Professional/therapeutic relationship?

hbscott · Dec 2, 2003

Therapy is not an ordinary social exchange between individuals. Indeed, it is quite different.

One of the characteristics of therapy is transference, where the patient begins transfer the feelings which emerge in therapy to the therapist. So, the patient may come to like or to hate the therapist. In psychoanalytic therapy, such transference is expected and is a sign of progress on the part of the patient.

Countertransference is when the therapist, during the course of therapy, develops positive or negative feelings toward the patient. This to is normal during therapy. However, therapists must not act on such feelings. To act on them is unethical as cited by Sections 4.05 and 4.07 of APA's Ethical Principles of Psychologists and Code of Conduct.

:nono:

perfectbluebuildings, BSN, RN · Dec 2, 2003

HBScott...

Maybe I'm missing something, and not to be rude, but I am confused as to how your post relates to my question. It is not a psychoanalytic clinical, and this issue is not just something I have felt in my psych rotation... it is all my rotations. Thank you for the input though, maybe you can clarify it a little more for me, I am not that sophisticated in psychiatric nursing. Also, I would NEVER think of acting on any "feelings" toward a client, it would definitely be unethical! Thank you so much!

hbscott · Dec 2, 2003

Rayrae,

The statement "Therapy is not an ordinary social exchange between individuals" can be applied (I believe) to any therapeutic relationship (not just psychiatry).

You said yourself that sometimes feelings of friendship stops and gives you pause concerning what construes a professional relationship. I am only suggesting that in itself can be a proverbial "red flag" and you should listen to you inner voice on that matter.

One example I can give is how members of a surgical team are not typically allowed to perform surgery on relatives and loved ones due to potential emotional responses negatively impacting the surgical procedure.

Let you conscience be your guide.

-HBS

llg, PhD, RN · Dec 2, 2003

Rayrea,

I think the fact that you recognize this as an issue indicates that you are probably going to deal with it just fine. There is nothing wrong with enjoying your interactions with your patients, liking them, etc. You seem to understand that there are certain lines you should not cross and that you may need to be particularly careful not to let those feelings of positive regard get in the way of your clinical assessment of your patient.

I suspect that you will simply "outgrow" your enchantment with the patients in a little while. Hopefully, you will always approach them with a positive regard -- but with time, your intellect will be less distracted by your emotional attachment to them or desire for social interaction with them.

However, you should probably work on this a little. It might be as simple as "standing back" for a few minutes every hour or so in clinical and asking yourself a few professional/intellectual questions about your patients What is your assessment of their status? What interventions have you been doing? How are those interventions working? What factors are influencing your patient's condition? How does this patient compare to other patients? How does this patient's situation relate to material you have learned in class or read about?

Ask yourself such questions and envision your patient's future status and future life without you being a part of it. In other words, take a few minutes and think clinically about your patient -- not as social acquaintance, but as a "case." This may help your mind develop the habit of thinking about your patient in this objective kind of way. Not that you want to totally "objectify" the patient -- but you need to learn to think objectively and not be drawn into a relationship based on social interactions. You'll find that balance.

Good luck,

llg

Katnip, RN · Dec 2, 2003

Well all want to treat our patients as unique individuals. But getting to the point where you might start feeling like "buddies" instead of nurse-patient could cause problems. I don't think HBScott was implying a relationship in a romantic or sexual content. It sounded to me more like a warning to guard yourself against feeling to close to a person. Also, if you become too open, a patient could develop an inappropriate attachment.

It takes time to learn that that detached compassion you will need to survive the losses you'll face often.

perfectbluebuildings, BSN, RN · Dec 2, 2003

Thanks, all, for the great advice! I will certainly use these strategies and thoughts in my future clinicals and when (if?) I graduate and get a real job! I really appreciate your experienced perspectives. :)

nurseygrrl, LPN · Dec 3, 2003

Rayrae...I have a slightly differing opinion. I work in LTC and I have found that the relationships I form with my patients help me to learn more about their disease processes wholistically. I also feel that close relationships help my patients to trust me and be able to talk to me about what's going on in their lives and with their bodies. Now, I'm not saying we hang out and go to the movies or anything...but I do have some pretty close relationships with my pts. and haven't had any bad come out of it. I think sometimes, at least in LTC, it's inevitable as humans to not get close to other people.

