Therapeutic Relationships (therapeutic + relationships)

Distribution by Scientific Domains

Selected Abstracts

Passive patient or engaged expert?

Using a Ptolemaic approach to enhance mental health nurse education, practice
ABSTRACT:, This discussion paper seeks to explore an approach that metal health nurses can adopt that ensures the patient is at the centre of training and professional development opportunities. Although nurse training and education is shaped by practice and theory, the lived experiences of the patients as an educational resource often become lost in the milieu of ,doing' nursing. We argue that in addition to theoretical knowledge and practice knowledge, there is the need to harness the equally important patient experience knowledge. Drawing upon Ptolemaic concepts, this paper explores the potential tensions for mental health nurses resulting from the imbalance in power when engaging in therapeutic relationships with patients. It is argued that in order for mental health nurses to become more effective, they need to learn how to relinquish some of their power, even where this gives rise to uncomfortable tensions for the nurse. Such tensions result from the centrality afforded to theoretical knowledge and ritualized practice that underpins nursing and the difficulties this may cause for many nurses in accepting the value of patient experience as a primary source of knowledge. The difficulties of adopting this approach point to a need for mental health nurses and nurse educationalists to take a more reflexive approach to their patient encounters and within their encounters with each other. [source]

Pivotal moments in the therapeutic relationship

Mark Welch
ABSTRACT:, It is perhaps conventional wisdom that the therapeutic relationship is a cornerstone of psychiatric nursing. It is almost a sine qua non. However, while its importance may be widely recognized, it is notoriously undefined and even those who profess to practise or utilize it, or those who advocate it most strongly, have difficulty in saying exactly what it is. This report details a study carried out with six experienced psychiatric nurses to explore and describe perceptions and understandings of pivotal moments within therapeutic relationships. The nurses were asked, in a series of one-to-one interviews, to consider relationships with clients that they would themselves describe as therapeutic and meditate on those moments at which everything seemed to change and the relationship became qualitatively different. Among the factors the nurses reported as being significant were empathy, uniqueness, meaning and purpose, and appropriate self-disclosure (although many of those terms may require clarification). This paper will consider the implications of these and others for nursing practice and the identity of psychiatric nursing practice. [source]

Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship

S. González rn
Aim:, To identify the perception of Primary Health Care (PHC) female nurses in the Balearic Islands in Spain who are smokers, regarding the suitability of their anti-smoking therapeutic relationships with their clients. Also, to identify what factors they consider may determine why nurses smoke less in PHC than in specialized care (SC). Background:, Backed by the signing of the WHO Framework Convention on Tobacco Control (WHO FCTC), a new Anti-Smoking law has been in force in Spain since 2006. This legislation limits the places where tobacco may be consumed. PHC nurses, because of their professional abilities, their number and their direct contact with society on all accounts , both health- and illness-wise , and also because of the proven efficacy of their interventions in the fight against the smoking habit, are called upon to play an important role against the smoking habit in the 21st century. Method:, A qualitative study using a semi-structured interview with 15 PHC female nurses who are smokers. Findings:, Regarding the therapeutic relationship, basically two attitudes are adopted: first, blaming themselves and feeling uncomfortable and inadequate to be able to help someone to give up smoking or, second, considering themselves to be in an optimum situation in which to be able to help by sharing their addiction and thereby understanding and empathizing much more with clients. PHC nurses believe they smoke less than SC nurses as a result of a greater degree of awareness. Conclusion:, We would suggest that SC nurses should acquire a more relevant role in the fight against the smoking habit. In light of their capacity, commitment and efficacy, we believe there is a case for total autonomy as far as their role as therapists in breaking smoking habits is concerned. [source]

Using the CORE-R battery in group psychotherapy

Bernhard Strauss
Abstract This article applies and illustrates the American Group Psychotherapy Association (AGPA) revised CORE battery to daily practice. The CORE can assist practitioners in periodically or continuously monitoring outcome and process factors to determine patient status (e.g., improved, deteriorated, or no change), and ruptures in the therapeutic relationships. The CORE-R provides group therapists with a tool kit of measures for assessing the effectiveness of their groups and includes three classes of measures: selection, process, and outcome. We provide a summary of each class of measures along with specific instruments. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,13, 2008. [source]

Sexuality, intimacy and subjectivity in social psychoanalytic thought of the 1920s and 1930s

Naoko Wake
Abstract Homosexuality has been one of the most contested issues in the history of social psychoanalysis. To better understand the issue's medical and social significance, we need a micro-historical analysis illuminating doctor-patient interactions in changing historical contexts. This paper sheds light on the clinical practice of the well-known founder of interpersonal theory, Harry Stack Sullivan (1892,1949), with a focus on four patients: two from the 1920s and two from the 1930s. During these decades, many psychiatrists, including neo-Freudians like Sullivan, considered homosexuality a mental illness. But Sullivan himself was a gay man, and he attempted to create efficacious therapeutic relationships amid a generally homophobic medicine. This comported with his effort to create professional coalitions with social psychologists and sociologists. In both clinical and non-clinical settings, he tried to find solutions to individual problems by redefining a limiting socio-cultural environment of therapy. Ambitious as this plan was, his patients' response to his approach varied from cautious cooperation to apparent rejection, as his actions became more immersed in the ambiguous realm of sexual subjectivity. In examining this change, I raise the question of what constituted ethically sound, professionally acceptable behaviours and efficacious therapeutic relationships, particularly in the historical context of the emerging collaboration between psychoanalysis and social psychology. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic alliance

