THERAPEUTIC RELATIONSHIPS AND COMMUNICATION

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THERAPEUTIC RELATIONSHIPS AND COMMUNICATION

• JO ANN NORRIS, RN, MN,CORLN

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(No Transcript)
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HISTORICAL PERSPECTIVE

• RELATIONSHIP BETWEEN NURSE AND CLIENT DYNAMIC
  AND CHANGES OVER TIME.
• ANA SAYS PSYCH NURSING IS A SPECIALIZED AREA
  THAT USES THEORIES OF NUMAN BEHAVIOR AS ITS
  SCIENCE AND POWERFUL USE OF SELF AS ITS ART

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• THERAPEUTIC RELATIONSHIP
• MUTUALLY DEFINED
• COLLABORATIVE
• GOAL ORIENTED
• PROFESSIONAL RELATIONSHIP
• PROFESSIONAL RATHER THAN A SOCIAL RELATIONSHIP

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THERAPEUTIC RELATIONSHIP

• 4 OVERLAPPING PHASES
• EVOLVE OVER TIME
• PRE-INTERACTION PHASE
• 1. SELF-EXPLORATION
• 2. MISCONCEPTIONS PREJUDICES
• 3. ANXIETY NERVOUSNESS
• 4. AMBIVALENCE UNCERTAINTY
• 5. THREAT TO NURSES ROLE IDENTITY

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ORIENTATION PHASE

• CAN LAST A FEW MINUTES OR LONGER
• TRANSFERRENCE STIRRING UP OF FEELINGS IN THE
  CLIENT BY THE NURSE
• COUNTER-TRANSFERENCE STIRRING UP OF FEELINGS IN
  THE NURSE BY THE CLIENT

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ORIENTATION PHASE

• ESTABLISHING TRUST
• NURTURED BY DEMONSTRATED GENUINENENESS
  (CONGRUENCE) AND EMPATHY

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EMPATHY VS SYMPATHY
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TRUST

• DEVELOPING POSITIVE REGARD
• SHOWING CONSISTENCY
• OFFERING ASSISTANCE IN ALLEVIATING EMOTIONAL PAIN
  OR PROBLEMS

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ISSUES TO ADDRESS IN ORIENTATION PHASE

• 1. PARAMETERS OF THE RELATIONSHIP
• 2. FORMAL OR INFORMAL CONTRACT
• 3. CONFIDENTIALITY
• 4. TERMINATION

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TESTING BEHAVIORS

• 1. NURSE MUST BE ABLE TO SET LIMITS WHEN THE
  CLIENT NEEDS THEM
• 2. STILL SHOW CONCERN IF CLIENT ACTS OUT
• 3. STILL BE THERE IF CLIENT IS LATE

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WORKING PHASE

• MOST THERAPEUTIC WORK IS CARRIED OUT IN THIS PHASE

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WORKING PHASE- TASKS

• 1. MAINTAIN RELATIONSHIP
• 2. GATHER FURTHER DATA
• 3. PROMOTE THE CLIENTS PROBLEM SOLVING SKILLS,
  SELF-ESTEEM AND USE OF LANGUAGE
• 4. FACILITATE BEHAVIORAL CHANGE
• 5. OVERCOME RESISTANCE BEHAVIORS

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TASKS OF WORKING PHASE

• 6. EVALUATE PROBLEMS AND GOALS AND REDEFINE THEM
  AS NECESSARY
• 7. PRACTICE AND EXPRESS ALTERNATIVE
  ADAPTIVEBEHAVIORS

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TERMINATION PHASE

• Difficult and critical phase
• Client may experience
• Loss Separation
• Time to wrap up
• Evaluate
• Synthesize

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TERMINATION PHASE

• REASONS TO TERMINATE THE NURSE-CLIENT
  RELATIONSHIP
• 1. SYMPTOM RELIEF
• 2. IMPROVED SOCIAL FUNCTIONING
• 3. GREATER SENSE OF IDENTITY
• 4. MORE ADAPTIVE BEHAVIORS IN PLACE
• 5. ACCOMPLISHED THE CLENTS GOALS

