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Date of Award

9-2011

Document Type

Campus Access

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Nursing

First Advisor

Genevieve E. Chandler

Second Advisor

Karen A. Kalmakis

Third Advisor

Richard Halgin

Subject Categories

Experimental Analysis of Behavior | Psychiatric and Mental Health

Abstract

The nurse-client relationship is the context in which all nursing care is delivered. Despite changing trends in mental health nursing, authenticity has been identified as an enduring aspect of the therapeutic relationship. A behavioral aspect of therapeutic relationships that expresses authenticity on the part of the clinician is self-disclosure. The decision to self-disclose to clients remains a complex and unexplored area of clinical practice. As healthcare and economic trends push for briefer treatment in mental health, nurses are exploring new ways to build the therapeutic alliance more efficiently. Research from other disciplines indicates that therapist self-disclosure may have therapeutic value. This hermeneutic, phenomenologic study explored the experiences and the meaning that psychiatric nurse clinicians make of self-disclosure, and inevitably, nondisclosure in their therapeutic relationships with clients.

Participants included 13 European American nurse practitioners or clinical nurse specialists board-certified in mental health nursing with at least 4 years experience. Data were collected from demographic questionnaires, interviews, written correspondence, and researcher notes.

Narrative analysis revealed five types of self-disclosure: (a) environmental; (b) intentional-direct; (c) intentional-indirect; (d) unintentional-direct; and (e) unintentional-indirect. The data also yielded antecedents contributing to decisions by participants for both disclosure and non-disclosure with clients. Goals, benefits, positive experiences, risks and negative outcomes were explored for clinician self-disclosure. The participants' perceptions of the meaning of self-disclosure were described. Results showed the context that participants developed for actual use of self-disclosure was well developed with specific antecedents. Self-disclosures were usually seen as effective when carefully applied based on assessment of the client's developmental stage, the length of the relationship, client need, and boundary strength. Self-disclosure, to be effective, seems to be associated with a level of context-dependent discernment and relational skill found in the experienced or expert nurse. Finally, changing patterns in the use of self-disclosure by nurse clinicians emerged from the interview data.

Implications for practice include participants' belief that self-disclosure by the clinician is unavoidable and that it can contribute to strengthening or weakening the therapeutic alliance. As such, self-disclosure by clinicians warrants training and discussion. Further research in the area of nurse clinician self-disclosure, especially client perceptions of the experience and its meaning, is indicated.

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