USC Nursing: Therapeutic Relationships with Depressed Patients

This report delves into the critical role of therapeutic relationships in mental health nursing, specifically focusing on interactions with patients experiencing depression. It explores key aspects of building a strong therapeutic alliance, including self-awareness, understanding physical space, appropriate use of gifts, and the importance of physical contact, self-disclosure, and cultural sensitivity. The report emphasizes the significance of nurses' countertransference and the phases involved in the therapeutic relationship, such as pre-orientation, beginning, middle, and resolution phases. Furthermore, it discusses the reasons why nurses establish these relationships, highlighting components like hope, empowerment, and identity, as crucial elements in a patient's recovery journey. The report underscores the nurse's responsibility in providing the right treatment and fostering trust, communication, and patient involvement in decision-making to improve patient outcomes. The report uses the literature and evidence to support the arguments and discussions in the report.

1) The therapeutic relationship between a mental health nurse and a mental health consumer
having depression, should always be positive. There are few key points through which a
mental health nurse can build a therapeutic bonding with a mentally disturbed and depressed
patient. In this article we will go through a detailed discussion to know how a therapeutic
nurse can build a good therapeutic relationship with her patient.
Through self-awareness, a nurse can learn about the feelings, thoughts, pains and the reasons
for depression of a patient. Self-awareness allows the nurse to understand the perspective of
the patient. This way the nurse can refrain herself from imposing her own belief and thoughts
upon the patient.
It is important to understand the physical space of the patient and accordingly provide the
same. It promotes verbal communication and minuses anxiety.
The idea of gifting can be fruitful in the case of the therapeutic relationship (Forrester, 2010).
It can be in the form of a social amenity (purchasing a cup of tea or coffee), by presenting a
valuable object (gifting an artwork or showpiece), or providing a gesture.
Physical contact is a very important aspect of the therapeutic relationship. Though trained
nurses should avoid unwanted touching because this can make the whole situation more
critical, sometimes depressive patients may get angry by touching. So Nurses should use the
art of physical contact very wisely, and within a therapeutic rationale (HAZELTON and
SWINSON, 2001).
Self-disclosure is also a vital aspect of therapeutic relationship. The term 'Self-disclosure'
refers to being open to others in terms of personal feelings and experiences. The self-
disclosure of a Nurse makes the patient feel free and relaxed. It also helps the nurse to gain
the trust of the patient. But nurses should use this technique consciously. A nurse must need
to know how much she should share with the patient to make the patient feel free. And the

topic of self-disclosure should not divert from the main motto of the therapeutic relationship
(Pope and Keith-Spiegel, 2008).
While establishing verbal communication with a depressed patient, a nurse should value the
culture and believes of the patient. In a formal conversation, communication may start by
asking about personal information about job, lifestyle, choices, etc. In both of the form of
formal and informal relationship, the nurse should build a strong therapeutic bonding of
working together with the patient which will enable the patient to address and understand
his/her reason of anxiety properly.
Another aspect of therapeutic relationship is Countertransference.The term
'Countertransference’ refers to the behaviour of the nurse towards her patient.
Countertransference is the opposite term of transference, which means the behaviour of the
mentally ill and depressed person to the nurse. To deal with and treat different types of
patients with mental illness and depression, a nurse should develop a strong
counterproductive nature. In the psychotherapeutic scenarios, Countertransference is
considered as an inevitable virtue of a nurse (Ellis, 2001).
The phases which are involved in the therapeutic relationship are-
i) Pre-orientation phase ( Nurse and patient are completely unknown to each other)
ii) Beginning( Through formal and informal communication, the nurse tries to build a rapport
with the patient)
iii) Middle phase( Addressing the issue of concern)
iv) Resolution phase ( Providing resolution to eliminate the mental illness of the patient.)
(Narise et al., 2017)

