Editing Mental Health and Psychosocial Nursing (section)

=== The Nurse-Client Relationship ===
The therapeutic relationship is goal-directed, time-limited, and centered entirely on the client's needs. It differs from a social relationship: there is no reciprocal self-disclosure for the nurse's benefit, no gift exchange, no contact outside the professional role.

Peplau's phases:
* '''Orientation''' - establish trust, set the contract (purpose, time, place, confidentiality and its limits), begin assessment.
* '''Working''' - the bulk of therapeutic work; the client explores problems, tests new behaviors, and experiences both progress and resistance.
* '''Termination''' - planned from the beginning; summarize gains, allow expression of feelings about ending, avoid introducing new issues. Regression and anger at termination are common and are addressed, not punished.

'''Boundary violations''' to recognize and avoid: accepting or giving gifts, meeting outside the setting, disclosing personal problems, keeping client secrets, treating one client as special, and any romantic or sexual contact. Transference (client redirects feelings about someone else onto the nurse) and countertransference (the nurse's unresolved feelings surface toward the client) are both expected; countertransference is managed through supervision and self-awareness, not denial.

'''Confidentiality has limits.''' The nurse must break confidentiality when there is a serious threat of harm to self or to an identifiable other, when child or vulnerable adult abuse is suspected, and when compelled by court order. Tell the client this during orientation, before it becomes relevant.