Establishing and Maintaining a Therapeutic Relationship with Trish

This essay discusses the importance of establishing and maintaining a therapeutic relationship with Trish, a woman with a personality disorder. It explores the signs and symptoms she displays and provides strategies for promoting mental health and recovery. The essay also highlights the role of various therapies in Trish's treatment.

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Mental Health
How would you establish and maintain a therapeutic relationship with Trish? How would you
promote mental health and recovery with Trish? Your answer should refer to the case scenario
and utilize appropriate supporting references.
The main aim of this essay is to display how to maintain and develop a therapeutic
relationship with Trish, a twenty-eight-year-old woman with the intention to help keep her
engaged with a variety of services to establish meaningful progress towards her progress.
According to the case study, she clearly understands health services, especially with the
proposed diagnosis personality. Therefore, I will highlight on etiology, including the signs and
symptoms she is displaying to help ascertain the type of disorder she could be suffering from.
Moreover, I will explain the fundamental techniques that could be used in the promotion of
mental health as well as the recovery interventions in the case of Trish.
The personality disorders are numerous, and they are described as the forms of behavior,
thoughts as well as feelings. Based on the case study of Trish, the key behaviors and symptoms
as presented imply that she could be suffering from a condition called emotional unstable
personality disorder often referred to as the borderline personality disorder. Such a disorder
usually meets the criteria of diagnosis in the International Classification of Disease (ICD-10)
(Osler et al.2019, p.1). Consequently, her condition is a subtype of personality disorder that
could also be referred to as a mental health condition (EUPD)
There are a variety of features of the EUPD. Some of the critical examples include
unpredictable mood, acting impulsively, lack of control of behavior and emotional outbursts
among others. However, the most dominant characteristics are impulsive actions that occur as a
result of emotional instability (Townsend and Morgan, 2017, p.1). The other feature is

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considered as the borderline type that is displayed through feelings of emptiness, involvement in
many unstable interpersonal relationships that counteracts together with suicidal ideation and
self-harm
The case of Trish indicates how complex her situation is due to the various features of
alcohol misuse, emotional withdrawal, depression, as well as post-traumatic stress that was
caused by sexual abuse from her uncle. The mentioned characteristics above are significant
contributors to her ailment. Research indicates that there is one particular cause of the infection;
however, there is a combination of several factors that include, environmental and biological
factors that make a person susceptible (Solli and Rolvsjord, 2015, p.80). Additionally, certain
individuals develop such infections as well as experience problems during their childhood.
It is crucial to be in possession of collateral information concerning Trish before meeting
her especially on her condition, social and personal history. Also, certain vital factors should be
taken into account to help in the establishment of a therapeutic relationship. Such factors are
interpersonal and development theory, background knowledge, knowledge of the person,
knowledge of the infection as well as the information concerning the contributing factors and
influences (Lysaker et al.2018, p.1). Based on the therapeutic relationship existing between
Trisha and the nurse, a fundamental purpose can easily be formed. With such a relationship, it
will be easy for her to work with as well as towards her key objectives that aim to help Trisha
develop better ways of dealing with her behavior, feelings, and thoughts. Eventually, she will be
in a position to effect beneficial change in relation to having the potential to manipulate positive
health outcomes, and this could be considered as a technique of treatment.
According to Linehan (2018, p. 34), to establish a therapeutic relationship, three phases
are involved, that is orientation phase that entails the introduction of both the service user and the

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nurse to get to know and trust one another. The next phase is the working phase where the
service user is asked to state his or her problem that will be worked upon by the nurse. Lastly,
there is the resolution phase that is also referred to as the weaning off process that gives the nod
for the service user to begin her independence. Another key important thing that is necessary in
this case is for the establishment of a rapport of trust by the nurse concerned with the assessment
of Trisha through respect as well as conduction of non-judgmental practice. Also, the nurse
should be competent enough to handle the assessment. The mentioned aspects will help in the
establishment of a therapeutic relationship to make Trisha feel accepted in the community.
Furthermore, the attainment of such a therapeutic relationship will be obtained by the
possession of aptitude and confidence by the nurse to help her engage with the Trisha through
the use of effective communication skills (Dixon, Holoshitz and Nossel, 2016, p.15). The nurse
will also act in an empathetic manner by taking into account her dignity as well as vulnerability.
Other essential factors that will be considered by the nurse include trust and commitment, limits
and boundaries of her professional role, self-knowledge, self-awareness and being mindful of
ethics among others.
According to the guidelines of NICE, Trisha’s mental recovery and health can be attained
through the use of a multidisciplinary care plan that should be put into action with the family as
well as the service user (Milani, 2017, p.58). The guideline clearly states the responsibilities and
roles of the social and health care professionals in charge of her care. Additionally, such a care
plan should be shared between the service user and the GP (Brown, 2018, p.1). Thus both the
pharmacological treatment and psychological interventions will be used. To increase her social
awareness, cognitive analytical therapy, dialectical behavior therapy, and mentalization-based

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therapy. Besides, the recommended therapies will assist Trisha to regulate her emotions, cope up
with distress and finally set up aspirations and realistic goals.
Conclusion
Based on the discussion, to form a therapeutic relationship, various stages and skills
should be taken into account. Trisha has met the criteria for diagnosis for the EUPD based on
ICD-10, as displayed by the signs and symptoms. However, certain factors have generally
hindered the establishment of a therapeutic relationship such as self-destructive behavior, being
sexually abused and misuse of alcohol. A combined psychological medication and interventions
can address Trisha's mental health and recovery process.

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References
Brown, N.W., 2018. Psychoeducational groups: Process and practice. Routledge.
Dixon, L.B., Holoshitz, Y. and Nossel, I., 2016. Treatment engagement of individuals
experiencing mental illness: review and update. World Psychiatry, 15(1), pp.13-20.
Linehan, M.M., 2018. Cognitive-behavioral treatment of borderline personality disorder.
Guilford Publications.
Lysaker, P.H., Hamm, J.A., Hasson-Ohayon, I., Pattison, M.L. and Leonhardt, B.L., 2018.
Promoting recovery from severe mental illness: Implications from research on metacognition and
metacognitive reflection and insight therapy. World journal of psychiatry, 8(1), p.1.
Milani, R., 2017. Implementing NICE guidelines. Coexisting severe mental illness and substance
misuse: community health and social care services NICE guideline [NG58].
Osler, T., Glance, L.G., Cook, A., Buzas, J.S. and Hosmer, D.W., 2019. A Trauma Mortality
Prediction Model Based on the ICD-10-CM Lexicon: TMPM-ICD10. The journal of trauma and
acute care surgery.
Solli, H.P. and Rolvsjord, R., 2015. “The opposite of treatment”: A qualitative study of how
patients diagnosed with psychosis experience music therapy. Nordic Journal of Music
Therapy, 24(1), pp.67-92.
Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of care in
evidence-based practice. FA Davis.