Psychotherapy and Therapeutic Relationships
Therapeutic Relationship
- Built on trust, empathy, respect, and confidentiality.
- Boundaries: avoid self-disclosure, gifts, dual relationships; maintain professional role.
- Phases: orientation (establishing rapport, setting goals), working (exploring problems, interventions), termination (summarizing progress, planning for future).
Psychotherapy Modalities
- Cognitive-behavioral therapy (CBT): identify and modify distorted thoughts and behaviors; used for depression, anxiety, OCD, PTSD.
- Dialectical behavior therapy (DBT): for borderline personality disorder; mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.
- Psychodynamic therapy: explore unconscious conflicts and past experiences.
- Interpersonal therapy (IPT): focus on relationships and role transitions.
- Group therapy: universality, altruism, instillation of hope; phases (forming, storming, norming, performing).
- Family therapy: systems approach; communication patterns.
Therapeutic Communication Techniques
- Active listening, open-ended questions, reflection, clarification, summarizing, silence.
- Non-therapeutic: giving advice, false reassurance, changing the subject, asking “why” questions.
Traps in Questions
- Confusing empathy (understanding the patient’s feelings) with sympathy (feeling pity).
- Overlooking boundary violations (e.g., nurse sharing personal problems).
- Selecting a non-therapeutic response that seems kind but blocks communication.
Worked Example
A patient says, “I’m worthless.” Which response is therapeutic? a) “Don’t say that, you’re great.” b) “You feel worthless right now?” Answer: b-reflection acknowledges feelings without judgment. Rule of thumb: reflect the feeling back; avoid reassurance.