We will explore the conditions necessary for Establishing a therapeutic relationship in nursing by a psychiatric nurse. A therapeutic relationship can be defined as one that helps achieve therapeutic goals between the caregiver and the recipient, and has meaningful interaction within their relationship. However, Establishing a therapeutic relationship in nursing is not as easy as it might seem. There are specific conditions necessary for a nurse to establish a therapeutic relationship, including rapport, empathy, trust, respect, and sincerity.
1. What is a Therapeutic Relationship?
A Therapeutic Relationship refers to the interaction between a caregiver, such as a doctor, nurse, or counselor, and the recipient of the care within a hospital setting.
To establish a good therapeutic relationship, high levels of self-awareness and professional expertise on the part of the caregiver are required.
Complex Therapeutic Relationship between Psychiatric Nurses and Patients
While a desirable therapeutic relationship is necessary across all caregiver-recipient interactions, the form it takes can vary depending on the type of caregiver. This text will focus on the therapeutic relationship formation between psychiatric nurses and patients.
The relationship between psychiatric nurses and patients is more complex and challenging than in any other profession. Unlike doctors or counselors who interact with the recipient only within a set time, psychiatric nurses must be present around the clock, fulfilling multiple roles.
Psychiatric nurses need to solve various problems for the patient while setting limits depending on the environment. They also need to mediate conflicts within the ward rules and among other patients. Therefore, Establishing a therapeutic relationship in nursing can be particularly challenging for psychiatric nurses.
2. Conditions for Establishing a therapeutic relationship in psychiatric nursing
Let’s explore what conditions are necessary for Establishing a therapeutic relationship in nursing by psychiatric nurses. These include rapport, empathy, trust, respect, and sincerity.
1) Rapport
The first condition for Establishing a therapeutic relationship in nursing is rapport. The term rapport, in psychology, means a close relationship. Originating from the French word Rapporter, it carries the meaning of ‘bringing back.’
Rapport in the relationship between a nurse and a patient can signify special emotions, based on acceptance, warmth, friendship, common interests, trust, and a non-judgmental attitude.
Joyce Travelbee, a nursing scholar, emphasized that rapport is crucial in recognizing and acknowledging each individual’s uniqueness to create harmony.
She stated that the essence of rapport is the ability to genuinely care for and nurture others, experiencing another person as a human being.
► What does it mean to genuinely care for and nurture others?
– Genuinely caring and nurturing mean that the caregiver goes beyond their professional duties to empathize with another person’s emotions and well-being.
► What does it mean to experience another person?
– Experiencing another person means that the caregiver sees the recipient not just as a patient but understands their personal traits and experiences as they are. This allows for recognizing and acknowledging individual uniqueness and enables personalized care.
2) Empathy
The second condition for Establishing a therapeutic relationship in nursing is empathy. Empathy, derived from the Ancient Greek ‘Em’ and ‘Pathos,’ means ‘to enter into feelings.’
Empathy involves the ability to understand a situation from another person’s perspective, extending beyond merely recognizing emotions to sharing in those emotions.
Nurses with empathic ability can accurately perceive and understand the meanings and validity of a patient’s thoughts and feelings, and communicate these back to the patient.
► Distinguishing Empathy from Sympathy
– When recognizing empathy, it is important to distinguish it from sympathy. Empathy involves emotional detachment, whereas sympathy can lead to losing objectivity by taking on the other person’s needs and problems as one’s own.
– An empathetic nurse perceives and understands the patient’s feelings, providing minimal help and aiding in problem-solving, while a sympathetic nurse may actually share the feelings, focusing on alleviating stress.
3) Trust
The third condition for Establishing a therapeutic relationship in nursing is trust. Trust, believed to have originated from the Old Norse word ‘traust,’ implying ‘strong’ or ‘safe,’ fundamentally means having faith and confidence in someone, associated with the expectation that the person will act consistently, predictably, and honestly.
In a therapeutic relationship, trust must be earned by the caregiver through genuine, warm feelings, respect, and kindness toward the patient.
For many psychiatric patients, focusing on solving immediate problems may be effective in building trust. This can include keeping promises, adhering to rules, consistency, confidentiality, and attending to everyday needs.
4) Respect
The fourth condition for Establishing a therapeutic relationship in nursing is Respect. Derived from the Latin ‘respicio,’ meaning ‘to look back’ or ‘consider,’ respect is about valuing and acknowledging another’s worth, even if their behavior is unacceptable, recognizing their freedom, thoughts, individuality, rights, and dignity.
Psychologist Carl Rogers referred to this as ‘Unconditional Positive Regard’, a non-judgmental attitude that does not let a recipient’s actions affect the respect they are given.
Many psychiatric patients often feel rejected by others due to their behaviors, which can severely impact their self-respect. Accepting and respecting the patient as a unique individual can enhance their sense of self-worth and self-respect.
► Examples of Respectful Attitudes
– Calling the patient by their name
– Spending time with the patient
– Taking ample time to respond to the patient’s questions and concerns
– Creating a private environment during consultations
– Always being honest with the patient
– Considering the patient’s opinions when planning care
– Understanding the motives behind unacceptable behaviors
5) Sincerity
The fifth condition for Establishing a therapeutic relationship in nursing is Sincerity. Sincerity, stemming from the Latin ‘Sincerus,’ meaning ‘clean’ or ‘pure,’ involves being genuine in one’s words and actions, behaving in accordance with one’s true beliefs, thoughts, and feelings, and expressing honest emotions and communication based on facts.
While therapeutic transparency might be necessary, it is important not to reverse the roles of nurse and patient by overly sharing personal feelings or experiences.
When nurses use self-disclosure, it should serve as a model of the caregiver’s humane aspects, providing comfort to the patient.
I have worked in the psychiatric ward of a major university hospital for over 10 years! Establishing a therapeutic relationship in nursing with other patients is not easy, but each caregiver has their strengths, and starting with these strengths can be the beginning of establishing a therapeutic relationship. If you are meeting a recipient as a caregiver, first identify your strengths!
3. Conclusion and Q&A
We have explored the conditions necessary for Establishing a therapeutic relationship in nursing by psychiatric nurses. These conditions may include rapport, empathy, trust, respect, and sincerity. Below are some frequently asked questions and key points.
1) What is the most important condition in Establishing a therapeutic relationship in nursing by nurses?
While all five conditions presented in this article are important, if one must be chosen, it would be respect. Without mutual respect between the caregiver and the recipient, the relationship is unlikely to develop therapeutically.
But all five conditions mentioned in this text for establishing a therapeutic relationship in nursing are important.
2) How can one provide unconditional respect to the recipient?
Unconditional respect involves acknowledging the inherent and dignified value of the recipient regardless of their attitude or behavior. To provide unconditional respect, the caregiver must believe in absolute values rather than conditional values.
Absolute value implies that being human in itself carries inherent dignity, regardless of conditions. The caregiver must also recognize themselves as beings of absolute value, which allows them to see others as beings of absolute value too.
If you are interested in the next part about the four stages of therapeutic human relationships or the role of psychiatric nurses, please refer to the link below!
► Information Source and References
– [Book] Psychiatric Nursing 9th edition, Part on Therapeutic Relationship Formation by Mary C. Townsend and Karyn I. Morgan, published by Hakjisa Medical
– [Interview] Interview with a psychiatric nurse from OO University Hospital’s psychiatric ward
– Be the Titan Brain
