A therapeutic relationship is an essential component of any successful health care intervention and this holds no more truth than in the relationship between nurse and patient. As registered nurses we are not trained counsellors, however we do have an understanding of basic counselling skills and how they are applied at a ward level and as such it is more important as a registered nurse to establish a proactive therapeutic relationship with a patient than it is to use an appropriate counselling approach. This paper will examine what counselling is, the role of the nurse counsellor, the basic counselling skills used by registered nurses and the differences in counselling approaches.
Counselling and psychotherapy are frequently used interchangeably, however the Psychotherapist and Counsellors Association of Western Australian [PACAWA] (2005) distinguishes between the two. PACAWA (2005) states that “counselling usually focuses on particular issues or concerns for an individual” and aims to help individuals “develop a clearer understanding of their concerns and their context, both personally and situational”, whilst “psychotherapy focuses more on issues of personal meaning, relationship to self, and the impact of past events and trauma” and aims to help individuals “gain a deeper understanding of themselves and to overcome core issues or blocks that persistently disrupt their lives.” A counsellor will help individuals on “dealing with feelings and reactions they are experiencing, and will assist them in accessing their own creativity to find a way of moving forward” opposed to a psychotherapist, who “works with individuals to gain an understanding of what is happening for that individual” (PACAWA, 2005). PACAWA acknowledges that there are many different approaches to counselling and psychotherapy but in all approaches the therapeutic relationship between practicioner and client is very important.
A good therapeutic relationship is developed between nurse and patient through the appropriate use of basic counselling skills. A qualitative study into Counselling and Mental Health Nursing (Stickley, 2002) describes the role of the nurse counsellor:
Although nurses utilize skills in their work, it is worth highlighting the key differences between nursing and counselling practice. The two roles have very different boundaries. The nurse invariable performs many roles in the course of his/her work; clinician, teacher, friend, gaoler. By contrast, the counsellor maintains only one role for their client, that of a listener, one who reflects feelings and meanings, and possibly offers interpretations. The counsellor’s contract with a client is usually limited to 1 hour per week in a counselling room. Nurses, however, fulfil many and varied activities with their clients. What is common to both professions is the necessity for the development of the therapeutic relationship between practitioner and client.
There is widespread understanding that although nurses...