Syllabus: Therapeutic Relationship: Client and therapist characteristics; illness, technique and other factors influencing the relationship.

Characteristic of the Therapeutic Relationship The therapeutic relationship has several characteristics. The characteristics may appear to be simple and basic knowledge, although the constant practice and integration of these characteristic need to be the focus of every client that enters therapy. The therapeutic relationship forms the foundation for treatment as well as large part of successful outcome. Without the helping relationship being the number one priority in the treatment process, clinicians are doing a great disservice to clients as well as to the field of therapy as a whole. Rogers defines a helping relationship as , a relationship in which one of the participants intends that there should come about , in one or both parties, more appreciation of, more expression of, more functional use of the latent inner resources of the individual ( 1961). There are three characteristics that will be presented that Rogerss states are essential and sufficient for therapeutic change as well as being vital aspects of the therapeutic relationship (1957). In addition to these three characteristics, this author has added two final characteristic that appear to be effective in a helping relationship. 1. Therapists genuineness within the helping relationship. Rogers discussed the vital importance of the clinician to freely and deeply be himself. The clinician needs to be a real human being. Not an all knowing, all powerful, rigid, and controlling figure. A real human being with real thoughts, real feelings, and real problems (1957). All facades should be left out of the therapeutic environment. The clinician must be aware and have insight into him or herself. It is important to seek out help from colleagues and appropriate supervision to develop this awareness and insight. This specific characteristic fosters trust in the helping relationship. One of the easiest ways to develop conflict in the relationship is to have a better than attitude when working with a particular client. 2. Unconditional positive regard. This aspect of the relationship involves experiencing a warm acceptance of each aspect of the clients experience as being a part of the client. There are no conditions put on accepting the client as who they are. The clinician needs to care for the client as who they are as a unique individual. One thing often seen in therapy is the treatment of the diagnosis or a specific problem. Clinicians need to treat the individual not a diagnostic label. It is

imperative to accept the client for who they are and where they are at in their life. Remember diagnoses are not real entities, however individual human beings are. 3. Empathy. This is a basic therapeutic aspect that has been taught to clinicians over and over again, however it is vital to be able to practice and understand this concept. An accurate empathetic understanding of the clients awareness of his own experience is crucial to the helping relationship. It is essential to have the ability to enter the clients private world and understand their thoughts and feelings without judging these (Rogers, 1957). 4. Shared agreement on goals in therapy. Galileo once stated, You cannot teach a man anything, you can just help him to find it within himself. In therapy clinicians must develop goals that the client would like to work on rather than dictate or impose goals on the client. When clinicians have their own agenda and do not cooperate with the client, this can cause resistance and a separation in the helping relationship (Roes, 2002). The fact is that a client that is forced or mandated to work on something he has no interest in changing, may be compliant for the present time; however these changes will not be internalized. Just think of yourself in your personal life. If you are forced or coerced to work on something you have no interest in, how much passion or energy will you put into it and how much respect will you have for the person doing the coercing. You may complete the goal; however you will not remember or internalize much involved in the process. 5. Integrate humor in the relationship. In this authors own clinical experience throughout the years, one thing that has helped to establish a strong therapeutic relationship with clients is the integration of humor in the therapy process. It appears to teach clients to laugh at themselves without taking life and themselves too serious. It also allows them to see the therapist as a down to earth human being with a sense of humor. Humor is an excellent coping skill and is extremely healthy to the mind, body, and spirit.

Therapeutic Relationships- Factors influencing therapeutic relationship. Genuine interest Empathy Acceptance Positive regard respect, using clients name, considering pts ideas.

Self-awareness & therapeutic use of self Self-awareness understanding own values, beliefs, feelings, prejudices & how these affect others. Values-abstract standards (sense of right & wrong, hard work, honesty, sincerity, cleanliness & orderliness). Exercise What are your beliefs about the chemically dependent? Attitudes general feelings hopeful, optimistic, optimistic, or pessimistic Its the journey, not the destination thats important.

Goals of a therapeutic relationship communication of distressing thoughts & feelings Assist client with problem solving to help daily living Help clients examine self-defeating behaviors & test alternatives Promote self-care and independence
Therapeutic Counselor-client Relationship 3 Phases
Beginning - orientation Facilitate

Middle - working End - termination

Therapeutic Relationship: 1. Phase One Orientation

Assessment and analysis

Communications Assessing pts reason for seeking help Developing trust Establishing mutually agreed-upon goals Developing a therapeutic contract Formulating nursing diagnosis What are your responsibilities? Responsibilities

State your name and role Establish time and place for interactions Define expected duration of your work with client Begin to establish trust immediately Begin client assessment and data collection
2. Working phase- Planning & Implementation Phase

Use communication skills to help client: learn about him/her self Explore feelings and problems Begin work on behavioral changes Interventions are planned to meet client goals Expression of thought and feelings is facilitated Constructive coping mechanisms are encouraged
Working Phase

Alternative, more adaptive behaviors by the client are practiced and evaluated Resistance and testing behavior are worked through
3. Termination (Evaluation) Phase

Termination date is stated in the 1st or 2nd client/nurse meeting Remind client periodically through out sessions of termination date Inform client of other sources of help available now and in future Evaluate therapeutic outcome Express feelings about termination Observe for regressive behavior Evaluate the counselor-client relationship
Counselor may have mixed feelings: happy with progress, sad to leave a rewarding relationship

Transference The process whereby a person (patient) unconsciously displaces (transfers) onto individuals (nurse) in his current life those patterns of behaviors that originated with significant figures from childhood.

Counter transference

The tendency of the nurse to displace onto the client feelings caused by people in the
therapists past. Behaviors that diminish therapeutic relationships Inappropriate boundaries

Client attracted to therapist or vice versa Accepting gifts or giving gifts Giving out home address or phone # to patient Boundary
Behaviors that diminish therapeutic relationships

Sympathy Encouraging client dependency Non acceptance or avoidance