Throughout the care of Andrew, one of the most important factors is the building of a therapeutic relationship with Andrew. O’Brien & Fanker (2005, p.441) state that “the formation of a therapeutic alliance with the person with a mental illness and their family is crucial to positive outcomes of treatment”. The therapeutic alliance is an alliance based on listening to the client without being judgemental. To build this relationship, Roger’s core conditions were applied: unconditional positive regard, genuineness and empathic understanding. Rogers (1980) argues that these core conditions must be present for therapeutic change. Rogers (1980) explains this therapeutic change by stating that, as “persons are accepted and prized, they tend to develop a more caring attitude towards themselves”. These core conditions are necessary for Andrew to realise that he is unwell as “Andrew feels there is nothing wrong with him”.
However, although these core conditions were present in each interaction with Andrew, Rogers’ work is specific to counselling where there are no time constraints, where as on a busy ward, it is not always possible to apply the core conditions and nurses must adopt a more proactive approach. In response to this argument, Bett (2003) argues that “time spent using counselling skills may actually be less demanding of resources in the long run”. In addition, Bett (2003) argues that it is beneficial to negotiate the actual time available at the outset. This helps to set the boundary for the client to say what they want to say. Although there are time constraints on a busy acute ward, the nurse should make time throughout a shift to spend some 1: 1 time with patients.
Ways of maintaining the therapeutic alliance was also practised in the PBL session where we practised interviewing techniques in the form of role play. The scenarios highlighted issues and complexities that occur during therapeutic engagement. One issue that occurred was that I had...
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