Noney · Dec 3, 2003

Never forget the patients a person. You're gonna be fine.

Noney

Dayray, RN · Dec 3, 2003

I don't think there is anything wrong with having friendly/loving relationships with your patients. Please don't mistake that statement to imply romantic relationships as I would consider that wrong.

I do however believe that nursing is more then science and that a strong nurse patient relationship extends beyond a quote "professional relationship". I have never felt a need nor seen benefit to extend that relationship beyond a hospital admission and think that would be a bad idea but for the time they are there it is a healthy thing.

doctors and lawyers need to stay emotionally unattached and also are expected to have a colder domineer then nurses(not all of them do). However nurses are not only supposed to treat the illness the patient has but also comfort the patient and help them deal with it. How can you do that if you don't have a friendly relationship?

I love my work and the science or medical side is only one part of that. I feel that I make a difference not only threw my medical interventions but that I augment that by making my patients less scared/sad and help them to deal with what they are going threw emotionally as well. I couldn't do that for them if I wasn't also there friend.

It makes me happy when my patients do well and it makes me a little sad when they don't. I want them to be well and happy and I want them to know I care about there welfare and I want them to trust me. I learn allot from them and enjoy talking to them as well as providing care.

The closest comparison I could make would be to the relationship of a parent and an adult child. As the nurse you are an authority and have responsibility for the patients welfare. At the same time you respect there autonomy. You have emotional investment in them. Sometimes you hold there hand and sometimes you cheer for them. You teach them what you know. Sometimes you have to do things that aren't much fun but you do it for there own good.

Don't worry you will be fine. As long as the relationship is focused on providing care for the patient it won't hurt you or them. It is Okay to be enjoy there personalities. It's also Okay to be happy or sad for a patient as long as you learn to deal with that without losing your mind. You will develop the ability to shut off your emotions when you need to and the ability to deal with them at the appropriate time.

I'm sure others will disagree with me but thats okay. we are each able to practice nursing in our own way.

I will give you 1 caution. I would never extend the friendship beyond the hospital walls or give the impression you planned to do so. Besides the obvious risks to doing this ie stalkers, con jobs, crime. I have have known allot of nurses that have allowed the friendship to go on and only seen bad things. The patient continues to see them as a care giver and asks for favors, unloads there problems and becomes very upset when asked to stop.

Rapheal · Dec 3, 2003

I really believe the more experience that you have, the more you will be able to establish boundaries with your patients. You will probally also be able, by experience and observation to know how friendly you can get- while still maintaining a professional relationship. These things take time. You sound like you enjoy your patients. A definate plus in your chosen career. Good luck in school.

perfectbluebuildings, BSN, RN · Dec 3, 2003

I can see a lot of these points too.

I do enjoy my patients, you are right! and part of the reason I chose nursing is because of the daily personal contact with patients and the relationship that can be formed. I have also worked in the summer in LTC (assisted living) and have formed special relationships with the residents, I think it is inevitable and not necessarily bad. I think that is a little different from a lot of arenas of care in that sense.

However, I feel that I sometimes let my enjoyment of the patients in clinical rotation get in the way of my clinical analysis of their diagnosis which could affect how I am able to help them. But that is what I am just going to be more aware of in the future, and not just go the entire opposite way- hopefully not be totally analytical and non-emotional or non-personal.

I agree not letting the pt. relationship go beyond the facility and the time the pt. is there.

This is confusing to me, feels like a delicate balance, so I appreciate all these perspectives so much; your experience gives you knowledge I don't have yet (I guess that is a "duh", huh? :rolleyes: ). But it really helps to hear these things from people who have been doing this a LOT longer than me and know they have dealt with it too! Thanks for the encouragement too.

Sorry for the long post. :imbar