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A therapeutic relationship is a relationship between a patient and a healthcare professional which is built on mutual trust and respect. There must be honesty, but clear professional boundaries, and the healthcare professional must show understanding, care and empathy.

In 1952, Hildegard Peplau devised a model for therapeutic relationships and interactions. In this model, Peplau focused on psychology and communication and produced a four‐stage model which is illustrated in Figure 5.1.

The first stage of Peplau’s model is the orientation phase. This, in healthcare, is when the practitioner and patient first meet. At this point, the patient has needs, and the healthcare professional is the person to address these needs. This is the stage where the felt need is expressed by the patient. It is here where questions are asked and information is given in order to understand each other and the situation, where boundaries are identified, and at this stage, trust starts to develop.

The second stage is the identification phase. This is where the patient and the healthcare professional work together to formulate goals and to implement the care. This is largely led by the healthcare professional, and in this phase, the healthcare professional may take on many roles including that of a care giver, an emotional supporter and educator amongst others.

The third stage is the exploitation phase; the patient is becoming more independent and more confident. They are starting to look after themselves and can start to look at being discharged from care. They have learnt from the healthcare professional and are no longer as dependent on them.

The final stage is the resolution phase. This is where the relationship ends because the patient is discharged home and is no longer in need of the therapeutic relationship. The interaction ends, and the relationship is terminated.

A direct correlation between Peplau’s model and the nursing process has been identified in literature over time as illustrated in Box 5.1. The major difference between the two is that Peplau’s model is linear, whereas the nursing process is cyclical. The key similarity is the mutual respect required for this relationship to work and the implemented care to be successful.

Figure 5.1 Peplau’s model of interpersonal relations.

Source: Based on Peplau (1952).