Therapeutic Relationship Between a Patient with Personality Disorder and the Healthcare Worker - Essay Example

Establishing and Maintaining a Therapeutic Relationship Introduction The relationship between a patient with personality disordersand the healthcare worker has a critical role in the fostering of character change, as well as alleviation of symptoms. This relationship can also act as a powerful vehicle for improvement of the patient, especially since it provides a supportive environment in which the patient’s problems can be explored. Therapeutic relationships differ from personal relationships because in the former, an inherent power balance exists where the patient places more trust in the therapist. This paper explores how a therapist would establish and maintain a therapeutic relationship with Sondra, a 30 year-old single British lady with personality disorder. Therapeutic Relationship Sondra is suffering from personality disorder issues including personality disorder and substance use. Establishing and maintaining a therapeutic relationship with Sondra is important, especially as it plays a critical role in cognitive behavioural therapy for adolescents and young adults with depressive disorder by increasing their engagement through CBT’s emotionally challenging and skill building tasks (Brown et al., 2014). A therapeutic relationship should foster support and acceptance for the person regardless of their actions or words, which involves unconditional positive regard that helps patients accept their situation and take responsibility for it (Rogers, 2012). The professional should ensure the client understands they will be working together, in partnership, while also communicating to the patient that the professional will be aiding her in helping herself (Linehan, 1994). Moreover, client-centred therapy should also include empathy, which works alongside unconditional positive regard in promoting personal growth (Rogers, 2012). McCabe and Timmins (2013) note that parallel and separate therapeutic relationships for both disorders would not result in an effective recovery plan and, therefore, the therapeutic treatment should happen in the same place, at the same time, using the same team. Indeed, substance use and personality disorder treatment systems commonly deliver ineffective and fragmented care, which makes patients unable to understand the disparate measures of treatment. As a result, any therapeutic treatment should be combined together. For Sondra, establishing and maintaining the therapeutic relationship begins with understanding and empathy. Rogers (2012), for example, states that for a person needs an environment that sees them with unconditional positive regard or acceptance, self-disclosure and openness or genuineness, and empathy or being understood and listened to. The NMC Code of Conduct will also play a critical role in establishing and maintaining a therapeutic relationship with Sondra, especially in relation to its four principles that require prioritization of patients, practicing effectively, safety, and promotion of trust and professionalism (Sutcliffe, 2011). Indeed, promoting trust and prioritizing Sondra’s individuality will instil a feeling of importance in Sondra, which is vital because Sondra is vulnerable to societal stigmatisation. Factors associated with suicidal tendencies are exacerbated by the shame and stigma attached to seeking personality disorder assistance (Chris Hahm et al., 2014). Notably, the professional can help Sondra understand herself, which empowers her to influence her treatment. As a result, this promotes personalised care for Sondra, which promotes independence, empowers individuals, and helps them to become more involved in care decision making (Department of Health, 2010). Individualised care for Sondra is mainly mediated through gaining increased knowledge of her, which entails a perspective of Sondra having a life beyond her disorders (Beutler & Clarkin, 2014). For instance, understanding Sondra’s relationships with men, her unemployment, and sexual abuse should contribute to how the professional sees her as an individual. Indeed, accepting Sondra’s individuality is critical since stereotyping may lead to discrimination. Thus, the therapeutic relationship should involve the professional not as a manager of her disorders, but in a supporting role for Sondra. Josse-Eklund (2014) states that the character traits of the professional are critical influencers in their ability to advocate on behalf of the patient and that in order for the professional to be secure and comfortable during patient advocacy, they must be familiar with the patient and their situation. Some of the strategies that professional can use to help the therapeutic relationship evolve include giving feedback and suggestions, reflecting concern in the conversations, conveying hope, and offering reassurances (Bruch, 2015). This will be particularly important given the abuse that Sondra has suffered, as well as her feelings of isolation following the retirement of her parents to Spain. There are also recommendations that the professional should offer support through providing support for the patients (Norcross & Wampold, 2011), especially in Sondra’s case given her issues with broken romantic and family relationships, as well as her uncle’s abuse. Sondra as a vulnerable patient involves the professional playing a nurturing, protective role, which can prove significantly effective in establishing and maintaining a therapeutic relationship because of a patient’s withdrawal from society (Haigh, 2013). As a health professional, being authentic and genuine plays an essential role in enhancing evolution of the therapeutic relationship, enabling the professional to get as close as possible to the patient (Conoley et al., 2015). Genuineness will require that the health professional should be authentic and natural as they interact with Sondra. In addition, the professional must be reliable and consistent because Sondra has issues with trusting other people. Sondra has a long history of relationship difficulties and emotional withdrawal, which means that the professional must ensure that the relationship is built on genuineness and authenticity to avoid exacerbating Sondra’s feeling of rejection by society. For instance, the professional should make sure that there is a level of consistency displayed between their non-verbal and verbal behaviour (Norcross & Lambert, 2011). Empowerment practice can be undermined if there is no refer to the theories of power which underpin the relationship. The professional’s role as a helper can place them in a position of power, which can be exacerbated by involuntary detainment and other similar clinical situations (Cruz & Pincus, 2014: p1259). An approach that unites Sondra and her nurse in pursuing knowledge can help (Repper et al., 2011). Sondra feels she is not in control of her life, as inferred from her failed relationships, suicidal feelings, and poor self-esteem and self-worth. The professional may also use power benevolently to protect Sondra from harm but it must be done thoughtfully and in line with guidance on capacity and ‘best interests’ (Muran & Barber, 2011). Finally, establishing and maintaining a therapeutic relationship should involve facilitation of the health promotion and recovery process for people with personality disorders, in which the practitioner inspires hope and empowers the patient as they seek to overcome the debilitating effects of personality disorder (Cloninger & Zohar, 2011). In Sondra’s case, this would involve the acknowledgement of her personhood with strategies that foster acceptance, empowerment, hope, and efficient personality disorder management. Moreover, the therapeutic relationship should constitute the foundation for building the health promotion and recovery and evidence-based-oriented practice. Conclusion Establishing and maintaining a therapeutic relationship with Sondra requires that the professional put into use a complex interplay of skills to meet the requirements at hand. The different skills applied in this paper are part of a framework from which the personality disorder professional should conceptualise personality disorder practice. Perhaps the most important thing for the professional is that they should continuously review and refine elements of the relationship that are relevant to their needs, as well as those of the patient. References Beutler, L. E., & Clarkin, J. F. (2014). 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