Learning Center Articles

Conditions Essential to Development of a Therapeutic Relationship

Conditions Essential to Development of a Therapeutic Relationship

  • Rapport- by getting acquainted and establishing rapport is the primary task in relationship development, and is accomplished by discussing non-health related topics. It promotes acceptance, warmth, friendliness, common interest, trust, and nonjudgmental attitude.
  • Trust- As an initial development task, it makes development of the relationship easier. It cannot be assumed but is earned. Things that may promote trust and build a relationship include:-
    • Providing a blanket when the patient is cold
    • Providing food when the patient is hungry
    • Keeping promises
    • Being honest (e.g., saying, “I don’t know the answer to your question, but I’ll try to find out”) and then following through
    • Simply and clearly providing reasons for certain policies, procedures, and rules
    • Providing a written, structured schedule of activities
    • Attending activities with the patient if he or she is reluctant to go alone
    • Being consistent in adhering to unit guidelines
    • Listening to the patient’s preferences, requests, and opinions and making collaborative decisions concerning his or her care
    • Ensuring confidentiality; providing reassurance that what is discussed will not be repeated outside the boundaries of the healthcare team
  • Respect- This shows dignity and worth of an individual regardless of their unacceptable behavior (Unconditional positive regard)
  • Genuineness- The nurse’s ability to be open, honest, and real in interactions with the patient.
  • Empathy- Do not confuse this with sympathy. In empathy the nurse accurately perceives or understands what the patient is feeling and encourages the patient to explore these feelings, while in sympathy the nurse shares what the patient is feeling and experiences a need to alleviate distress. Example
    • Situation: BJ is a patient on the psychiatric unit with a diagnosis of dysthymic disorder. She is 5 ft 5 in. tall and weighs 295 lb. BJ has been overweight all of her life. She is single, has no close friends, and has never had an intimate relationship with another person. It is her first day on the unit, and she is refusing to come out of her room. When she appeared for lunch in the dining room following admission, she was embarrassed when several of the other patients laughed out loud and call her “fatso.”
    • Sympathetic response: Nurse: “I can certainly identify with what you are feeling. I’ve been overweight most of my life, too. I just get so angry when people act like that. They are so insensitive! It’s just so typical of skinny people to act that way. You have a right to want to stay away from them. We’ll just see how loud they laugh when you get to choose what movie is shown on the unit after dinner tonight.”
    • Empathetic response: Nurse: “You feel angry and embarrassed by what happened at lunch today.” As tears fill BJ’s eyes, the nurse encourages her to cry if she feels like it and to express her anger at the situation. She stays with BJ but does not dwell on her own feelings about what happened. Instead she focuses on BJ and what the patient perceives are her most immediate needs.