Therapeutic Nurse-Client Relationship

The therapeutic nurse-client relationship is the basis, the very core, of all psychiatric nursing treatment ap- proaches regardless of the specific aim. The very first process between nurse and client is to establish an un- derstanding in the client that the nurse is entering into a relationship with the client that essentially is safe, confidential, reliable, and consistent with appropriate and clear boundaries (LaRowe, 2004). It is true that disorders that have strong biochemical and genetic components such as schizophrenia and major affective disorders cannot be healed through therapeutic means. However, many of the accompanying emo- tional problems such as poor self-image and low self- esteem can be significantly improved through a thera-

peutic nurse-client alliance or relationship (LaRowe, 2004).
Randomized clinical trials have repeatedly found that development of a positive alliance (therapeutic re- lationship) is one of the best predictors of outcomes in therapy (Kopta et al., 1999). The authors analyzed data from the large-scale National Institute of Mental Health Treatment of Depression Collaborative Re- search Program that compared treatments for depres- sion. Analysis indicated that the development of a therapeutic alliance (therapeutic relationship) was pre- dictive of treatment success for all conditions.
Establishing a therapeutic alliance or relationship with a client takes time. Skills in this area gradually im-
ELIZABETH M. VARCAROLIS
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