5 THERAPEUTICRELATIONSHIPS 91
The ability to establish therapeutic relationships with
clients is one of the most important skills a nurse can
develop. Although important in all nursing special-
ties, the therapeutic relationship is especially crucial
to the success of interventions with clients requiring
psychiatric care, because the therapeutic relationship
and the communication within it serve as the under-
pinning for treatment and success.
This chapter examines the crucial components
involved in establishing appropriate therapeutic
nurse–client relationships: trust, genuine interest,
acceptance, positive regard, self-awareness, and ther-
apeutic use of self. It explores the tasks that should be
accomplished in each phase of the nurse–client rela-
tionship and the techniques the nurse can use to help
do so. It also discusses each of the therapeutic roles of
the nurse (teacher, caregiver, advocate, and parent
surrogate).COMPONENTS OF A
THERAPEUTIC RELATIONSHIP
Many factors can enhance the nurse–client relation-
ship, and it is the nurse’s responsibility to develop
them. These factors will promote communication and
enhance relationships in all aspects of the nurse’s life.Trust
The nurse–client relationship requires trust. Trust
builds when the client is confident in the nurse and
the nurse’s presence conveys integrity and reliability.
Trust develops when the client believes that the nurse
will be consistent in his or her words and actions and
can be relied on to do what he or she says. Some be-
haviors the nurse can exhibit to help build the client’s
trust include being friendly, caring, interested, un-
derstanding, and consistent; keeping promises; and
listening to and being honest with the client (Box 5-1).
Congruenceoccurs when words and actions
match: for example, the nurse says to the client, “I
have to leave now to go to a clinical conference, but I
will be back at 2 pm” and indeed returns at 2 pm to
see the client. The nurse needs to exhibit congruent
behaviors to build trust with the client.
Trust erodes when a client sees inconsistency
between what the nurse says and does. Inconsistent
or incongruent behaviors include making verbal com-
mitments and not following through on them. For ex-
ample, the nurse tells the client she will work with
him every Tuesday at 10 am, but the very next week
she has a conflict with her conference schedule and
does not show up. Another example of incongruent
behavior is when the nurse’s voice or body language
is inconsistent with the words he or she speaks. For
example, an angry client confronts a nurse and ac-
cuses her of not liking her. The nurse responds by
saying, “Of course I like you, Nancy! I am here to help
you.” But as she says these words, the nurse backs
away from Nancy and looks over her shoulder: the
verbal and nonverbal components of the message do
not match.
When working with a client with psychiatric prob-
lems, some of the symptoms of the disorder, such as
paranoia, low self-esteem, and anxiety, may make
trust difficult to establish. For example, a client with
depression has little psychic energy to listen to or toA group of 12 nursing students has arrived for their first
day on the psychiatric unit. They are apprehensive, un-
certain what to expect, and standing in a row just inside
the locked doors. They are not at all sure how to react to
these clients and are fearful of what to say at the first
meeting. Suddenly they hear one of the clients shout,CLINICALVIGNETTE: THERAPEUTICRELATIONSHIPS
“Oh look, the students are here. Now we can have some
fun!” Another client replies, “Not me, I just want to be
left alone.” A third client says, “I want to talk to the good-
looking one.” And so, these students’ nurse –client rela-
tionships have just begun—not quite in the best or text-
book circumstances.Box 5-1
➤ TRUSTINGBEHAVIORS
Trust is built in the nurse –client relationship when the
nurse exhibits the following behaviors:- Friendliness
- Caring
- Interest
- Understanding
- Consistency
- Treating the client as a human being
- Suggesting without telling
- Approachability
- Listening
- Keeping promises
- Providing schedules of activities
- Honesty