For those with psych history

elkpark · Oct 21, 2013

The rule is "never." Once you start sharing personal hx, the conversation tends to become about you instead of about the client, which is countertherapeutic.

Keep in mind that psychotherapists have a great deal more formal education in that specific area than generalist psychiatric nurses do, and there is a significant difference between being a psychiatric nurse and being a psychotherapist.

As a long-time psychiatric nurse (generalist) and long-time psych CNS (psychotherapist), I have to say I'm suspicious of the therapists you say were so helpful because they "confided" personal hx to you. Even for psychotherapists, that is frowned upon and considered poor practice.

Retired APRN, MSN, RN, APRN · Oct 21, 2013

I worked for a few years as a floor nurse and then head nurse in psychiatry, and for many years after that as a psych NP, and I strongly agree with what elkpark said. The floor nurse on a psych unit does not have the training and supervised experience that therapists gain. (Though I also agree that "the rule is 'never'" and only in very, very rare and special circumstances (that I can't think of off the top of my head) would I consider that degree of self-disclosure to a patient.

Part of a therapist's training is to examine his or her own inner world in tandem with close observation and interacting with the patient. Learning to understand our own motivations isn't always easy or obvious. (Why do I want to make this disclosure? What do I want to achieve? Is it my desire to be liked and admired? To be special? Is this for the patient's benefit or my own?)

But again, the rule is "never" and the exceptions are rare.

smoup · Oct 21, 2013

I thought it was never but have heard/read about self disclosure facilitating patient trust and sharing, and had experiences with therapists sharing, or maybe making up?, experiences they've had.

I certainly find it easier to talk to someone about something, especially something difficult, if there is some sort of bond there and knowing they had similar experiences has been a bond that has gotten me to open up to people, and in my personal life, people to open up to me.

Thanks for feedback on the real world!

elkpark · Oct 22, 2013

Well, as the old saying goes, you don't have to have had pneumonia to treat pneumonia. It's only in psych that anyone ever even mentions the possibility that having had problems or challenges of one's own might offer some kind of professional advantage. I think the whole "similar experiences" thing is seriously overrated. :)

smoup · Oct 23, 2013

While I agree you don't have to have had a disease to treat a disease, be it physical or psychological, I do think psych is different. I car read about how it affects the patient all day long, and then read about the treatment, and still not really understand the patient or how to treat the patient. Treatment isn't as uniform in psych as it it for other areas and there is huge variability in what works for patients. What works for some might not work for another.

Group therapy is based on the assumption that people with similar illnesses can better help each than people with other illnesses can. AA is a great example. The leaders are often recovering/recovered alcoholics themselves, which not only shows people that it is possible, but confers a sense of understanding between people as they know that the leader has been in their shoes.

People form bonds by similar interests so it only makes sense that nurses can bond with their patients with similar experiences. I'm not saying to tell every patient you have something in common your history, but I certainly don't think having a similar history could be a bad thing.

That goes for physical diseases as well. Anything that better allows you to empathize with a patient, be it your own battle with an illness or what have you, can further the nurse-patient relationship. I certainly don't think sharing similar experiences as a patient, be it physical or psychological, is overrated.

Retired APRN, MSN, RN, APRN · Oct 23, 2013

Anything that better allows you to empathize with a patient, be it your own battle with an illness or what have you, can further the nurse-patient relationship.

Yes, of course.

My point, though, is that we do not have to share our personal history with the patient in order to use it to enhance our relationship and therapeutic interactions with them. All our experiences inform our patient interactions, but maintaining professional distance helps us remember that when we are working it's all about them.

elkpark · Oct 23, 2013

Group therapy is based on the assumption that people with similar illnesses can better help each than people with other illnesses can. AA is a great example. The leaders are often recovering/recovered alcoholics themselves, which not only shows people that it is possible, but confers a sense of understanding between people as they know that the leader has been in their shoes.

For what it's worth, group therapy and AA are two entirely different matters. Group therapy is a professional psychotherapeutic modality in which clients with similar issues work together under the guidance of trained, licensed psychotherapists. AA is an entirely nonprofessional (and very proud of that), community-based, self-help group. It's not accurate to refer to it as "group therapy."

And I didn't mean to suggest that there is no possible value in a mental health professional having had similar experiences to those of a client; just that I think that is overrated, and certainly not required in order to have empathy for others.

