Therapeutic impasses/ Obstacles in TNPR


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
·         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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item Therapeutic impasses/ Obstacles in TNPR
Therapeutic impasses/ Obstacles in TNPR
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