CHAPTER 5: Therapeutic Relationships

Chapter 5: Therapeutic Relationships

Key Terms:
o Acceptance: avoiding judgments of the person, no matter what the behavior
o Advocacy: the process of acting on the clients behalf when he or she cannot do so
o Attitudes: general feelings or a frame of reference around which a person organizes knowledge about the
world
o Beliefs: ideas that one holds to be true
o Compassion Fatigue: a type of secondary trauma or stress resulting from helping others works through
traumatic stress; experienced by those in the helping professions
o Confidentiality: respecting the clients right to keep private any information about his or her mental and
physical health and related care
o Congruence: occurs when words and actions match
o Countertransference: occurs when the therapist displaces onto the client attitudes or feelings from his or
her past; process that can occur when the nurse responds to the client based on personal, unconscious
needs and conflicts
o Duty to Warn: the exception to the clients right to confidentiality; when health-care providers are legally
obligated to warn another person, who is the target of the threats or plan by the client, even if the threats
were discussed during therapy sessions otherwise protected by confidentiality
o Empathy: the ability to perceive the meanings and feelings of another person and to communicate that
understanding to that person
o Exploitation: phase of nurse-client relationship, identified by Peplau, when the nurse guides the client to
examine feelings and responses and to a residence where they fulfill their own responsibilities and
function without on-site supervision from paid staff
o Genuine Interest: truly paying attention to the client, caring about what he or she is saying; only possible
when the nurse is comfortable with himself or herself and aware of his or her strengths and limitations
o Intimate Relationship: a relationship involving two people who are emotionally committed to each other;
both parties are concerned about having their individual needs me and helping each other to meet needs as
well; the relationship may include sexual or emotional intimacy as well as sharing of mutual goals
o Orientation Phase: the beginning of the nurse-client relationship; begins when the nurse and client meet
and ends when the client begins to identify problems to examine
o Patterns of Knowing: the four patterns of knowing in nursing are empirical knowing (derived from the
science of nursing), personal knowing (derived from life experiences), ethical knowing (derived from
moral knowledge of nursing), and aesthetic knowing (derived from the art of nursing); these patterns
provide the nurse with a clear method of observing and understanding every client interaction
o Positive Regard: unconditional, nonjudgmental attitude that implies respect for the person
o Preconceptions: the way one person expects another to behave or speak; often roadblock to the formation
of an authentic relationship
o Problem Identification: part of the working phase of the nurse-client situation, when the client identifies
the issues or concerns causing problems
o Self-Awareness: the process by which a person gains recognition of his or her own feelings, beliefs, and
attitudes; the process of developing an understanding of ones own values, beliefs, thoughts, feelings,
attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others
o Self-Disclosure: revealing personal information such as biographical information and personal
experiences, ideas, thoughts, and feelings about oneself
o Social Relationship: primarily initiated for the purpose of friendship, socialization, companionship, or
accomplishment of a task
o Termination or Resolution Phase: the final stage in the nurse-client relationship; it begins when the
clients problems are resolved and concludes when the relationship ends
o Therapeutic Relationship (Therapeutic Nurse-Client Relationship): professional, planned relationship
between client and nurse that focuses on client needs, feelings, problems, and ideas; interaction designed
to promote client growth, discuss issues, and resolve problems; includes the three phases of orientation:

UNIT 2: Building the Nurse-Client Relationship 1

CHAPTER 5: Therapeutic Relationships
working (identification and exploitation) and termination (resolution); also called therapeutic nurse-
patient relationship
o Therapeutic Use of Self: nurse use themselves as a therapeutic took to establish the therapeutic
relationship with clients and to help clients grow, change, and heal
o Transference: occurs when the client displaces onto the therapist attitudes and feelings that the client
originally experienced in other relationships; it is common for the client to unconsciously transfer to the
nurse feelings her or she has for significant others
o Unknowing: when the nurse admits she does not know the client or the clients subjective world; this
opens way for a truly authentic encounter; the nurse in a state of unknowing is open to seeing and hearing
the clients views without imposing any of his or her values or view points
o Values: abstract standards that give a persona sense of right and wrong and establish a code of conduct for
living
o Working Phase: in the therapeutic relationship, the phase where issues are addressed, problems identified,
and solutions explored; nurse and client work to accomplish goals; contains Peplaus phases of problem
identification and exploitation
Objectives:
o Describe how the nurse uses the necessary components involved in building and enhancing the nurse-
client relationship (trust, genuine interest, empathy, acceptance, and positive regard)
o Explain the importance of values, beliefs, and attitudes in the development of the nurse-client relationship
o Describe the importance of self-awareness and therapeutic use of self in the nurse-client relationship
o Identify self-awareness issues that can enhance or hinder the nurse client relationship
o Define Carpers four patterns of knowing, and give examples of each
o Describe the difference between social, intimate, and therapeutic relationships
o Describe and implement the phases of the nurse-client relationship as outlined by Hildegard Peplau
o Explain the negative behaviors that can hinder or diminish the nurse-client relationship
o Explain the various possible roles of the nurse (teacher, caregiver, advocate, and parent surrogate) in the
nurse-client relationship

UNIT 2: Building the Nurse-Client Relationship 2