8 (Therapeutic Relationships) Flashcards
Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference?
a. ) “My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again.”
b. ) “My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go ‘cold turkey’ and to get away from her dysfunctional family and to do it now!”
c. ) “My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge.”
d. ) “My patient, Gayle, is an elderly woman with depression. She calls me by her daughter’s name because she says I remind her of her daughter.”
b.) “My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go ‘cold turkey’ and to get away from her dysfunctional family and to do it now!”
This statement indicates countertransference; Bethany may be overidentifying with the patient because of her own past history of alcoholism. She is providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to her own past than to the patient’s.
The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference.
The patient calling the nurse by her daughter’s name is transference rather than countertransference.
You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed?
a. ) “Allison, you are being discharged today, so I’d like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained.”
b. ) (to fellow nurse): “I haven’t met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself.”
c. ) “Allison, now that we are working on your problem-solving skills and behaviors you’d like to change, I’d like to bring up the issue of termination.”
d. ) “Allison, now that we’ve discussed your reasons for being here and how often we will meet, I’d like to talk about what we will do at the time of your discharge.”
d.) “Allison, now that we’ve discussed your reasons for being here and how often we will meet, I’d like to talk about what we will do at the time of your discharge.”
The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.
Your patient, Emma, is crying in your one-to-one session while telling you of her father’s recent death from a car accident. Which of the following responses illustrates empathy?
a. ) “Emma, I’m so sorry. My father died two years ago, so I know how you are feeling.”
b. ) “Emma, you need to focus on yourself right now. You deserve to take time just for you.”
c. ) “Emma, that must have been such a hard situation to deal with.”
d. ) “Emma, I know that you will get over this. It just takes time.”
c.) “Emma, that must have been such a hard situation to deal with.”
This response reflects understanding of the patient’s feelings, which is empathy.
Feeling sorry for the client represents sympathy, whereas not addressing the patient’s concern belittles the patient’s feelings of grief she is expressing by changing the subject.
Telling the patient she will get over it does not reflect empathy and is closed-ended.
Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship?
a. ) “It’s good that you feel guilty. That means you still have a chance of being helped.”
b. ) “Of course you feel guilty. You did a horrendous thing. You shouldn’t even be out of prison.”
c. ) “The biggest question is, will you do it again? You will end up right back in prison, and have even worse guilt feelings because you hurt someone again.”
d. ) “You are suffering with guilt over what you did. Let’s talk about some goals we could work on that may make you want to keep living.”
d.) “You are suffering with guilt over what you did. Let’s talk about some goals we could work on that may make you want to keep living.”
This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship.
Although it is difficult, nurses are more effective when they don’t use their own value systems to judge patients’ thoughts, feelings, or behaviors.
The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.
Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply):
a. ) In a social relationship, both parties’ needs are met; in a therapeutic relationship only the patient’s needs are to be considered.
b. ) A social relationship is instituted for the main purpose of exploring one member’s feelings and issues; a therapeutic relationship is instituted for the purpose of friendship.
c. ) Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic.
d. ) In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient.
e. ) In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship communication remains on a more superficial level, allowing patients to feel comfortable.
a, c, d
a.) In a social relationship, both parties’ needs are met; in a therapeutic relationship only the patient’s needs are to be considered.
c.) Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic.
d.) In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient.
The other options describe the opposite meanings of social and therapeutic relationships.
The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the
a. ) preorientation phase.
b. ) orientation phase.
c. ) working phase.
d. ) termination phase.
d.) termination phase.
Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses.
To help a client develop his or her resources, the nurse must first be aware of
a. ) the client’s strengths.
b. ) negative transferences.
c. ) countertransferences.
d. ) resistances.
a.) the client’s strengths.
Nurses work to bolster a client’s strengths, to identify areas of dysfunction, and to assist in the development of new coping strategies.
When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n)
a. ) crisis intervention.
b. ) therapeutic encounter.
c. ) autonomous interaction.
d. ) preorientation phenomenon.
b.) therapeutic encounter.
A therapeutic encounter is a short but helpful interaction between the nurse and client.
During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established?
a. ) Preorientation
b. ) Orientation
c. ) Working
d. ) Termination
b.) Orientation
Contracting is part of the orientation phase of the relationship. Establishing the operational “rules” provides a foundation for the relationship.
The primary difference between a social and a therapeutic relationship is the
a. ) type of information exchanged.
b. ) amount of satisfaction felt.
c. ) type of responsibility involved.
d. ) amount of emotion invested.
c.) type of responsibility involved.
In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client’s needs, facilitating communication, assisting the client with problem- solving, and helping the client identify and test alternative coping strategies.
The pre-orientation phase of the nurse-client relationship is characterized by the nurse’s focus on
a. ) self-analysis of strengths, limitations, and feelings.
b. ) clarification of the nursing role.
c. ) changing the client’s dysfunctional behavior.
d. ) incorporating coping skills into client’s routine.
a.) self-analysis of strengths, limitations, and feelings.
During the preorientation phase the nurse prepares for a relationship with a client by engaging in self-examination.
The orientation phase of the nurse-client relationship focuses on
a. ) the nurse identifying personal biases.
b. ) the nurse and client identifying client needs.
c. ) overcoming resistance to changing behavior.
d. ) reviewing situations that occurred in previous meetings.
b.) the nurse and client identifying client needs.
The orientation phase is the first stage of the nurse-client relationship and focuses on, among other things, the identification of client needs.
Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of
a. ) resistance.
b. ) transference.
c. ) countertransference.
d. ) emotional abreaction.
b.) transference.
The stirring up of feelings in the client by the nurse is referred to as transference.
The use of empathy and support begins in the stage of the nurse-client relationship termed the
a. ) orientation stage.
b. ) working stage.
c. ) identification stage.
d. ) resolution stage.
a.) orientation stage.
The use of empathy and support should begin in the orientation stage. These tools are helpful in building trust and furthering the relationship.
A client reports that her mother-in-law is very intrusive. The nurse responds, “I know how you feel. My mother-in-law is nosy, too.” The nurse is demonstrating
a. ) self-disclosure in an appropriate way.
b. ) to the client permission to continue.
c. ) countertransference.
d. ) empathy to establish trust.
c.) countertransference.
Countertransference refers to the stirring up of feelings in the nurse by the client.
