Social Relationship
A social relationshipis primarily initiated for the
purpose of friendship, socialization, companionship,
or accomplishment of a task. Communication, which
may be superficial, usually focuses on sharing ideas,
feelings, and experiences and meets the basic need
for people to interact. Advice is often given. Roles may
shift during social interactions. Outcomes of this kind
of relationship are rarely assessed. When a nurse
greets a client and chats about the weather or a sports
event or engages in small talk or socializing, this is a
social interaction. This is acceptable in nursing, but
for the nurse–client relationship to accomplish the
goals that have been decided on, social interaction
must be limited. If the relationship becomes more
social than therapeutic, serious work that moves the
client forward will not be done.
Intimate Relationship
A healthy intimate relationshipinvolves two peo-
ple who are emotionally committed to each other. Both
parties are concerned about having their individual
needs met and helping each other to meet needs as
well. The relationship may include sexual or emo-
tional intimacy as well as sharing of mutual goals.
Evaluation of the interaction may be ongoing or not.
The intimate relationship has no place in the nurse–
client interaction.
Therapeutic Relationship
The therapeutic relationshipdiffers from the so-
cial or intimate relationship in many ways because it
focuses on the needs, experiences, feelings, and ideas
of the client only. The nurse and client agree about
the areas to work on and evaluate the outcomes. The
nurse uses communication skills, personal strengths,
and understanding of human behavior to interact
with the client. In the therapeutic relationship, the
parameters are clear: the focus is the client’s needs,
not the nurse’s. The nurse should not be concerned
about whether or not the client likes him or her or is
grateful. Such concern is a signal that the nurse is
focusing on a personal need to be liked or needed. The
nurse must guard against allowing the therapeutic
relationship to slip into a more social relationship.
The nurse must constantly focus on the client’s needs,
not his or her own.
The nurse’s level of self-awareness can either
benefit or hamper the therapeutic relationship. For
example, if the nurse is nervous around the client,
the relationship is more apt to stay social because
superficiality is safer. If the nurse is aware of his or
her fears, he or she can discuss them with the in-
structor, paving the way for a more therapeutic re-
lationship to develop.ESTABLISHING THE
THERAPEUTIC RELATIONSHIP
The nurse who has self-confidence rooted in self-
awareness is ready to establish appropriate thera-
peutic relationships with clients. Because personal
growth is ongoing over one’s lifetime, the nurse can-
not expect to have complete self-knowledge. Aware-
ness of his or her strengths and limitations at any
particular moment, however, is a good start.Phases
Peplau studied and wrote about the interpersonal
processes and the phases of the nurse–client rela-
tionship for 35 years. Her work has provided the
nursing profession with a model that can be used
to understand and document progress with inter-
personal interactions. Peplau’s model (1952) has three
phases: orientation, working, and resolution or termi-
nation (Table 5-2). In real life, these phases are not
that clear-cut; they overlap and interlock.ORIENTATION
The orientation phasebegins when the nurse and
client meet and ends when the client begins to identify
problems to examine. During the orientation phase,
the nurse establishes roles, the purpose of meeting,
and the parameters of subsequent meetings; identifies
the client’s problems; and clarifies expectations.
Before meeting the client, the nurse has impor-
tant work to do. The nurse reads background materi-
als available on the client, becomes familiar with any
medications the client is taking, gathers necessary
paperwork, and arranges for a quiet, private, comfort-
able setting. This is a time for self-assessment. The
nurse should consider his or her personal strengths
and limitations in working with this client. Are there
any areas that might signal difficulty because of past
experiences? For example, if this client is a spouse
batterer and the nurse’s father was also, the nurse
needs to consider the situation: How does it make him
or her feel? What memories does it prompt, and can he
or she work with the client without these memories
interfering? The nurse must examine preconceptions
about the client and ensure that he or she can put
them aside and get to know the real person. The nurse
must come to each client without preconceptions or
prejudices. It may be useful for the nurse to discuss
all potential problem areas with the instructor.
During the orientation phase, the nurse begins to
build trust with the client. It is the nurse’s responsi-
bility to establish a therapeutic environment that5 THERAPEUTICRELATIONSHIPS 97