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Therapeutic Relationship

Therapeutic Relationship

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The therapeutic relationship is the most significant component in healthcare delivery for elderly patients suffering from depression. The paper focuses on patients over 65 years of age with the mental condition of depression. The resulting stress from the depression changes how the patients relate with healthcare providers (Busch, Rudden and Shapiro 2004). The above are based on a patient's nervousness and resulting emotional effects on the mind. The elderly depressed patients also tend to focus on irrelevant issues at home or workplace. So it is very possible that their brains are attempting very had to cope with overwhelming emotions. The group of elderly patients are often neglected in healthcare delivery due to their unique psychological and physiological needs. For instance, mental and motor impairments. As such, the manner in which the nursing staff interact with them is critical towards their recovery.

Nevertheless, understanding the main components of the present relationship is key to the nursing profession and practice. The focus of this paper will be the elderly rehabilitation care for patients diagnosed of depression. The objective of the above in most health facilities is to help the patients in lifestyle and functional abilities. With the good therapeutic relationship, the patients can perfectly fit into the society after discharge. As a result, many healthcare professionals, besides nurses provide their input in their care including physicians, occupational therapists and physiotherapists. The paper, therefore, aims at providing an evidence-based understanding of how nurses can improve their relationship with mentally-depressed elderly patients.

Defining therapeutic relationships.

According to Luther (2007) and Bender (2002), therapeutic relationships should always be a reciprocal interaction. In the present context, the players in the therapeutic relationship should include the patient, their siblings and the nursing staff (Mijolla 2005), emphasizes the aspect of care in the relationship. He mentions that the care must emphasize clear boundaries and positive communication. Therefore, the therapeutic relationship between the patients and the nurse must conform to a patient-centred model. In this case, patients are encouraged in the participation towards their wellbeing.

Further, therapeutic relationship includes three domains. That is emotional, psychological and physical care. The domains are profoundly encountered by the nursing staffs within mental units due to their long contact with "special patients." Within the mental rehabilitation units, most patients evolve from chronic and acute care to the community care. From the community care, the elderly patients will still need special nursing care in conforming to the society (Drugay 2012). Therefore, the nursing staff in any health facilities that cares for mentally depressed-elderly patients must appreciate the holistic therapeutic relationship approach towards their patients. In the present context, the therapeutic relationship is defined as an establishment of patient capabilities and working with the patients and their siblings to achieve the treatment objectives. In addition, the nursing staff should ensure that emotional and psychological aspects of the depressed patients are effectively managed.


Communication with adults diagnosed of any condition is very critical (Whisman 2008). As a result, all healthcare professionals must understand the role that effective communication plays in the recovery process of their patients. Depression often makes elderly patients easily irritated by minor issues accentuating from poor communication skills (Whisman 2008). From the above definition of therapeutic relationship, the rest of the paper presents the important aspects of maintaining the therapeutic relationship with the patients. This section concentrates on the communication aspects. The elderly and depressed patients are always eager to maintain independence (Kathol, Perez and Cohen 2010). In most case, the independence interferes with their judgement, capabilities, and abilities. It is necessary to accept the ideas and feelings of such patients by acting accordingly. It is also an act of negligence if the nurses fail to respond with the best interest of the patient. Moreover, nurses need to demonstrate actions that are guided by professional protocols and medical evidence (Whisman 2008). Further, reflecting the patient's desires and needs are prudent in every action taken.

Therefore, communication with elderly depressed patients will involve both verbal and non-verbal aspects. The non-verbal components reflect actions and the body language (Kathol, Perez and Cohen 2010). Nurses should speak with open body postures that include avoidance of arm crossing to establish rapport with their patients. Also, avoiding distractions by establishing eye contact during every conversation will improve the bond with elderly depressed patients. Similarly, communication with elderly depressed patients involves passing information as much as it involves receiving information. Therefore, the nursing professionals should probe for the concerns of their patients without bias (Whisman 2008). On the other hand, the nurses should take precaution in handling overly expressed patients that may limit the professional aspects of the dialogue. Those mentioned above may be difficult to realize but with realizing fruition in the therapeutic process of the patients.


