2.2.4: Therapeutic Relationship

A therapeutic relationship means creating a positive alliance, or relationship, with a patient. Establishing a therapeutic relationship with a patient takes time, practice, and skill. It is important for a HHA/PCA to take the time to establish a good working relationship with their patient. It will make all the difference in their ability to provide good care to their patient and for their patient to feel good about the care they receive.

The relationship between a HHA/PCA and their patient/family is different from the one they have with their own family or friends. The relationship the HHA/PCA has with their own family and friends is reciprocal, or mutual, meaning both they and their family member share goals and work to meet each other’s needs. The relationship they have with their patients and their families is one where they focus on their patient’s needs, problems, and goals. While they may take on many roles with their patients and the patients may come to view the HHA/PCA as “family,” or as a “friend”, it is important to always remember that Home Health Aides/Personal Care Aides are there to care for the patient. The patients cannot work to help the HHA/PCA meet their own needs. This does not mean that Home Health Aides/Personal Care Aides are not friendly with their patients and their families. It just means that they must always focus on their patient and be aware of professional boundaries.

How to Establish a Therapeutic Relationship:

Trust: Especially during the first few interactions with a patient and their family, it is important for Home Health Aides/Personal Care Aides to demonstrate that they are trustworthy. This means showing up when they say they will, performing tasks and skills well, being honest, and demonstrating their concern for their patient’s well-being.

Setting boundaries: When meeting a patient and their family, Home Health Aides/Personal Care Aides should let them know who they are and what their role is. Tell them the tasks they can and cannot perform. For instance, they can say something like, “I am Karen. I will be your HHA/PCA. If it is okay with you, I will be coming here Monday, Wednesday, and Friday to help you bathe, dress, and eat. I am also here to be a support to you and your family.” If a patient/family asks a HHA/PCA to perform a task they are either not trained to do, is outside of their scope of practice, or that they are uncomfortable with, let them know, and inform their supervisor. They can say something to the effect of, “I‘m sorry, I am not able to put a catheter in you. I will let your nurse know that this is something you need help with.”

Confidentiality: It is important to let their patients know that they will protect their privacy. However, they should never tell a patient that they will keep something a secret, especially from their supervisor and the rest of the healthcare team. If a patient asks if they can tell their HHA/PCA a secret and that they not tell their nurse, they should politely let them know they cannot do this as their whole team is there to help care for them. They can say something like, “Mr. Thorpe, I cannot keep a secret from your nurse or doctor. They are here to help care for you. I do have to share what we do and talk about with my supervisor so that she knows you are properly being cared for. However, I will not share what you tell me with anyone outside of your health–care team if you do not wish.”

Empathy: Having empathy for another person means that you understand the thoughts and feelings of the other person. Empathy is different from sympathy. With sympathy, we feel sorry for another person. Home Health Aides/Personal Care Aides should be careful not to feel sorry for their patient as this often comes across as pity, or being condescending (looking down upon a person), which most people do not like. Sympathy is also more of an expression of one’s own feelings, while empathy shows one understands a patient‘s feelings. In expressing sympathy, we are showing agreement with the other person instead of helping them explore their feelings. Demonstrating that they are empathetic, or understanding, of their patient’s thoughts and feelings shows their patient that they care for them and are there to help them.

Example \(\PageIndex{1}\)

Scenario: Here is an example of the difference between sympathy and empathy. In this scenario a patient has just told their HHA/PCA that they have been diagnosed with cancer.

• Sympathetic response: “Oh! I am so sorry! That is terrible! I know exactly how you feel. My mother was diagnosed with cancer last year and it has been just awful.” You then go on to describe the situation with your mom and how upsetting it has been to deal with her diagnosis.
• Empathetic response: “How upsetting this must be for you. When my mom was diagnosed with cancer last year I had so many different emotions. What are your thoughts and feelings about your diagnosis?” You then sit with the patient and allow them the time and space to explore their thoughts and feelings. Here, the focus is on the patient and not on you.

Positive regard: Positive regard is respecting another person and demonstrating that you value them as a person, regardless of your differences, and whether or not you agree with their thoughts, feelings, or behaviors. We demonstrate our positive regard for someone by our verbal and nonverbal communication. What we say, how we say it, and our body language all demonstrate our respect for another person. If a patient does something that the HHA/PCA does not approve of or says something that is in disagreement with their own beliefs, it is important for them to convey to the patient that they are not judging them. Home Health Aides/Personal Care Aides should watch their tone of voice, facial expressions, and body language. For example, a patient may tell a HHA/PCA that they have decided to stop receiving life-saving treatments. While they may not agree with their decision, they must convey an understanding of and respect for their decision. “Mr. Wahlman, that must have been a difficult decision for you to make. How are you feeling about it?” This response demonstrates that they respect their right to make a decision and are interested in understanding how they feel about it.