Pivotal moments in the therapeutic relationship.

It is perhaps conventional wisdom that the therapeutic relationship is a cornerstone of psychiatric nursing. It is almost a sine qua non. However, while its importance may be widely recognized, it is notoriously undefined and even those who profess to practise or utilize it, or those who advocate it most strongly, have difficulty in saying exactly what it is. This report details a study carried out with six experienced psychiatric nurses to explore and describe perceptions and understandings of pivotal moments within therapeutic relationships. The nurses were asked, in a series of one-to-one interviews, to consider relationships with clients that they would themselves describe as therapeutic and meditate on those moments at which everything seemed to change and the relationship became qualitatively different. Among the factors the nurses reported as being significant were empathy, uniqueness, meaning and purpose, and appropriate self-disclosure (although many of those terms may require clarification). This paper will consider the implications of these and others for nursing practice and the identity of psychiatric nursing practice.