Nurses can help clients move from the orientation phase to the working phase by remaining available, consistent, and acting in a way that promotes trust. When the relationship does not progress to the working phase within 6 months, a therapeutic transfer should be considered.

This descriptive qualitative study of the nurse-client relationship used an interpersonal focus and Leininger's (1985) method of qualitative analysis. The setting was a tertiary care psychiatric hospital in southern Ontario, Canada. Nurses within 10 newly formed dyads participated in interviews. The research questions focused on the nature and progression of the relationship and the identification of helping and hampering influences. Helping influences identified included consistency, pacing, listening, positive initial impressions, and attention to comfort and control. Relationships were hampered by inconsistency, unavailability, client factors related to trust, nurses' feelings about the client, confronta tion of delusions, and unrealistic expectations. Phases consistent with those described by Peplau (1952, 1991) were identified within dyads that progressed well. However, a different set of phases was identi fied in nontherapeutic relationships. (J Am Psychiatr Nurses Assoc [2000]. 6, 3-10.)

Understanding the theoretical process of denial gives the nurse a framework within which to assist patients.

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