NURS310 Lecture Notes - Lecture 7: Sexual Attraction, Countertransference, Active Listening
22 Jun 2018
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*Therapeutic Communication
*Think back to a positive relationship you may have had with a helper in the context of a
helping relationship. What qualities did the helper have and how would you describe
the relationship?
*Qualities of Therapeutic Relationship
*Genuineness
*Empathy
*Positive Regard
* Deteriorating Therapeutic Relationships
*3 Phases
*Initial - ‘withholding’ -client’s perceived nurses as ‘withholding’ nursing support
*Second - ‘avoiding and ignoring’ - avoiding the nurse so as to ‘not cause problems
*Third - ‘struggling with and making sense of’ – reflection of the situation
(CoatsworthPuspoky, Forchuk, & Ward Griffen, 2006).
*Boundaries
*Therapeutic Relationships
*Professional Boundaries
*Professional boundaries are the spaces between the nurse’s power and the client’s
vulnerability.
*Signs,Crossings,and Violations
*Signs – warnings
*Crossing – brief excursions over boundaries
*Violation- act of abuse
*Transference
*Turn into biological time machine
*Something that is said or done that reminds you of your past
*As if you are reacting to someone from your past
*It is like projection of your feelings on to someone without knowing it and is more about
you than person
*Patterns may be negative or positive
*Negative pattern – result from unmet needs as a child due to abuse or neglect
*Therapist may allow it to develop as a way to understand and recognize – allows the
person to control the transference if it is triggered in the future
*Transference
*Is from the standpoint of the patient –
*Unconsciously displaces onto the nurse his or her behaviors and feelings that belong to
a significant other
* Example- patient assigned to you is elderly and starts to talk about how you are like
their grandchild (can be positive in this instance especially if there is a positive
relationship).
*Transference
*Example – patient you meet for the first time, has been sexually assaulted by a middle
aged white male – you are in this category – patient is distrustful towards you
*Transference
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*How do you know you are having a "transference reaction"?
*It’s not always easy, but probably are if your client knows very little about a therapist (or
you) and you are having a powerful reaction that is not justifiable to a reasonable
person.
*Countertransference
*Is about the helper and their feelings and reactions to the client/patient
*Same phenomenon as transference
*Therapists emotional time warp
*Countertransference
*Examples – Feeling parental towards client
Over identify with client’s difficulties
Client reminds of someone who we have strong feelings towards
Sexual attraction (Pope & Tabachnick, 1993)
*Countertransference - Signs
*Inappropriate disclosure
*Therapeutic alliance breaks down (no longer helping)
*May not be able to discuss in supervision
*May be defensive
*Difficult to end therapy
*Reinforcing client’s patterns
*Over involvement
*Over identification
*Countertransference – Resolution
*Reflective and reflexive practice is key
*Examine feelings and behavior towards client (Am I behaving in a way that is like
me/professional?)
*Use supervision more
*Talk about the relationship with tutor/supervisor
*Be consistent with boundaries
*Exercise
What Is Therapeutic Communication?
Therapeutic communication is a collection of techniques. Nurses provide patients with support
and information while maintaining a level of professional distance and objectivity. With
therapeutic communication, nurses often use open-ended statements and questions, repeat
information, or use silence to prompt patients to work through problems on their own.
Therapeutic Communication Techniques
There are a variety of therapeutic communication techniques nurses can use.
Using Silence
At times, it’s useful to not speak at all. Deliberate silence can give both nurses and patients an
opportunity to think through and process what comes next in the conversation. It may give
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