Establishing Therapeutic Relationships With Vulnerable and Potentially Stigmatized Clients

Abstract

Grounded theory was employed to elucidate how public health nurses (PHNs) develop therapeutic relationships with vulnerable and potentially stigmatized clients, specifically, single mothers living in low-income situations. We named the emerging theoretical model Targeting Essence: Pragmatic Variation of the Therapeutic Relationship, after discovering that although PHNs strove to achieve relational goals, their attention was primarily focused on the goal of ascertaining concerns foremost on the hearts and minds of mothers, and that PHNs had to accomplish these goals within short practice timeframes. The study's focused context elicited a nuanced explanation of the dynamic relationship-building process derived from subjective relationship experiences of PHNs and single mothers living in low-income situations. We believe Targeting Essence will serve as an effectual relationship-building model, enabling PHNs to know essentially what mothers want and need, and enabling mothers to know essentially that their PHN can be trusted not to render judgment.

Negotiating policy in practice: child and family health nurses’ approach to the process of postnatal psychosocial assessment

“…These engagement strategies were observed in the non-verbal and verbal communication of CFHNs such as smiling at the woman, complimenting her on the baby and her mothering and negotiating with her as to how best to commence the visit. This projection of optimism by the nurse is described as an initial phase of interaction and was also observed in public health nurses in Canada interacting with women [28]. The nurses also conveyed a happy and friendly disposition at the onset of contact with the woman sending a message of the nurse being easy going and that the rest of the assessment may consequently go well.…”

“…The nurses also conveyed a happy and friendly disposition at the onset of contact with the woman sending a message of the nurse being easy going and that the rest of the assessment may consequently go well. This also assisted in establishing initial rapport with the women [28]. This sensitivity to the commencement of the visit establishes a sense of attunement to the woman which Oberle and Tenove [30] describe as a discrete balance between the nurse and the woman.…”

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

“…Other studies have also found that practitioners of embedded counselling have integrated existing counselling theories and approaches into idiosyncratic "situated working models" (see e.g. Abildsnes, Walseth, Flottorp, & Stensland, 2012;Degner, Henriksen, & Oscarsson, 2010;Easton & van Laar, 1995;Flesaker & Larsen, 2012;Porr, Drummond, & Olson, 2012). Several studies have explored the experiences of clergy in relation to their counselling role (Leavey et al, 2007;Lount & Hargie, 1997;O'Kane & Millar, 2002), and described a process of practitioner development that starts with a high level of willingness to adopt a counselling role, combined with a sense of being under-prepared for what is being asked from them, leading to selectivity about the types of issues that they are willing to consider and the adoption of a largely cognitive problem-solving approach as a means of self-protection.…”

Therapeutic Alliance with Juvenile Sexual Offenders: The Effects of Trauma Symptoms and Attachment Functioning

“…The sexual abuse severity, perpetrator, and duration may all impact the extent to which youth form later healthy and meaningful relationships (Lalor & McElvaney, 2010). Therapeutic relationships, in particular, are inauspicious in the manner by which they demand vulnerability, candidness, and in some cases, weakness (Porr, Drummond, & Olson, 2012). It may be particularly challenging to develop a therapeutic relationship when youths' sexual victimization has somehow contributed to sexual perpetration, as they may harbor fears disclosing sexual victimization, feel shameful, or have experienced prolonged stigma (Somer & Szwarcberg, 2001).…”