Often the relationship is a partnership wherein each

 differs from both a social & an intimate relationship

 In therapeutic relationship nurse maximizes communication

 The focus of the relationship is on the patient’s ideas,

Assisting the client with problem solving

Helping the client examine self-defeating behaviors &

Promoting self-care & independence.

 Teach new patterns of behaviour

2. Attitude towards the patient

3. Ability of developing the rapport

If a nurse has a positive self concept about herself she

But if she has developed a negative self concept, she will

Nurse must develop an attitude of acceptance of

She should avoid passing the judgement on the

The essential qualities for developing rapport are warmth,

 included all that the nurse thinks, feels or does

Analyze own professional strengths &

Gather data about patient whenever possible.

Plan for first meeting with patient.

Analyze herself & recognize her asset &

One of the nurse’s primary concerns is to find out

 Establish rapport, trust & acceptance.

 Gather data, including the client’s feelings, strengths &

 Define client’s problems; set priorities for nursing intervention.

 Mutually set goals

• Nurse must feel free to reveal self without fear of criticism.

• Difficulty may be faced in assisting a nurse with

The nurse & the patient explore relevant stressors

• Promote patient’s development of insight & use of constructive

• Facilitate behavioral change; encourage him to evaluate the

• Provide him with opportunities for independent functioning.

• Evaluate problems & goals & redefine as necessary.

The goal of this phase is to bring a therapeutic

Mutually explore feelings of loss, sadness, anger &

Review progress of therapy & attainment of goals

Formulate plans for meeting future therapy needs.

Assist the patient by openly eliciting his thoughts &

Supervisor can assist the nurse in preparing patient for

• Transference reactions are harmful to the

Gift is something of value is voluntarily

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