The Therapeutic Relationship
A major expectation of the keyworker
is that they develop a therapeutic relationship with the client. Its
quality is a major factor in helping engagement in treatment and so bringing
about meaningful changes in behaviour.
This term is appearing in a number of drug and alcohol contexts, again
without proper definition.
New Brunswick nurses have developed
standards they can use to examine how the therapeutic relationship is
working and maintain its health. They see that it has four components. These
are
“• Power:
The therapeutic
nurse-client relationship is one of unequal power. Although nurses may not
perceive themselves as having power in the relationship, nurses have more
power than the client. The power of the nurse comes from the authority of
own position in the health care system, specialized knowledge, influence
with other health care providers and the client’s significant others, and
access to privileged information.
In any
professional-client relationship, there is an imbalance of power in favour
of the professional, and is reinforced in health care services by the
inherent vulnerability of a client needing care.
• Trust:
Clients expect the
nurse to have the necessary knowledge and skills and to demonstrate caring
attitudes and behaviours, and so entrust their care to the nurse. Trust is
critical, as the client is in a vulnerable position in the relationship.
Part of trust is keeping promises to clients. If trust is breached, then it
becomes very difficult to re-establish it.
• Respect:
Respect for the
dignity and worth of the client is fundamental to the relationship.
The nurse needs
to know and understand the culture and other aspects of the client’s
individuality and to take these into account when providing care. Part of
respect is being non-judgmental of the client, and seeking to discover the
meaning behind certain of the client’s behaviours.
• Intimacy:
This does not refer
to sexual intimacy. Intimacy relates to the kinds of activities nurses
perform for and with the client which create personal and private closeness
on many levels. This can involve physical, emotional and spiritual
elements.”
So, in establishing a therapeutic
relationship a worker offers to the client:
-
dedicated time
-
their full attention
-
a commitment to help them get their needs met
-
a supportive, boundaried and ethical relationship
-
empathy- (not the I know what it was like, I was
there too – but rather ‘’skillful reflective listening that clarifies
and amplifies the person’s own experience and meaning, without imposing
the counselor’s own material’
Or more informally; the ability to be with someone who is in distress
without being overwhelmed.
-
a suspension of normal moral judgment as the client
tries to work out what has been happening for them – often called
‘unconditional positive regard’
-
reflective comment and feedback.
Offering this kind of relationship is itself an important resource for the
client involving what is known as ‘modeling’. The client can learn from the
worker ways of effective communication, handling conflict and so on from how
they are dealt with. If the worker behaves in certain ways the client may
see this as an acceptable way of dealing with others. This relationship
becomes an important place where the skills, attitudes and values necessary
for a dependency free life are rediscovered or learned
Extracted from the Essential Drugs and Alcohol Worker by Tim Morrison,
DrugScope 2006
Standard For The
Therapeutic Nurse-Client Relationship Nurses Association Of New
Brunswick Nurses Association Of New Brunswick, 2000
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