In the nursing profession, empathy is the most significant element when managing patients with mental problems. Empathy implies an ability to identify with or share the patient's emotional state (Tolman 2005). When one properly, empathy can result in shared care. Further, it can reinforce the concern of elderly depressed patients who tend to seek attention (Green, 2012). The establishment of empathic patient responses marks the ability to connect with patients experiences. As such, the nurses can understand their patients better and can manage them more effectively (Kathol, Perez and Cohen 2010). As a result, empathy is one of the pillars of establishing important therapeutic patient relationships in the mental health settings. Nurses can build their empathic skills in several ways. For instance, through training that involve communication skills. The above-mentioned training emphasize the importance of open-ended questions. Further, they train on empathic body language. (Tolman 2005) For instance, the need for nurses to probe on the feelings and emotions of patients during the therapeutic management. In most cases, empathic therapeutic relationships with elderly depressed patients are enough to reduce the depression. The concept involves allowing them to convey their depressing feelings and thoughts. Nurses should realize that empathic relationships work best when they provide active approaches of listening (Green 2012). When dealing with the elderly, the nurses should avoid redirecting the conversation's focus into clinical therapeutics. The integration of empathy in therapeutic relationships is significant in managing elderly patients with depression hence should be effected from emotional, non-verbal and verbal communication skills.

Respect and Trust

Establishing a trusting and caring therapeutic relationship between patients and nurses is key in the management of the elderly. Such patients easily listen to people they trust and have confidence in. The relationship may take the time to build (Drugay 2012). Nevertheless, nurses must strive to create strong bonds of trust with their patients with the intention of helping them recover from their mental disability. Unless the mentally depressed elderly patients trust their nurses, they may fail to comply with recommendations presented to them. As a result, there shall be a reduced potential of positive intervention impacts.

Moreover, establishing respect within the context of therapeutic relationships need the nurses to appropriately manage their skills of communication. The aim is to ensure that the elderly patients feel part of their management. Both the patient and the nurse must welcome the idea of respect to help in achieving the therapeutic goals (Busch, Rudden and Shapiro 2004). The process involves addressing trust barriers inclusive of suspicions. Other barriers to achieving trust with the elderly patients include disrespect and poor communication skills (Sutton 2011). Patients tend to be positive when trusting relationships are built hence positive outcomes. Similarly, the nursing professionals will be sure that their patients can appropriately follow therapeutic guidelines.

Professional Values

Nurses have a professional responsibility of engaging patients in the therapeutic relationship (Whisman 2008). As such, they should construct dignity, trust and respect when treating the elderly patients with mental depression. Moreover, the nursing care practice recognises the need for respecting patient's personal boundaries (Green 2012). Nurses are urged to act as professionals in all cases rather than acting as friends to their patients. In the present context, professionalism includes the necessity of being realistic with the expectations of the patients. Further ensuring that necessary commitment and motivation levels are achieved in the patient's therapeutic plans.


In conclusion, the paper considers the experiences of nursing professionals when managing elderly patients diagnosed of mental depression. The aim is to appreciate the tenets and values of therapeutic relationships with such patients. The major components of therapeutic relationships with mentally depressed elderly patients have been highlighted. The relationship includes empathy, professionalism, establishing respect and trust and effective communication skills with patients. The relationship aims at developing better reflective episodes of therapeutic management. The episodes involve a reflective event description, analysis, evaluation and conclusion. The therapeutic relationship with patients should result into suitable action plans for managing the patients. For instance, engaging the patients professionally while ensuring a maintenance of the nursing boundaries of practice. To help in realising those above, effective communication skills can be improved when the nurses attend training on communication. The training will help them manage potential hostility and conflict from depressed patients easily. The above can improve therapeutic relationships by ensuring that mentally depressed patients are handled according to their needs.


Luther, S. (2007). Coleridge, creative (day)dreaming, and "The Picture.". Dreaming, 7(1), 47-65. doi:10.1037/h0094465

Bender, E. (2002). Depression Screening Day Adds Anxiety Disorder Assessment. Psychiatric News, 37(15), 9-9. doi:10.1176/pn.37.15.0009 Mijolla, A. (2005).

International dictionary of psychoanalysis. Detroit, Mich.: Macmillan Reference USA. Busch, F., Rudden, M. and Shapiro, T. (2004). Psychodynamic treatment of depression. Washington, DC: American Psychiatric Pub. Drugay, M. (2012).

Influencing holistic nursing practice in long-term care. Holistic Nursing Practice, 7(1), p.46. Green, B. (2012). Applying Feminist Ethics of Care to Nursing Practice. Journal of Nursing & Care, 01(03).

Kathol, R., Perez, R. and Cohen, J. (2010). The integrated case management manual. New York: Springer.

Sutton, A. (2011). Stress-related disorders sourcebook. Detroit, MI: Omnigraphics, Inc. Tolman, A. (2005).

Depression in adults. Kansas City, MO: Compact Clinicals. Whisman, M. (2008).

Adapting cognitive therapy for depression. New York: Guilford Press.

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