Posted: October 11th, 2023

Building Therapeutic Relationships in Inpatient Psychiatric Care

Client Journal Entry

Reflect on the clinical experiences you’ve had over the past week, and record your thoughts in a document no more than 500 words long. Your peers will be able to read and reply to what you have written.

Your reflection must satisfy these criteria:

It must be about a client encounter you had this week.
It must include an analysis of the nurse practitioner role or the potential role in the clinical setting.
All clinical discussion or communication must protect the confidentiality of clients; your reflection must not use any patient names, ages, or other personal identifiers.
You will not be graded on the experiences you have had, but instead on your commitment to reflecting on those experiences and using those reflections to improve your professional identity and skill set.

Select one of the following options to help you give your reflection focus:

Option 1

Write about a situation that you felt you handled well. What did you do?

Option 2

Write about a situation in which you felt unsure of yourself. What happened? What made you question your decision making? If faced with the same situation in the future, how would you like to handle it differently?

Option 3

Write about a situation that you felt you handled incorrectly. What happened? How would you change your actions to result in a different outcome?

Option 4

Write about a continuing situation that began earlier in your clinical. How has the situation evolved since you first faced it? What have you done to guide the relationship? What interventions or strategies have you tried? What is the current outcome? What are your goals with this patient?

Building Therapeutic Relationships in Inpatient Psychiatric Care
Effective communication and relationship building are essential for nurse practitioners and other healthcare providers working in inpatient psychiatric settings. Developing trust and rapport with patients, who are often in vulnerable mental states, can help improve outcomes and facilitate engagement with treatment. This was demonstrated in a recent clinical experience I had with a patient on an inpatient psychiatric unit.
When I first encountered “John” earlier in my clinical rotation, he had been admitted following a suicide attempt and was despondent and unwilling to interact. Over subsequent weeks, I made a conscious effort to slowly build rapport with John through daily visits. Initially our conversations were brief, with John only providing one-word answers. However, employing some key relationship-building strategies seemed to gradually help John open up. I ensured I spent dedicated one-on-one time with him each day without interruptions, giving him my full attention. I also validated his feelings without judgment and emphasized my supportive role.
By the latest week, I noticed John was more engaged during our meetings. He asked questions about his treatment plan and prognosis, expressing less hopelessness about the future. While progress has been incremental, these small signs suggest the approaches used, such as active listening and unconditional positive regard, are gaining his trust. The overall goal is to continue offering John support through this difficult period until he feels ready to more actively engage in treatment and work towards discharge.
Research has found therapeutic relationships to be a core component of effective mental healthcare (1). Factors like empathy, trust and non-judgmental support have been linked to improved outcomes for patients (2). However, developing these relationships can be challenging, especially initially when patients are distressed or unwilling to engage. Studies have shown focused attention on building rapport through dedicated visits, active listening and validating emotions can help overcome this barrier (3, 4).
In John’s case, interventions like uninterrupted one-on-one meetings and reflecting back his feelings seemed instrumental in gradually gaining his cooperation. This aligns with research finding such “engagement behaviors” facilitate relationship development with reluctant psychiatric patients (5). The experience highlights how nurse practitioners can apply science-based strategies, even in small steps, to foster the collaborative relationships critical for care. With continued support, John’s increasing investment in his treatment bodes well for his recovery progress.
In psychiatric nursing, forming therapeutic alliances is a core responsibility. This case study provides an example of how focusing attention on communication skills from the start of the nurse-patient relationship can help initiate engagement and lay foundations for improved outcomes. While building trust takes dedicated time and effort, even small successes in this area make a difference for patients. Nurse practitioners are well-placed to lead this important work through compassionate, research-informed care.
References:
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of consulting and clinical psychology, 68(3), 438–450.
Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based responsiveness. Oxford University Press. INPATIENT PSYCHIATRIC PATIENT

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, research & practice, 16(3), 252-260.
Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of consulting and clinical psychology, 61(4), 561-573.
McCabe, R., & Priebe, S. (2004). The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. International journal of social psychiatry, 50(2), 115-128.

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