There is a concept often used in psychiatric mental health nursing known as "Therapeutic use of self. " Although the critical attributes of this concept are not agreed upon, it has been discussed at length in nursing. To many, it means using oneself as an instrument or a means wherein the "other" or patient/ client, may experience a healing force or a corrective emotional experience and thus, may grow and change. Although the limits of this relationship must be delineated by professional norms, the term implies becoming an important healing source to the patient. Rather than applying or simply using techniques or procedures, therapeutic use of self implies more of a reaching out of self to others.
When attempting to use oneself as a therapeutic agent, the nurse should ask, 1) Why am / doing this? 2) Who will benefit most from these actions/ activities? and 3) Will the patient experience positive growth and change from the relationship? Therapeutic use of self, when used effectively, could carry out the central task of gerontological nursing - facilitating the health of older adults.
Therapeutic use of self assumes that personal relationships are the sine quo non of emotional ills, and that emotional problems may be overcome via corrective emotional experiences. Whether one accepts these assumptions, few would deny that interpersonal relationships are extremely important to alt persons. To be denied interpersonal relationships is equivalent to the agonizing experience of solitary confinement. One need only think of the tales of prisoners in such a situation to recall the importance of people to all of us.
One reason this concept is seen as central to gerontological nursing is that by the time one reaches the fifth or sixth decade of life, one has, in almost all cases, experienced sustained interpersonal relationships as well as losses related to these relationships. Therefore, when there are reduced numbers of relationships in the older adult's life, the remaining relationships become of major importance.
Consider then, what happens when one is admitted to a "total institution" such as a nursing home. Essentially cut off from prior interpersonal relationships, the elderly person must try to establish new relationships. It is in these types of settings that therapeutic use of self by nurses becomes extremely important. Through the use of self, these transitions and adjustments may be eased and facilitated. Without this use of self by nursing personnel, one could argue that the patient/client might suffer and possibly die. After all, nursing personnel are not only key to controlling the major types/amounts of interpersonal relations for patients/clients, but nurses also interact with patients on a 24-hour basis. Thus, nurses are very important to patients' emotional well-being.
How one uses oneself to heal and help, rather than to hinder, is a question central to therapeutic use of self. The answer to this question falls within the specific situation, the specific nurse, and specific aspects of the situation.
One way to facilitate therapeutic use of self, however, is by asking oneself questions in terms of human needs: What do I think the patients might need? What is their behavior telling me about their needs? What are my personal/professional abilities to meet these needs? Regardless of background, as one human being viewing another we will all have "hunches" as to the answers to these questions. These hunches, discussed with other professionals and outcomes of such discussions, made part of the nursing care plan, go a long way to meeting patients'/clients' interpersonal needs. Before we can use ourselves therapeutically, a willingness is needed on our part to reach out to other human beings in these situations.
Therapeutic use of self also requires a willingness to understand our own motives and needs. One principle of psychiatric mental health nursing applicable when one considers therapeutic use of self is that without self knowledge (which comes through some self-examination as to our motivation, our feelings, our personal likes/dislikes, why aspects of care are important to us , and why we are acting in a certain way) - therapeutic use of self will go astray.
Perhaps two hypothetical examples will illustrate this point: A nurse assessed that an elderly, chronically, mentally-ill patient needed a home and an increase in numbers of interpersonal relationships. The nurse moved the elderly person into her own home. When the nurse's home life and her children's lives became horribly disrupted, she tried to move this elderly person out of the home. The elderly person refused to go and finally was forcibly ejected in an emotionally disruptive scene. The nurse, prior to deciding to move the patient into her home, did not address her own motivations or recognize that there was a need on her part to "save" this person and to "prove" the others wrong who counselled her against the move. The original intent of therapeutic use of self thus went astray. Because the nurse sought to meet her own needs more than that of the client, the patient was harmed.
Contrast this situation with one in which a nurse assessed that an institutionalized elderly woman identified with her as a daughter. By talking with the patient about past joys and sorrows related to a deceased daughter, the nurse established a trusting relationship. She used this relationship to help the patient make new friends and establish new interpersonal relationships.
The outcome of this use of self was that the patient became better adjusted to the nursing home environment. By resisting her own inclination to showcase herself as a "super excellent nurse," perhaps the "only one" patients could relate to, she facilitated growth on the part of the patient. This nurse thus avoided the patient dependence which might have fulfilled the nurse's need, but would have been counterproductive to patient adjustment.
The author wishes to thank Dr Carol Boyd for her review and suggestions regarding this column.