Psychiatric
which is carelessly divulged
Therapeutic Relationship
- Refers to the type of relationship grounded
in empathy where the professional
practitioners use the interaction with the
patient for therapeutic purposes and for his
general well-being or for the intention of
helping the patient achieve the goal of
therapy.
Component
o Contract refers to the agreement that
sets the conditions of the relationship.
Such is important to make sure that the
interaction is professional. It includes
the time, place and objectives of the
interaction.
o Boundaries refers to the limit of the
relationship that must stay within
professional grounds. It defines the
roles of each participant such as:
▪ The Professional Mental
Health Practitioners is to
render services within legal
scope of his practice.
▪ The patient’s mental health
problems is the focus of the
relationship.
o Confidentiality refers to the secrecy of
all contents of the entire therapeutic
relationship.
▪ It is built on the mutual trust
and confidence between the
professional and the
patient.Identity,history,perso
nal address, treatment and
other diseases are some of
the issues that must be
protected.
▪ Never discuss the pt issues in
any place and in any person
not involved in the health
team caring for the pt.
▪ Do not use the pt case for
case studies without written
consent and without
protecting that pt identity
case presentation.
▪ Pictures,names, nicknames
and other means that can
help trace the pt identity
Transcribed by: M.D. Cordova
2/18/24
by the practitioners is a
professional and legal
liability.
▪ Otherwise,the professional
may be charged of breach of
confidentiality which may
even lead to the revocation of
the license to practice.
o Therapeutic Behaviors and practices -
refers to the consistent actions of the
professional aligned to the standards of
the legal practice. These are the ff:
➢ Self- awareness and control
➢ Warm and respectful behaviors
➢ Empathy
➢ Cultural and gender sensitivity
➢ Ethics
o Phases of therapeutic relationships -
refers to the events that lead to the
achievement of the therapeutic
purposes of the relationship and its
subsequent termination.
o Orientation- is the phase where the
professional informs the pt of the
general mental health purposes of
interaction, which is to help the pt in his
treatment and recovery. It is initiated
with assessment of the pt case and
establishment of diagnosis.
o Working phase- is the phase where the
plan for the treatment is set and both
parties work together to implement the
plan care.
o Termination- is the phase where the
goal of treatment is either achieved or
failed. When achieved, the pt is
discharged to go home when failed the
professional evaluations the reason of
failure and decided to continue, stop or
have someone else do it.
• Challenges of therapeutic relationship
- Transference refers to the feeling of the pt
being transferred to the professional which
may arise from his previous experience with
a significant other.
- Counter transference – refers to the
professional feelings transferred to the
patient which may arise from his previous
experience with significant other.
Therapeutic Communication
- Refers to the verbal and nonverbal exchange
of information from the professional and the
1
 patient for the purpose of therapeutic your assessment
communication. to begin clients
sharing of
feelings.
Component
4. Encoura Refers to "Go on,
o Sender – refers to initiator of the communication gement responses that I'm
by giving out the first message. motivates the listening",
patient to continue "uh huh",
o Message- refers to the data or information that
his verbalization. "uhhumm
contains obvious or hidden meanings.
".
o Receiver- refers to the person who receives the
message. 5. Offering self Refers to “ I will
o Feedback- refers to the recipient reply to the responses seat with
message. where the you for
proffesiona 30 min.
l verbally and you
inform the can tell
patient to me
his offer to about
shares his your plan
time and to travel
attention. abroad”.
6. Accepting Refers to "I see", "
remarks by Get your
the point"
profession "Nodding
al that "
shows
recognition
of the
Techniques in Therapeutic Verbal patients
Communication feeling and
statements
.
Communication Explanation Example
7. Placing the Refers to "What
Strategy s
order of events remarks come
1. Establis Provide a Good
that helps next
h concrete morning!
to after
Rapport professional I'm Dr.
establish that?"
relationship by Aliswag,
the timeline "where
indicating your I'm here
on the have you
objective and to help
details of been
centered on you get
the before
patient welfare. better!
patients' that
story. happens
2. Then Initiate How are ?"
Start communication you
with by today?
Open Encouraging
Ended continuous
8. Restating Refers to Client:
Questio response thru an
restart the Ever
ns: open-ended
main since the
question.
content of typhoon
the clients Yolanda,
3. Give Provide I noticed message. my life
general encouragement to that you This was
remarks engage in are well
assurance never
communication. It groomed the client the same
must be based on today! that the after

