Therapeutic friendliness and the development of therapeutic leverage by mental health nurses in community rehabilitation settings
Andrew Gardner
School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, City East Campus, Adelaide SA
PP: 140 - 148
Abstract
In a world dominated by technology and driven by fiscal policy the emphasis on the therapeutic relationship as a healing modality is still a central theme to Mental Health Nurses (MHN) in their everyday work. This research as part of a PhD program used a Constructivist Grounded Theory approach to explore the process of therapeutic relationships and professional boundaries. The current paper outlines how therapeutic friendliness provides a connection for the therapeutic relationship to develop but in doing so requires a balancing of the therapeutic relationship and constant maintenance of the professional boundary. The authors also discuss how Community Mental Health Nurse's (CMHN) invest in the therapeutic relationship in order to develop a therapeutic alliance and how the alliance between the CMHN and the client facilitates the use of therapeutic leverage applied by the Community Mental Health Nurse as part of the therapeutic process.
Keywords
Community Mental Health Nurse, Constructivist Grounded Theory, Therapeutic friendliness, Therapeutic relationship, Therapeutic leverage, Professional relationship / Boundary.
Article Text
Community mental health nurses who work in the rehabilitation and recovery program of a large metropolitan mental health service were interviewed as part of this research project. Their role includes client advocacy, individual and family therapy, group therapy and milieu management. A central component to their work is managing the therapeutic relationship with all clients in the rehabilitation service. Therapeutic relationships are not a new concept in nursing, "Therapeutic relationships are the central activity of mental health nursing [and] are the foundation upon which all other activities are based." (Jackson and O'Brien 2005, p4) meaning that nurses conduct their work with the client through the therapeutic relationship that they construct with each of their clients.
The purpose of this paper is to report on some of the preliminary concepts that are emerging from this research using a Constructivist Grounded Theory approach to explore the process of how mental health nurses establish therapeutic relationships and how they maintain professional boundaries. New themes that have previously not been thoroughly discussed in the literature are emerging. For example, one of the themes identified is therapeutic friendliness, this describes how CMHN's initially make a connection with clients, and another theme, therapeutic leverage represents an approach used by CMHN when working with clients to subtly influence the client's decision making with regard to their own health care when the client's mental health may be compromised.
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