Establishing Therapeutic Relationships with Schizophrenia Patients

This report delves into the critical aspects of developing therapeutic relationships with patients diagnosed with schizophrenia. It explores the methods nurses employ to establish these relationships, emphasizing the application of Peplau's theory of interpersonal relations, and the importance of empathy, authenticity, and active listening. The report outlines the phases of nurse-patient relationships and the challenges specific to patients with schizophrenia. Furthermore, it discusses the reasons for fostering these relationships, highlighting their impact on medication adherence, reduced rehospitalization rates, and improved patient outcomes, including the development of self-coping abilities and self-management skills. The report references various studies to support the significance of therapeutic alliances in mental health treatment, underscoring the need for a supportive and understanding approach to enhance the quality of life for individuals with schizophrenia.

Running head: THERAPEUTIC RELATIONSHIP DEVELOPMENT
THERAPEUTIC RELATIONSHIP DEVELOPMENT
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Question number 1:
Ways to develop therapeutic relationship with patients of schizophrenia:
Therapeutic relationship with the patients can be defined as establishment of an
interaction between two people like that of nurse and patient where collaboration between the
two can result in development of a curative climate along with the promotion of the growth or
prevention of the disorders. Studies are of the opinion that caring of the schizophrenia
patients would require great capacity of the nurses for understanding the patients and
developing empathy and displaying non-stigmatisation of the mental ailments (Westermann
et al. 2015). The nursing professional should be able to see beyond the different types of
symptoms where a patient is present in stage of excessive mental suffering and filled with
hopelessness, despair, even suicidal thoughts. Nursing professionals must have the ability in
understanding that such affected people are seen to live in a frightening as well as the unreal
world. They are also seen to have the difficulty to distinguish the reality from hallucinations
and delusions, as all the things seem real for the patient (Cavelti et al. 2016).
For establishing therapeutic relationship between the nurses and the patients, Peplau’s
theory of interpersonal relations can be applied. This theory talks about putting the most
significant and prior approach “to nurses’ action-centred on provide care in partnership with
the patient rather than doing things to the patient”. Peplau is of the opinion that nursing is one
of the therapeutic as well as interpersonal procedures occurring among two or more people
and they should know that this interaction can become therapeutic if the nursing professionals
are aware of her communication and takes the responsibility for it. Studies are also of the
opinion that in order to develop such relationship with schizophrenia, nurses need to have
high levels of self-knowledge and at the same time need to be genuine, as well as authentic
and even be capable of expressing and exhibiting empathy (Klingaman et al. 2015). Nurses

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following the Peplau model need to follow four psychobiological experiences that would
compel the patients in developing “constructive responses to need frustration, conflict, and
anxiety”. They should also identify the four phases of nurse-patient relationships, which are
“orientation, identification, exploitation and resolution”.
Studies are of the opinion that orientation phase is extremely difficult and complex in
patients with schizophrenia. In this beginning phase, it is essential to have the schizophrenia
patient understand the various types of complications they are facing and they need
cooperation. This is followed by the next stage called the identification stage. In this stage,
the patient has developed awareness of the problems and the disorder where there are found
to be highly interdependent setting targets. This is followed by the exploitation phase where
the patient would be expected for exploring all the possibilities and services that are offered
(Sendt et al. 2015). In this stage, it is the duty of the nurse in making all the possibilities
available to the patients with schizophrenia for the recovery known and thereby presents the
different forms of the psychosocial rehabilitation programmes. Finally, in the resolution
phase, the unique and individual needs of the patients would be met for completion of this
relationship. In case of patients with schizophrenia, this phase can only take place when the
procedure of psychosocial rehabilitation occurs that is when the patient is able to live with the
disorder and become autonomous in meeting their own needs.
Developing therapeutic relationship with the schizophrenia patient is thereby not easy
and it requires special attention from nursing professionals. Studies opine that active listening
along with attributes of the empathy is important and nurses need to focus on experiences of
the patients. Nurses also need to follow authenticity that is significant in allowing the patient
to distinguishing what are the parts of the disorder and what are not the parts of the disorder
and what is real and what is not (Searles 2018). Nurses need to help the patients in finding
their personal resources and help them in identifying achievable goals that can be set for