2) There is no singular concept or recipe to treat a mentally depressed patient. To provide the
right treatment to a mentally distressed patient, a nurse needs to play a very responsible role
throughout the whole therapeutic relationship process. In this article, we will discuss about
the reasons for which mental health nurses should establish a therapeutic relationship with
mental health consumers affected by depression.
Nurses should always work for the betterment of their patients. They should greet a patient by
their name, make proper eye contact with confidence, and also show professionalism while
providing treatment. The nurse should make the patient understand that she was caring for the
patient and understands the patient’s concern.
A nurse should build a bonding of trust and communication with the patient. They should
involve the patient also in the process of decision making. Besides it, they should value
privacy, and understand the concern of the patient. Being culturally sensitive is also
important. Patients who get admitted to the Medicare facility are less aware of the medication
process. So they might feel lost or tensed while staying in the hospital. Adding to that, most
of the times in the hospital, mental health patients have to stay with the unknown faces. In
this situation, patients may feel helpless and may get angry and stubborn. Building a bond of
trust and communication with the patient can obsolete the probability of these things
(Registerednursing.org, 2019).
To recover mental health patients from depression and anxiety, nurses should build a
therapeutic relationship with the patients. There are few components of recovery which are
Hope, Empowerment, Identity, Understanding, etc.
The idea of Hope in the context of mental healthcare situation is- being able to look forward
to the better future beyond illness (McCauley, McKenna, Keeney & McLaughlin, 2015).
Commonly people who face mental illness, anxiety, and depression lose Hope. And this

worsens their situation. They started to believe that they have nothing to live for, and this
thought led them to more anxiety and depression. So, a nurse should regain Hope into the
mind-set of her patient.
Empowerment refers to gaining self-confidence. Often mental health patients lose their
confidence because of the high level of depression and extensive negative thoughts. In the
way to revive the lost self-confidence, a nurse should take the role of a motivator by joining
the patient in the process of decision making (Moxham et al., 2013).
Every person should be equipped with a sense of identity. Identity means defining yourself;
who you are, what are your thoughts and vision, what characteristics you carry, and how
others think about yourself. People who are mentally ill, they start to build a negative
impression on themselves, which can be destructive. Reconstructing the idea of identity in a
mentally depressed patient can fasten the recovery process (Cruwys and Gunaocelan, 2016).
In case of any illness, people tend to research and read about the type of illness so that they
can get a hint about what type of treatment he can expect. In the whole journey of recovery of
a mentally depressed person, he must get a good understanding of his illness, the type of
treatment he will get and how the treatment will help him to be cured. And nurses are the key
person to let the patients know about the progress of their treatment.

References-
Cruwys, T. and Gunaocelan, S. (2016). Depression is who I am': Mental illness identity.
stigma and wellbeing. Joma/ of Affectil'e Disonlers., pp.X9, 36-42.
Ellis, A. (2001). Rational and irrational aspects of Countertransference. Journal of Clinical
Psychology, pp.57(8), 999-1004.
Forrester, K. (2010). What you see may not be what you get: Beware of patients bearing gifts.
Journal of Law and Medicine, pp.18(2), 268-274.
HAZELTON, M. and SWINSON, S. (2001). CONTEMPORARY PSYCHIATRIC-MENTAL
HEALTH NURSING. 3rd ed. Melbourne: Pearson Education.
McCauley, C., McKenna, H., Keeney, S. and Mclllu, D. (2015). Concept analysis of recovery
in mental illness in young adulthood. Journal of Psychiatric and Mental Health Nursing,
pp.21(8). 579-589.
Moxham, L., Hazelton, M., Muir-Cochrane, E., Heffernan, T., Kneisl, C. and Trigoboff, E.
(2013). Contemporary psychiatric-mental health nursing. 3rd ed. Melbourne: Pearson
Australia, pp.pp. 552-586.
Narise, A., Bonam, J., Datla, D., Gamini, S., Bondada, N. and Lolla, S. (2017). Therapeutic
Relationship of Nurses in Mental Health-A Review. [online] Rroij.com. Available at:
http://www.rroij.com/open-access/therapeutic-relationship-of-nurses-in-mental-healtha-
review-.php?aid=85940 [Accessed 28 Aug. 2019].
Pope, K. and Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy:
Making decisions, bypassing blunders, and mending fences. Journal of Clinical Psychology,
pp.64(5), 638-652.

Registerednursing.org. (2019). The Importance of the Nurse-Patient Relationship for Patient
Care. [online] Available at: https://www.registerednursing.org/importance-nurse-patient-
relationship-care/ [Accessed 28 Aug. 2019].