Therapeutic impasses/ Obstacles
1. Resistance- is the
patient's reluctance or avoidance of verbalizing or experiencing troubling
aspects of oneself. Resistance is often caused by the patient's unwillingness
to change when the need for change is recognized. It usually occurs in working
phase.
Signs of resistance
According to Wolfberg:
·
Not revealing relevant information
·
Increase in symptoms
·
Breaking appointments
·
Hostility
·
Reporting physical symptoms only at the time of
appointment.
Management of resistance
·
Listen
·
Use reflection to make patient feel and
understand resistance.
·
Explore possible reason and try to resolve
·
Ask for guidance from supervisor in dealing with
difficult resistance.
2. Transference: In
this the patient unconsciously attributes a feeling and behavioural
predispositions towards the nurse which he had towards a person from past
experiences-
Signs of transference
·
Verbal expression by the patient on similarity
between nurse and a significant person in patient's life.
·
Anger
·
Hostility
·
Over dependence
·
Overwhelming affection.
Interventions for transference
·
Need not terminate the relationship
·
Sort out present from past
·
Help in reassigning new role.
·
Assign correct meaning to the relationship
·
Avoid overdependence
·
Involve other staff in the care of patient.
3. Counter transference: Nurse's
behavioural and emotional responses to the client which is inappropriate to
therapeutic relationship.
Signs of Countertransference
·
Over identification of patient with someone from
past experiences or one's own past.
·
Affection
·
Encourages dependency
·
Personal or social relationship with the patient
·
Sexual or aggressive fantasies towards the
patent Push or force the patient for
early recovery
·
Angry when patient is not willing to change
Interventions for
Countertransference
·
Other staff members should identify and
recognize this phenomena
·
Assisting to overcome
·
Evaluate and provide feedback during team
interactions
·
Be open and clear in communications
4. Boundary violation:
Going outside the boundaries of therapeutic relationship and engaging in
social, economic or personal relationship with the patient.
Types of boundary violation
·
Self-disclosure
·
Gift giving
·
Touch
·
Friendship or romantic association
Interventions
·
Do limit setting
·
Maintain professional integrity
·
Follow the code of conduct
·
Help other staff members by identifying boundary
violation at early stage.
Intervention to overcome
therapeutic impasses
·
Aware about impasses and its signs
·
Reflect on feeling
·
Identify impasses at an early stage
·
Self-awareness
·
Be open and genuine in interactions Limit setting
·
Taking help from supervisors.
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