NURS 748 DISCUSSION BOARD -The Initial Contact and Maintaini…

INCLUDE REFERENCES AND CHOOSE ONLY ONE QUESTION

The two most important goals of the first session are to initiate a therapeutic alliance and to assess safety. Both are foundational to the treatment hierarchy described in , and they provide the basis for the psychotherapeutic process. The psychobiological underpinnings of the therapeutic alliance are discussed in , in light of Porges’s research on neuroception. Neuroception takes place without our conscious awareness and tells us whether situations or people are safe, dangerous, or life threatening (). This chapter discusses strategies that enhance and/or allow the person who comes for help to feel safe in relationship in order to do the work of psychotherapy. It is only in a safe environment that one is able to inhibit defense systems and engage with the therapist. The therapeutic alliance fosters the ventral vagal response or resilient zone so that the emotional safety of the healing environment allows the patient to continue psychotherapy and to benefit from treatment. Safety issues also include assessment of how safe the patient is from himself or herself and from others. The first contact with the patient is described in this chapter along with issues germane to the first session, such as making practical arrangements, setting goals, how to end a session, and what records to keep. Therapeutic communication techniques are reviewed.

The other important dimension to psychotherapy is maintaining the frame of the session. The frame refers to the parameters of the psychotherapeutic relationship and includes maintaining appropriate boundaries and safeguarding the rules of therapy. Maintaining the frame is relevant for all models of psychotherapy and ensures that the patient is in a safe environment for the emotional intensity that often accompanies the therapy process. Although the rules may seem strange and arbitrary to the novice psychotherapist, they are of paramount importance in safeguarding the integrity, structure, consistency, and objectivity of the relationship. Attention to the frame of traditional psychotherapy facilitates the best possibility of clinical improvement and personal growth. The therapist is responsible for keeping the frame of the sessions.

The frame provides guidelines for the parameters of therapy, such as adherence to a schedule, fees, confidentiality, therapeutic relationship boundaries, and for minor but important issues during sessions, such as whether eating or smoking or interruptions are allowed during sessions, phone calls between sessions, and starting or stopping on time. By being consistent and trustworthy, punctual, unconditionally accepting, keeping commitments, maintaining boundaries while at the same time being caring, warm, and available, the advanced practice psychiatric nurse (APPN) facilitates neural integration. This chapter begins with a discussion of boundaries and countertransference, self-disclosure, fees, and how to deal with patients who are late or who do not show up for sessions. Change is always fraught with anxiety, and understanding violations of the frame as manifestations of anxiety is key to developing communication strategies that meet this challenge.

Please review the PowerPoints and textbook chapter. Choose ONE question from the list below and post to the discussion board.

DISCUSSION QUESTIONS

1.Discuss transference, and give a clinical example from your practice. Describe how your understanding of transference affects your response as a therapist.

2.Develop specific goals for how and what therapeutic communication skills you would like to integrate and further develop in your practice.

3.Generate a list of words for the various nuances that can be used to describe the feeling of anger, and generate another list for the feeling of sadness.

4.Discuss the goals of the first session.

5.Discuss why the therapeutic alliance is important, and identify psychotherapeutic strategies that can help in developing this alliance.

6.Is empathy always a good thing? Give some examples of when it may be a problem.

7.Using the example of a practice contract from Appendix 4.2 or from the website cited in the chapter, develop a one-page contract or office policy that you could give to patients.

8.Identify from your clinical practice an example of complementary or concordant countertransference, and explain how your feelings might have helped you in understanding your patient.

9.Describe a clinical situation in which paradoxical interventions may be useful, and develop a plan to use this strategy.

10.Discuss communication techniques for dealing with three specific instances of resistance, and give examples for each.

11.Examine your own areas of chronic countertransference and what may be helpful to you in your future APPN practice.

12.What is meant by the slippery slope and what problems may arise as a result of integrating therapeutic touch and Reiki in your APPN practice? Discuss strategies for how you could address these issues.

13.A patient who has been depressed most of her life comes to therapy complaining that she is hopeless, helpless, and will never have a good life. Discuss your gut reaction with someone with this characterological issue and how this could impact frame issues such as money, time, and therapist availability.