Transcribed by: M.D. Cordova 2

2/18/24
 proffesiona losing Clarification Refers to Do vou
l is listening my seek to mean
attentively family in concretize that you
and that unclear prefer to
actively to hurrican thoughts be alone
what he is e. and ideas than
saying. by putting it sharing
Professi to words. your
onal : place
you told with a
me that friend?
because
of losing
your Sharing of relevant Refers to I have
family, Information the act of the result
your life discussing of your
was important laborator
never data about y test
the same the patient and I will
since the to the discuss it
typhoon. patient with you
himself. It for your
9. Reflecting Refers to Client, I fosters needed
redirect the feel that I confidence medicati
statement no linger and give on.
of the client have any the patient
back to him purpose a sense of
to ever control on
encourage since ai the
him to lost my manageme
ponder on work. nt of his
his mental
thoughts health
more. issues.
Focusing Refers to Professi
ask ask onal: Exploring alternatives Refers to Regardin
questions Let’s talk communic g your
directed at about ation concern
specific your strategy over the
goal to refusal which deadline,
gather for permits the have you
further cancer client to tried
evidence screenin explore requesti
about g. other ng for an
specific options and extensio
matter. enhances n or
Elaboration Refers to Professi the sense consider
ask for onal: Tell of control ed
details of me more over his outsourci
the topic about mental ng the
being your plan health work
discussed to leave manageme needed
to gather your nt. to meet
complete family it?
or holistic
data on the
multi- Validating Refers to Did I get
factorial the means your
problems of making respons
of the sure e right
patient. whether regardin
the g

Transcribed by: M.D. Cordova 3

2/18/24
 information your
gathered is sexual Changing the topic Shifting to Patient: "I've
accurate. preferen another topic been sad since
ce? away the death of
from what the my wife".
Summarizing Refers to We just patient is Professional:
integrating talked narrating. "what have
pertinent about your kids been
information your doing since the
and making concern death of their
a unified over mother, your
general your wife?
data about salary,
the topic retireme
being nt plan, Requesting an Compelling the "After all these
discussed benefits explanation patient to years from her
prevent and explain and death, why do
confusion insuranc justify his you still feel or
and keep e. answer sad"
the topic actions.
being
discussed Disagreeing Verbally Patient: "I don't
on tract. expressing like the newly
desire to elected
negate the president"
patient's Professional: "I
statement. don't see nor
understand
any reason
why you don't
like him at all"

Challenging Giving probing Do you think it

questions that is logical and
might make reasonable to
the patient hate the newly
questions his elected
values, answer president?
Non- Therapeutic Communication or purposes
while narrating
Ineffective Explanation Examples his feelings.
Responses False assurance Giving out Despite the
false hopes to stage 4 cancer
Stereotyping Using typical "I see that
the of your mother,
comments that you're the
patient without please don't
may make the silent type,
certainty of worry,
patient feel hhhmmm....
scientific everything will
awkward and Silent waters
knowledge be alright.
ridiculous. run deep"

Belittling the pt Disregarding You're the only

feelings the patients' who might be
Parroting Repeating Patient: "I'm so
as something thinking that
exactly as the afraid"
insignificant. way. Your
patient says Professional:
mother surely
like as if an "You're
loves you too!
echo SO afraid"
of the original
message.
Probing Asking “Tell me more
questions that about your
forces the pt to secret affair

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2/18/24
 reveal certain with your
information. It neighbor”.
is not
therapeutic if - Refers to all means of communication
used when the that does use spoken and written
pt is not yet language.
ready to reveal - It covers facial expression, sign
his private life. language, distance, touch, tone of voice
It is therapeutic and silence.
if used when - Kinetics refers to all types of body
the patient movements including facial expressions,
showns the raising an eyebrow, pouting the lips etc.
sign of
openess.
Advising Giving If you think
directions and your husband
suggestions on is gay, then I
what to do with think you
his personal should divorce
problems. your husband.
It is not
therapeutic
since the pt is
supposed to
figure out by
himself what is
the most
effective
means to
handle the
problems.
Professional
therefor must
not advise but
help the the
patient explore ❖ Personal and Intimate – nursing care
all available
options to • Touch refers to the physical contact between
choose from. the messenger and receiver. It is important to
Imposing values Insisting your Patient: I convey sincerity of support in situations where
personal value wanted to go to no words can comfort the patient. Such as
system to the bar and party when
patient and all night on my the patient is grieving and crying over a loss.
constricting 30th birthday. o However, be careful to use touch is
them to Professional: it cases of cultural prohibition where a
behave in would be male is not allowed to touch a
a similar way wrong to get female, in cases of patients with
to your value drunk and stay paranoia or those who fell victim of
system. up late sexual abuse. In these populations
partying... you avoid touch because it may lead to
would look like harassment issues.
an • Silence refers to pauses on strategic and
irresponsible timely moments to allow the client or patient
30-year-old in expressing his feelings. This allows for
adult. reflection on the side of the nurse and gives
more opportunity to observe for non-verbal
cues present while the patient is talking.

o Ex. Patient is verbalizing how angry

she was about her rape.
o The professional is silent about it in
Non- verbal Communication selective moments and notice that

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2/18/24
 there are no verbal or tone indicator
that the patient is angry.
o She's smiling occasionally and her
tone is a bit excited in narrating how
she was raped.
o This requires follow up on the
truthfulness of the claim of the
patient.

• Paralanguage refers to tone and quality of

voice.
o Ex. While the patient is narrating her
anger about her rape the
professional notices that the tone
shows excitement and the quality of
vocal expression does not stammer,
does not show fear but exudes
confidence.
o This may lead to suspicion over the
patients claim.
o It has to be validated whether the
patient was really raped or
something else is behind the claim.

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2/18/24