The nurse–patient therapeutic relationship: phases, boundaries, self-awareness and transference
- Safe practice
A therapeutic relationship has a purpose, goes through orientation, working and termination phases, and needs clear boundaries and self-awareness.
What it is
The therapeutic relationship is the base of mental-health care. It differs from a social relationship because it has a goal centred on the patient. Peplau described three phases: orientation (introductions, first data, trust), working (most of the time: goals, interventions, teaching) and termination (reviewing progress, discharge goals and referrals). Professional boundaries protect a patient who is vulnerable to the nurse's authority and access to private information. Self-awareness lets the nurse notice their own reactions: transference is when the patient places on the nurse feelings that belong to someone else; countertransference is when the nurse places their own feelings or history on the patient.
What it requires
- A purpose for each encounter, set around the patient's needs.
- Empathy, acceptance and unconditional positive regard, without judging.
- Limited self-disclosure and no personal or business relationship with the patient.
- Supervision or discussion with the team when the nurse notices strong feelings towards a patient.
Components
- Orientation phase: introductions, first assessment, agreement on how you will work together.
- Working phase: shared goals, interventions, health teaching and feedback.
- Termination phase: review of progress, post-discharge goals and community referrals.
How it is applied (and why)
- Introduce yourself with name and role and ask how the patient prefers to be called: it shows respect and starts trust.
- Explain the purpose and length of the encounter and ensure privacy: the patient knows what to expect and can talk safely.
- Agree on goals with the patient in the working phase: shared goals increase participation.
- Use therapeutic communication (open questions, reflecting, silence, summarising): it helps the patient clarify thoughts and feelings.
- Keep boundaries: little personal disclosure, no secrets, no favouritism, no contact outside work: it protects the patient and the relationship.
- Notice your own reactions (frustration, boredom, wanting to rescue) and talk them through with the team: it prevents countertransference from guiding care.
- If the patient directs anger meant for someone else at you, do not take it personally; name the feeling and explore it: it may be transference.
- Prepare the ending from the start and review progress and referrals at discharge: it reduces the sense of abandonment.
In nursing practice
- Brief encounters (emergency, crisis) also have a goal and can be therapeutic.
- With agitated, manic or psychotic patients, avoid touch and keep more distance.
- With a history of trauma, ask before touching and explain procedures that require contact.
- In small communities, acknowledge any dual relationship openly and make clear when you act as a professional.
Common mistakes
- Sharing personal problems with the patient.
- Keeping a secret the team needs to know, such as a plan to harm oneself.
- Spending much more time with one patient or giving them privileges.
- Ending the relationship abruptly at discharge without reviewing progress or referrals.
Test yourself
Think of the answer, then tap the question to see it.
What are the three phases of the nurse–patient relationship described by Peplau?
Orientation, working and termination.
In which phase does the nurse spend most of the time, and what happens there?
The working phase: shared goals are set, interventions and teaching are carried out and the patient is helped to clarify thoughts, goals and coping.
What is countertransference?
When the nurse places their own feelings or experiences on the patient, for example giving advice that comes from their own life rather than from the patient's needs.
What are three signs that a professional boundary is being crossed?
For example: personal self-disclosure, keeping secrets with the patient, favouritism, meeting outside work, contact on social media or believing that only you can help.
Elsewhere in DurgiPedia
- Psychodynamic therapy, transference and countertransference
- Difficult encounters: anger, demands and boundaries
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing: Mental Health and Community Concepts, 2.2: Basic concepts of communication (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 1.5: Boundaries (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 4.5: Assessment (transference and countertransference) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 2.3: Therapeutic communication (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022).
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Representative model, for educational purposes only.