For Carl Rogers, discussing therapeutic relationships suggests that the relationship between the one being helped and the helper is a mutual one. Buber (1966) opposed and disagreed with Rogers and suggested that, because it is always the patient that comes to the professional for help and not the other way around, the relationship can never be a mutual one. Mutualism is defined as ‘the relation between two different species of organisms that are interdependent; each gains benefits from the other’, (dictionary. eference. com (2008). Campbell (1984) said the role of a nurse in a therapeutic relationship is; somebody who shares freely with others, but does not interfere and allow others to make and define their own journey. Patterson (1985) believes that the relationship itself is central and quoted that ‘counselling or psychotherapy is an interpersonal relationship. Note that I don’t say that counselling or psychotherapy involves an interpersonal relationship-it is an interpersonal relationship’.
The Nursing and Midwifery Council (NMC) influence a therapeutic relationship throughout The Code (2008), it quotes ‘you must listen to the people in your care and respond to their concerns and preferences and you must make arrangements to meet people’s language and communication needs’. It encourages nurses to develop their relationship with the patient through the use of communication skills and through educating the patient about their illness. A therapeutic relationship is based on the communication between the nurse and the client themselves.
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Communication involves almost every aspect of our interactions with others; and it plays an important part in any relationship. The holistic approach helps us, as nurses to encourage/support and authorize the patient with the accurate knowledge and understanding in order to help them to recover from their illness. If the nurse has the aptitude to communicate skilfully with the patient, throughout developing a therapeutic relationship, the patient will be more eager and willing to communicate and be more open with the nurse.
Within a therapeutic relationship, trust is essential (holisticlocal. co. uk), and helps the nurse to increase their chance in healing the patient to overcome their illness and gain their respect. Patients expect the nurse to have the essential knowledge and to be able to display caring attitudes, so that they are able to trust the nurse and assign their care to the Professional. Breaching trust can make it very hard to re-establish it and therefore if a promise is made it should be adhered to.
Mitchell and Cormack(1998) agree with this as they believed ‘patients themselves value therapeutic relationships which offer respect, trust, and care and it seems that such relationships may in themselves prove to be healing in the broadest sense’ (Mitchell & Cormack (1998). In relationships constantly agreeing/ disagreeing with the other person on every occasion is not necessary as this could lead to aggravation, annoyance, and eventual dissatisfaction.
Particular skills are needed to be adequately assertive without damaging the relationship. There are a variety of key skills which incorporate inside this relationship. Listening attentively and fully taking in to consideration what the patient is saying is perhaps the single most important skill that must be accomplished by the nurse. Listening to the patient without instantly giving suggestions and advice or diminishing the client’s opinion, is central to the establishment of developing a relationship.
Listening refers to more than hearing what the patient says and Rogers (1980) believed that ‘In some sense attending and listening means that you lay aside yourself; this can only be done by persons who are secure enough in themselves that they know they will not get lost in what may turn out to be the strange and bizarre world of the other, and that they can comfortably return to their own world when they wish’, he is referring to ‘getting lost in the world of the other’.
Burnard (1997) describes the art of ‘attending’ as the act of truly focusing on the other person, consciously making ourselves aware of what they are saying and what they are trying to communicate. Vital to the establishment and construction of a therapeutic relationship is the nurses own capability to use an extensive range of communication skills, strategies and interpersonal skills. Effective and successful communication is a necessary aspect in producing and preserving a successful relationship.
Regardless of the surroundings and the duration of interaction, the nurse acts in therapeutic ways to supervise the limitations of the relationship. This could involve tasks such as, the nurse introducing themselves to the client and addressing the patient by their preferred name/title, or showing a genuine interest in, and compassion for the client. In a therapeutic relationship between the nurse and the patient the power tends to be unequal, although nurses may not observe themselves as having power and authority in the relationship.
The nurse should always try and remember that the patient is in a vulnerable position and due to the nurse’s amount of health care knowledge and her position in the health care system the patient may feel more vulnerable than they already are. The misuse of power /authority can be known as abuse and using it appropriately enables the nurse to maintain paramount professionalism as well as dealing with the patients requirements. Empathy is also part of the structure of a nurse and patient relationship.
Burnard (1995) defines empathy as ‘the ability to perceive accurately the feelings of another person and to communicate this understanding to him’. The nurse should be able to view the patient’s illness and circumstances from their position and not look down upon them from an exalted position and the patient should not be made to feel vulnerable. Millenson concludes by stating ‘accurate empathy is always empowering, since it represents an understanding and acceptance of the speakers feelings’ (Millenson, 1995).
Respecting the client and their dignity at all times is fundamental to the relationship between the nurse and the client. The nurse should appreciate and understand the patient’s religion, culture and the other aspects related to the patient themselves and the patient’s background, and whilst providing care these factors should be taken in to account. Respect is not an attitude; it is an element that nurses should ‘master’ and when showing respect nurses should make a difference in the way a patient is seen.
Mayeroff (1971) believes that it is ‘more than good intentions and warm regards’. There are certain skills that users can use in attending to clients, in order to generate a therapeutic environment. They can be summarised in the acronym S-O-L-E-R. Sit facing the patient squarely; adopting a posture that indicates involvement is important. Open posture, crossed arms and legs illustrate lessened participation/availability; an open posture shows that you are open to the client and to what they have to say. Lean slightly towards the other person to enhance communication.
Establish eye contact with the patient, keeping it fairly steady but not staring. Relax, and don’t be nervous, adopt a comfortable posture and this will also helps put the client at ease. People might use these guidelines differently in relation to culture and individuality, so they should not be taken as absolute rules. Therapeutic relationships are also encouraged, supported and developed by members of the multi-disciplinary team, for example; doctors. Doctors support patients by educating them about their illness and also by developing a therapeutic relationship with the patient.
They have to consider professional intimacy and also the method in which they communicate with the patient, since giving bad news is very different to giving good news and they also have to think about their facial expressions and body language and show empathy. This also relates to other members of the Multi Disciplinary team (MDT), such as physiotherapists, psychologists, dieticians etc. During practice, I have had to think about my communication skills, key elements and professional intimacy, on an occasion, were I communicated with the relatives of a terminally ill patient.
The wife of this patient was crying, and therefore in order to comfort her, I talked to her, held her, hand and gave her a hug. The communication skills I used were Empathy, which Mayeroff (1971) believes is an essential part of caring. I also used verbal communication and non verbal communication, which is described as ‘an awareness of your body and mind as a source of communication’ Egan(1990) and also showing respect, Rogers (1961, 1967) ‘You are there to help clients, not to judge them’, following Standal (1954), who calls this kind of respect ‘unconditional positive regard’ Egan(1990).