Long Term Care Columnist / Guide · Oct 26, 2013

I've never worked in psych nursing (unless you count dealing with dementia and mental illness in elders) but I would worry that there's too much danger of over-identifying with the patients. I know that I couldn't do it, even though I would certainly be empathetic with them because of my own diagnosis.

Unfortunately, that's where the boundary lines can get blurry and the interaction becomes more about the nurse than the patient, which is NOT therapeutic IMO. It's bad enough being a psych patient trying to get well without feeling like you should help the nurse too. That's not to say that no one with mental health issues should work in the field, just that one should think long and hard before sharing one's own MH history with a patient. It seems like the most natural thing in the world to do, but it's unwise......and it's much safer to make it a "never" rule, as some of the above posters stated.

Meriwhen, ASN, BSN, MSN, RN · Oct 26, 2013

I find that the exception to sharing is usually found in CD/recovery settings; nurses/staff who have struggled with addiction and are now in recovery will sometimes share that with patients. Even so, it's something that would need to be carefully weighed before doing, as the nurse needs to be able to keep their own recovery separate from the patients' recovery. I've seen some nurses do that beautifully...and some, not so much. Sometimes the nurse sees too much of their own recovery in the patient, and is then frustrated when the patient chooses to manage their recovery in a different way. And yes, this can negatively affect the care the nurse is giving.

Also, their sharing in no way means they are actually providing or capable of providing better care that the nurse who has no CD history or chooses not to share it.

Otherwise, I agree with the others: "never" with the very rare exception.

JustKeepDriving · Oct 26, 2013

I'm jumping on the NEVER bandwagon. Being a peer works well for addiction setting because the NA/AA model runs off of therapeutic peer relationships and peer counseling. In fact I would say that some of the best CDAC's had addictions histories. However - addictions and mental illness are very different from one another (even if they are very related). What helps the addictions counselor connect to their peer group (and many addictions settings tend to be of the voluntary variety so that in and of itself creates a different dynamic) would hurt the credibility of the psych nurse.

Many people that work in psych have historical and current psych issues (many of which in my facility are actually caused by the job). However, at my facility nurses need to be seen as an authority figures NOT as a peers. I have 20+ criminally insane patients that need to follow my cues when I do crisis intervention, they need to be able to confide in me, and they need to trust me when I tell them I will keep them safe. Mental illness also has a stigma among the mentally ill. I am not there to be their friend. I am there to establish healthy boundaries, listen to their stories and problems (when I can), and keep them safe.

I don't do group therapy. I do Milieu therapy, Crisis Intervention, and some DBT stuff. I need good professional boundaries with my patients and quite frankly, in the population I work with any self disclosure would haunt me for the rest of my career. They can and will use every piece of self disclosure against you We have had patients find out where staff live because they overheard a conversation between two staff and then threaten to show up to that staff members' house and kill their entire family after that staff member said "No you can't have (insert contraband item here).

I hate to say it but as a psych nurse I'm not there to bond with my patients. I'm there to act as a guide with nursing knowledge and professional skills that is a neutral figure that can help them on their way out of the mental health system. That doesn't mean I don't have fun with my patients or enjoy spending time with them. It means that I am very cautious about how I present myself so that I can have a good time with them while still maintaining my ability to set rules and limits. It's possible to use personal psychiatric experience to guide ones knowledge and choices, and use it as a way to build empathy - not through verbal answers, not through conversation, but through the decisions that are made when doing crisis intervention, and milieu management. This does not mean that it makes one a better psych nurse than a psych nurse with no psych history. You don't have to break your femur to know that it hurts like hell, and you don't have to be schizophrenic to understand that it's a very frightening experience.

What it comes down to is credibility. The nurse that utilizes her nursing knowledge of therapeutic relationships and therapeutic communication to get patients in crisis contract for safety by setting limits and preventing self or other harm is much more valuable than the "Psych diagnosis" that uses self disclosure to build relationships with patient and then have that self disclosure thrown back her face when she asks a patient if taking a PRN would help enhance their coping skills because PRN ativan helped her with her anxiety. More than likely (at my hospital) one might get the reply, "Why don't you take the PRN then your crazy *****".

Just saying.

MrChicagoRN, RN · Oct 27, 2013

"We all have our challenges in life, whether our own or friends and family members. But we're here to focus on you right now."