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patients in the medium as well as that of the long term and the various ways in achieving
them. This has positive outcomes as it helps patients in developing adhering to the disorder
and not abandoning educations midway.
Question number 2:
Reasons for development of therapeutic relationship with patients of schizophrenia:
Schizophrenia can be described as the serious mental illness that are characterised by
different types of psychotic symptoms like that of hallucinations, delusions as well as
disorganisation of thoughts and behaviours. Many negative symptoms are seen to occur
which are social isolation, lack of will as well as lack of initiative and even losing the
pleasures in activities that were previously enjoyable. These factors ultimately result in
causing severe damages to both the social as well as occupational functioning of the
individuals affecting their quality of lives (Thompson et al. 2016). Studies are also of the
opinion that that people suffering from schizophrenia face difficulties in understanding the
symptoms as well as to perceive what is happening in the specific part of the world around
them. It is also found to be quite difficult for those people surrounding the patient who are
unaware of the disorder to understand the disorder. Therefore, such patients are found to be
stigmatised. Therefore, it results in a tendency of the patients to distrust others and this causes
the individuals to become more and more isolated and causes delaying treatments. These
aggravate the clinical picture even by multiplied means. The first contacts with that of the
different types of the health services take place after the appearance of the symptoms.
It has been seen that therapeutic relationships is important in treatment of
schizophrenia as it has shown to result in better compliance with that of medication, lower
drop-out rates as well as fewer rehospitalisation along with improvement of symptom levels
and better health outcomes. Studies have also stated that quality of the therapeutic

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relationship including the degree of the shared opinion between professionals and the patients
regarding the quality of the alliance also determined the health outcomes of the patients
mentally and physically. Studies have found that disruption of the therapeutic relationship
between patients and nurses regarding problems relating to experience of positive emotional
bond between them or lack of agreement on the tasks of goals of the therapy can affect the
treatment outcomes (Goldsmith et al. 2015). It has been also found in studies that higher
levels of psychotic symptoms were found in schizophrenia-affected patients when there was
lower levels of therapeutic bonds and engagement of nurses with patients. One of the crucial
aspect of develop therapeutic relationships with patients of schizophrenia is that it increases
adherence to treatments that is regarded as the central focus for optimising recovery in the
patients. Non-adherence to treatment is linked with release as well as rehospitalisation and
poor quality life. However, therapeutic relationship developed by nurses with schizophrenia
patients based on mutual trust, showing of empathy and compassion, being non-judgemental,
relying on patients’ thoughts and conditions, respecting the autonomy and dignity – all that
can help such patients live better quality life. This relationship helps the patients to feel
empowered that increases their adherence (El-Makkah et al. 2015). Feeling of empowerment
is also associated with better development of self-coping abilities and self-management skills
when therapeutic relationship is formed between patients and schizophrenia nurses.

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References:
Cavelti, M., Homan, P. and Vauth, R., 2016. The impact of thought disorder on therapeutic
alliance and personal recovery in schizophrenia and schizoaffective disorder: An exploratory
study. Psychiatry research, 239, pp.92-98.
El-Mallakh, P. and Findlay, J., 2015. Strategies to improve medication adherence in patients
with schizophrenia: the role of support services. Neuropsychiatric disease and treatment, 11,
p.1077.
Goldsmith, L.P., Lewis, S.W., Dunn, G. and Bentall, R.P., 2015. Psychological treatments for
early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an
instrumental variable analysis. Psychological medicine, 45(11), pp.2365-2373.
Klingaman, E.A., Medoff, D.R., Park, S.G., Brown, C.H., Fang, L., Dixon, L.B., Hack, S.M.,
Tapscott, S.L., Walsh, M.B. and Kreyenbuhl, J.A., 2015. Consumer satisfaction with
psychiatric services: The role of shared decision making and the therapeutic
relationship. Psychiatric rehabilitation journal, 38(3), p.242.
Searles, H.F., 2018. Collected papers on schizophrenia and related subjects. Routledge.
Sendt, K.V., Tracy, D.K. and Bhattacharyya, S., 2015. A systematic review of factors influencing adherence to
antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry research, 225(1-2), pp.14-30.
Thompson, L., Howes, C. and McCabe, R., 2016. Effect of questions used by psychiatrists on
therapeutic alliance and adherence. The British Journal of Psychiatry, 209(1), pp.40-47.

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Westermann, S., Cavelti, M., Heibach, E. and Caspar, F., 2015. Motive-oriented therapeutic
relationship building for patients diagnosed with schizophrenia. Frontiers in Psychology, 6,
p.1294.