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TERMINATION PHASE

• 6. AN IMPASSE IN THERAPY THAT THE NURSE IS
  UNABLE TO RESOLVE
• BECAUSE OF REISTANCE OR COUNTERTRANSFERENCE THAT
  CANT BE WORKED THROUGH

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TERMINATION PHASE

• WHAT CAN BE ACCOMPLISHED
• EXCHANGE FEELINGS AND MEMORIES
• BOTH EVALUATE PROGRESS AND GOAL ATTAINMENT
• NURSE AND PATIENT AGREE WHEN TERMINATION IS
  DESIRABLE

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TERMINATION PHASE

• NURSE MUST
• ESTABLISH THE REALITY OF THE SEPARATION
• REVIEW PREGRESS
• EXPRESS AND EXPLORE FEELINGS
• TRANSFER TRUST
• PATIENT DEFENSE MANEUVERS

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LISTENING

• PROBLEMS OF LISTENING
• 1. DAYDREAMING
• 2. PRETENDING ATTENTION
• 3. PRE-JUDGING
• 4. CLOSING OFF SPEAKER
• 5. GIVING IN TO DISTRACTION

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TIPS FOR EFFECTIVE LISTENING

• STOP TALKING AND LISTEN
• FOCUS ON WHAT IS BEING SAID
• PAY ATTENTION TO VOICE INFLECTION AND BODY
  LANGUAGE
• WAIT UNTIL THE SPEAKER FINISHES BEFORE RESPONDING
• BE NONJUDGEMENTAL
• DONT BE TURNED OFF BY JARGON

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TIPS FOR LISTENTING

• DONT DECIDE EARLY THAT THE SUBJECT IS TOO HARD
  OR TOO EASY
• LISTEN BETWEEN THE LINES FOR FEELINGS
• ASK SPEAKER TO CLARIFY

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FOUR ZONES IN HUMAN INTERACTION

• INTIMATE UP TO 18 INCHES
• PERSONAL - 18 INCHES TO 4 FEET
• SOCIAL 4 FEET TO 12 FEET
• PUBLIC 12 FEET AND BEYOND

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SPECIFIC TECHNIQUES

• GIVING BROAD OPENINGS
• PARAPHRASING
• OFFERING GENERAL LEADS
• RFLECTING FEELINGS
• FOCUSING
• VOICING DOUBT
• CLARIFYING

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SPECIFIC TECHNIQUES

• PLACING EVENTS IN TIME SEQUENCE
• GIVING INFORMATION
• ENCOURAGING FORMULATION OF A PLAN
• TESTING DISCREPANCIES

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AGGRESSIVE
ASSERTIVE
I COUNT YOU DONT COUNT.
I COUNT YOU COUNT
PASSIVE AGGRESSIVE I COUNT. YOU DONT COUNT
BUT IM NOT GOING TO TELL YOU THIS
PASSIVE I DONT COUNT YOU COUNT
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YOUR PERSONAL PATTERN OF COMMUNICATION
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DEFENSE MECHANISMS

• UNCONSCIOUS MEASURES THAT CLIENTS USE TO DEFEND
  THEIR PERSONAL STABILITY AND PROTECT AGAINST
  ANXIETY.
• THEY ARE NOT REAL IN AN THE SENSE THAT THEY CAN
  BE TESTED.
• THE MENTAL HEALTH PROFESSIONAL MUST REGOGNIZE
  THEIR USE BY WHAT THE CLIENT SAYS OR DOES

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DEFENSE MECHANISMS

• SOME ARE MORE ADAPTIVE THAN OTHERS
• ALL ARE USED, CONSCIOUSLY OR UNCONSCIOUSLY, AS
  PROTECTIVE DEVICES FOR THE EGO IN AN EFFORT TO
  RELIEVE MILD TO MODERATE ANXIETY