Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Process of Therapeutic Relationship

Orientation:

  • The parameters of the relationship are established (e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship).
  • Trust, respect, honesty and effective communication are key principles in establishing a relationship.
  • The expectations the nurse and the client have of each other and of their relationship are discussed and clarified (Peplau, 1952).
  • The nurse gathers information and ensures that priority issues are appropriately addressed.
  • Consistency and listening are considered by clients to be critical at the beginning of the relationship (Forchuk et al., 1998abcd; Sundeen et al., 1989).
  • The nurse assists in promoting client comfort that may include reducing anxiety or tension.

Working Phase:

  • The working or middle phase of the relationship is where nursing interventions frequently take place.
  • Problems and issues are identified and plans to address these are put into action.
  • Positive changes may alternate with resistance and/or lack of change (Sundeen et al., 1989).
  • The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviours (e.g. promiscuity, aggression, withdrawal, hyperactivity).
  • The content to be explored is chosen by the client (Parse, 1981; Peplau, 1989) although the nurse facilitates the process.
  • The nurse continues his/her assessment throughout all phases of the relationship.
  • New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed.
  • The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care.

Resolution phase:

  • The resolution or ending phase is the final stage of the nurse-client relationship.
  • After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated.
  • The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met (Hall, 1993; Hall, 1997).
  • Termination may be met with ambivalence.
  • Both should share feelings related to the ending of the therapeutic relationship.
  • Validating plans for the future may be a useful strategy (Hall, 1997; Sundeen et al., 1989).
  • Increased autonomy of both the client and the nurse is observed in this phase (Sundeen et al., 1989).