Let’s explore the dynamics of the therapeutic relationship between psychiatric nurses and patients. The dynamics of the therapeutic relationship broadly refer to the interactions and forms that occur within the therapeutic relationship between the therapist and the patient. In a hospital’s psychiatric therapy environment, situations can vary depending on who the therapist is. The therapeutic relationship applies not only to the relationship between nurses and patients but also to doctors and other therapeutic staff, though the nurse-patient relationship can be the most complex and challenging.
1. Dynamics of the Therapeutic Relationship
We will explore the dynamics of the therapeutic relationship specifically between psychiatric nurses and psychiatric patients, although this content is relevant to all medical staff encountering individuals with mental disorders.
1) What are the Dynamics of the Therapeutic Relationship?
The dynamics of the therapeutic relationship in a mental and psychological therapy environment refer to the interactions and the nature of the relationship between the therapist and the client.
Here, the term ‘therapist’ refers to doctors, psychotherapists, nurses, and all other therapeutic staff interacting with the client. This article will specifically address the nurse-patient therapeutic relationship.
Among the forms of therapeutic relationship dynamics, the nurse-patient relationship can be the most complex. This complexity arises because nurses are required to be present 24 hours a day and provide a variety of services to patients.
2) Meaning of Psychodynamics
Before examining the dynamics of the therapeutic relationship, let’s understand what psychodynamics means.
Psychodynamics refers to a theory emphasizing how various interactions within the mind affect behavior, emotions, and an individual’s reality.
Psychodynamics is a field of psychology developed by Sigmund Freud. It includes concepts like the unconscious, consciousness, preconscious, id, ego, and superego.
Humans can suddenly feel angry, depressed, or anxious, and respond accordingly, often driven by unconscious motives or intentions that they are not aware of.
2. Joyce Travelbee’s Relationship Model Theory
We will examine the relationship model theory developed by nursing theorist Joyce Travelbee, which focuses on the dynamics between the therapist and patient in therapeutic relationships.
1) Joyce Travelbee
Joyce Travelbee, an American nursing theorist, extended Hildegard E. Peplau’s interpersonal theory.
She developed the Human-to-Human Relationship Model, which highlights the importance of therapeutic relationships in psychiatric nursing and provides direction on this topic.
Travelbee argued that nursing is not just about treating diseases or alleviating symptoms but about empathizing with patients’ personal experiences and pain, emphasizing the importance of treating patients as individuals.
2) Human-to-Human Relationship Model
The Human-to-Human Relationship Model developed by Travelbee is a significant theory in the dynamics of therapeutic relationships.
Travelbee emphasized that the relationship between a nurse and a patient is not just a professional therapeutic relationship but a human-to-human relationship.
She described this relationship as ‘an experience meaningful to both,’ suggesting that nurses and patients view each other as unique individuals, each fulfilling the other’s needs.
Key elements of the Human-to-Human Relationship Model include Meeting, Empathy, Nonjudgmental Attitude, Helping, and Hope.
3) Characteristics of the Therapeutic Relationship
Joyce Travelbee stated that a therapeutic relationship is goal-oriented. Nurses and clients should jointly decide what the goals of the relationship should be, and therapy should proceed towards these goals.
Generally, the goals of the relationship focus on learning and growth, and the therapist should work towards changing the client’s life.
4) Therapeutic Use of Self
The concept of Therapeutic Self-Disclosure means that the nurse themselves is used therapeutically in the relationship with the client.
For a nurse to be used as a therapeutic tool, they need self-awareness and self-understanding, and a high level of philosophical belief about life and death is necessary.
To enhance self-awareness, it is helpful to apply the seven stages of value clarification and the Johari Window to understand one’s beliefs, attitudes, and values.
3. Seven Stages of Value Clarification
The Value Clarification Method helps individuals clarify their values through a seven-step process and understand the dynamics of the therapeutic relationship.
You can choose values related to freedom, justice, safety, love, achievement, knowledge, health, spirituality, community, and creativity, and reflect on what is important in your life.
1) [Cognitive] Freely Choosing
Individuals can freely choose based on the values they find important and desirable in their lives.
2) [Cognitive] Choosing Among Alternatives
Once values are set, they can be referenced to consider various possibilities and make choices.
3) [Cognitive] Carefully Choosing Considering Outcomes
Consider the long-term outcomes that may arise from a decision.
4) [Emotional] Valuing and Enjoying the Choice
Take pride and enjoy the values you have chosen.
5) [Emotional] Expressing Values Publicly
Actively share and support the values you have chosen in front of others.
6) [Behavioral] Acting According to Values
Consistently act according to your values in everyday life and interpersonal relationships.
7) [Behavioral] Repeatedly Acting on Values
Consistently maintain actions based on your values, making them habits and patterns in your life.
4. Johari Window
The Johari Window helps in understanding how oneself and others perceive an individual. It also helps to understand the dynamics of the therapeutic relationship.
It includes four areas: Open or Public Self, Unknowing Self, Private Self, and Unknown Self.
1) The Open or Public Self
Aspects of oneself that both the individual and others are aware of.
2) The Unknowing Self
Areas that others know but the individual is unaware of.
3) The Private Self
Aspects that the individual knows but consciously hides from others.
4) The Unknown Self
Areas that are unknown to both the individual and others. Understanding the four areas of the Johari Window can be facilitated by asking specific questions to others, counseling, self-exploration, and various educational methods.
I have worked as a nurse in a psychiatric ward at a major university hospital in South Korea for over 10 years. From my experience, I feel that self-awareness as discussed in psychiatric nursing textbooks is not easy. Simply understanding oneself through preferred values and the Johari Window can be challenging!
Personally, I believe that studying cognitive-behavioral therapy and schema therapy can accelerate self-understanding, and psychoanalytic therapy and analytical psychology therapy can also be helpful.
5. Conclusion and Q&A
We have explored the dynamics of the therapeutic relationship, focusing on the interactions and forms that occur within the relationship between the therapist and the client, and examined Joyce Travelbee’s Human-to-Human Relationship Model for ideal mental dynamics.
In the Human-to-Human Relationship Model, for a good therapeutic relationship dynamic, the therapist must have high self-awareness and understanding, achievable through the seven stages of value clarification and the Johari Window. Let’s review some frequently asked questions and key points.
1) What does the dynamics of the therapeutic relationship mean?
The dynamics of the therapeutic relationship refer to the relationship between the therapist and the patient and the various situations that occur within that relationship. A good therapist is likely to form a therapeutic relationship.
2) How can the dynamics of the therapeutic relationship improve?
For therapeutic self-use, therapists must develop themselves and explore their own values. Nursing textbooks suggest using the seven stages of value clarification and the Johari Window for this exploration.
If you are curious about the next part on therapeutic communication or want to know your current life satisfaction level, please refer to the link below!
► Source of information and references
[Book] Psychiatric Mental Health Nursing 9th edition, Therapeutic Relationship part / by Mary C. Townsend∙Karyn I. Morgan / Hakjisamedical Publishing
[Interview] 10-year experienced psychiatric nurse & 4-year experienced nurse at OO University Hospital
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