Manuel Paris Jr.
This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith-based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299,312, 2005. [source]

The role of second health professionals under New Zealand mental health legislation

A. J. O'BRIEN rgn rpn ba mphil
The development of generic statutory roles in mental health care has been the subject of discussion by New Zealand nurses for the past decade. One such role is that of second health professional in judicial reviews of civil commitment. Issues identified by New Zealand nurses have also been raised in England, where it seems that nurses are likely to assume the role of Approved Mental Health Worker under English mental health law. A survey of mental health nurses found that few had received any preparation for the role of second health professional and 45% did not feel adequately prepared for the role. Some of these issues are reflected in a New Zealand inquiry which resulted in the Ministry of Health developing a written report form for second health professionals. However, the form has the potential to reduce the mental health nursing role to a narrow legal role. Statutory roles such as that of second health professional challenge mental health nurses to critically reflect on the conceptual and ethical basis of their practice. While traditional concepts such as therapeutic relationships and advocacy need to be reviewed in light of these changes, nurses need to be vigilant in articulating the moral and clinical basis of their roles. The development of guidelines for he second health professional role is suggested as a way of supporting clinical practice in this area. [source]

Pregnant with possibilities: drawing on hermeneutic thought to reframe home-visiting programs for young mothers

Lee SmithBattleArticle first published online: 11 AUG 200
Although the positive outcomes achieved in home-visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse,family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After describing how a scientific,clinical gaze misrepresents teen mothers and contributes to a rational,technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life-world. Dialogical understanding also disrupts the scientific,clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers' long-term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know-how that ,strays' from protocol-driven care is addressed. [source]

Interpersonal Issues Between Pain Physician and Patient: Strategies to Reduce Conflict

PAIN MEDICINE, Issue 8 2008
Kate Diesfeld BS
ABSTRACT Objective., This article analyzes scholarship on the interpersonal challenges that pain physicians face, with an emphasis on strategies to reduce conflicts within therapeutic relationships. Results., Scholarship on the dilemmas pain physicians face suggests that 1) there are unique and perhaps unrecognized features of pain medicine that generate stress; 2) interpersonal conflict may contribute to stress; and 3) clinicians' biases may interfere with the doctor,patient relationship and with the best practice of pain medicine. Application of a framework based on clinicians' beliefs and Papadimos' reflections on justice and temperance may reduce such conflicts. Conclusion., The challenges of pain medicine may be complicated by the clinician's undisclosed attitudes regarding their roles and their perceptions of pain sufferers. A strategy for physicians to examine their beliefs within a supportive environment may aid physicians caring for people with chronic pain. Papadimos' reflections upon the virtues of justice and tolerance guide this analysis. [source]

Enhancing Intellectual Empathy: The Lived Experience of Voice Simulation

Karen S. Dearing PhD
PURPOSE., This study aimed to understand the lived experience of voice simulation with the novice nurse and to describe the impact on the nurse's empathy and desire to develop a therapeutic relationship. DESIGN AND METHODS., Twenty-eight women and men participated in a detailed narrative investigation of reflective writing of the lived experience of hearing voices through a voice simulation experience. FINDINGS., A sense of insight was developed, and participants felt they could empathize with this type of suffering. The ability to change attitudes to focus on the development of therapeutic relationships was enhanced. PRACTICE IMPLICATION., Voice simulation assists the novice nurse in developing intellectual empathy. [source]

Lives in Isolation: Stories and Struggles of Low-income African American Women with Panic Disorder

Michael Johnson
Research evidence points to the existence of racial-ethnic disparities in both access to and quality of mental health services for African Americans with panic disorder. Current panic disorder evaluation and treatment paradigms are not responsive to the needs of many African Americans. The primary individual, social, and health-care system factors that limit African Americans' access to care and response to treatment are not well understood. Low-income African American women with panic disorder participated in a series of focus-group sessions designed to elicit (1) their perspectives regarding access and treatment barriers and (2) their recommendations for designing a culturally consistent panic treatment program. Fear of confiding to others about panic symptoms, fear of social stigma, and lack of information about panic disorder were major individual barriers. Within their social networks, stigmatizing attitudes toward mental illness and the mentally ill, discouragement about the use of psychiatric medication, and perceptions that symptoms were the result of personal or spiritual weakness had all interfered with the participants' treatment seeking efforts and contributed to a common experience of severe social isolation. None of the focus-group members had developed fully effective therapeutic relationships with either medical or mental health providers. They described an unmet need for more interactive and culturally authentic relationships with treatment providers. Although the focus-group sessions were not intended to be therapeutic, the women reported that participation in the meetings had been an emotionally powerful and beneficial experience. They expressed a strong preference for the utilization of female-only, panic disorder peer-support groups as an initial step in the treatment/recovery process. Peer-support groups for low-income African American women with panic disorder could address many of the identified access and treatment barriers. [source]