THERAPEUTIC IMPASSES-

Blocks in the progress of NPR. They provoke intense feelings in both the nurse and the patient,
which may range from anxiety and apprehension to frustration, love or intense anger.

List of therapeutic impasses-

 Resistance
 Transference
 Counter transference
 Boundary violation
 Gift giving

RESISTANCE-

Patient’s attempt to remain unaware of anxiety producing aspects within the self.

Forms of resistance displayed by patient (identified by WOLFBERG)

 Suppression and repression of relevant information.
 Intensification of symptoms.
 A helpless outlook on the future.
 Breaking appointments, coming late to his sessions, being forgetful, silent and sleepy during
the interactions.
 Acting out or irrational behaviour.
 Expressing an excessive liking for the nurse and claiming that nobody can replace her.
 Reporting physical symptoms which may occur only during the time the patient is with the
nurse.
 Hostility, dependence, provocative remarks, sexual interest in the nurse.

TRANSFERENCE-

it is an unconscious response in which the patient experiences feelings and attitudes toward the
nurse that were originally associated with significant figures in the patient’s early life.

Transference can be both positive and negative.

Eg. A patient perceives the nurse as acting the way that his mother did, regardless of how the nurse
is truly acting.

NOTE- Transference is a form of resistance behaviour. It is the unconscious transfer of qualities or

attributes originally associated with another individual by the patient.

It occurs because the patient brings frustrations, conflicts and feelings of dependence from a past
relationship into the therapeutic relationship.
COUNTER TRANSFERENCE-

Refers to a specific emotional response by the nurse towards the patient that is inappropriate to
the content and context to the therapeutic relationship or inappropriate in its emotional intensity.

THREE TYPES OF COUNTER TRANSFERENCE REACTIONS-

 Reactions of intense love or caring

 Reactions of intense hostility or hatred
 Reactions of intense anxiety often in response to a patient’s resistence.

FORMS OF COUNTER TRANSFERENCE DISPLAYED BY NURSES-

 Difficulty in empathizing with patient in certain problem areas.

 Recurrent anxiety, unease, or guilt related to patient.
 Personal or social relationship with patient.
 Encouraging patient’s dependency, praise or affection.
 Sexual or aggressive fantasies towards patient.
 Arguing with patient or tendency to PUSH patient before he is ready.
 Feeling angry or important because of patient’s unwillingness to change.

BOUNDARY VIOLATION-

It occurs when a nurse goes outside the boundaries of the therapeutic relationship and
establishes a social, economic or personal relationship with a patient.

EXAMPLES R/T BOUNDARY VIOLATIONS-

 Nurse accepts free gifts from patient.
 Nurse attends a social function of patient.
 Nurse regularly reveals personal information to patient.
 Nurse routinely hugs or has physical contact with patient.
 Nurse does business with or purchases services from patient.