The psychiatric mental health nurse practitioner (PMHNP)

 

The psychiatric mental health nurse practitioner (PMHNP) is responsible for creating and maintaining a therapeutic environment with established boundaries and a trusting therapeutic alliance. The boundaries and rules of the therapeutic relationship are known as the frame. Common elements of the frame include the process for contacting the provider, what to do in case of an emergency, adherence to a schedule, fees, confidentiality, and boundaries of the therapeutic relationship. Other elements of the frame may include minor details such as whether eating and drinking during the session are appropriate, whether session interruptions are allowed, whether phone calls between sessions are acceptable, and starting and stopping on time.

Include the following sections:
Application of Knowledge: Answer all questions/criteria with explanations and detail. Imagine you are establishing a frame for a therapeutic relationship with clients. Follow the directions below to complete your initial discussion post.
Describe at least TWO elements your frame would include. Provide support from at least one scholarly source.
Describe how your frame might be altered for ONE of the following situations:
Your client is receiving court-mandated therapy.
Your client is a minor.
You are providing therapy via telehealth.
Your client has a history of making threats against their former therapist.
Identify at least TWO strategies that meet the ethical and legal requirements for a client who frequently misses appointments without notice and has failed to pay for the last four sessions. The client has received psychotherapy for six months

 

Sample Solution

As a Psychiatric Mental Health Nurse Practitioner (PMHNP), establishing a clear and consistent therapeutic frame is paramount for creating a safe, predictable, and effective treatment environment. This frame not only defines the structure of the therapeutic relationship but also serves as a crucial boundary-setting mechanism, safeguarding both the client and the provider.

 

Application of Knowledge: Establishing a Therapeutic Frame

 

When establishing a therapeutic frame with clients, two essential elements I would always include are Confidentiality and its Limits and Session Structure and Emergency Procedures.

  1. Confidentiality and its Limits: This element is foundational to building trust, which is the cornerstone of any effective therapeutic alliance. Clients need to feel secure that the information they share will be protected. My frame would clearly articulate that all discussions within the therapeutic context are confidential and will not be shared with third parties without their explicit written consent. However, it is equally critical to delineate the limits of confidentiality. This is not only an ethical imperative but a legal requirement. These limits typically include:
    • Duty to Warn/Protect: If the client expresses a serious and imminent threat of harm to self or others.
    • Child or Elder Abuse/Neglect: If there is suspicion or disclosure of ongoing abuse or neglect of a minor or vulnerable adult.

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