Six months into my first staff nurse position in a psychiatric hospital, I learned, in an unbridled moment of spontaneity, that revealing oneself could be enormously therapeutic not only to patients but to me as well. I had lunch duty that week; I was assigned to dine with 2 patients everyday. I looked forward to "lunch" with my 2 patients, both in their late twenties and both experiencing serious psychotic disorders. Diana and Armand had often been my luncheon companions over the months. We had a special, unspoken bond that comes with the regularity of dining together.
The seventh-floor dining room had enormous glass windows that looked onto the expressway below. I always managed to get a window seat, since Armand thought it was the "best seating in the house." Both Diana and Armand were less than calm as we started our meal. Armand was particularly withdrawn, perhaps hearing "the voices." Diana was agitated, talking loudly, eating fast, and moving back and forth in her chair. I decided to try some distracting conversation. "Lots of traffic on the expressway today," I offered. Immediately Diana turned her attention to the road and exclaimed to Armand, "See those two vans down there, they are mine, I own them, it's Deen Van Lines, I own those vans, I own a moving company, Armand, see them!!" Armand looked directly into Diana's eyes and responded, "Yes I see them. Get them off my expressway!!"
I laughed out loud. I tried to catch myself but could not. Diana and Armand began laughing also, and we laughed together for what seemed to be a very long time. A rather rational conversation then ensued as if we were merely dining companions, not patients and nurse. Furthermore, my relationship with both patients changed qualitatively in ensuing weeks, including my ability to reach and comfort them when their symptoms were getting out of control. We had a special bond.
"The nurse-patient relationship must have a one-way focus," the nursing instructor asserted. That meant that in the course of establishing therapeutic relationships with patients we were to share as little as possible about ourselves and we were to react thoughtfully, analytically, and objectively. We were to be that blank slate, that objective sounding board, and that nonjudgmental professional to whom patients would feel free to express feelings, symptoms, and problems. "Do not express too much emotion, approval or disapproval." One clinical psychiatric nursing teacher advised, "Just be there!!" In retrospect, this was not bad advice and was certainly a reflection of a dominant therapeutic method of the era. It also prevented students from revealing too much of themselves in their attempts to manage the anxiety associated with learning to "be therapeutic."
My lunchtime experience was the exception that put the rule to the test. I learned that to be human is to be spontaneous as long as that spontaneity is authentic and egalitarian. Simply said, I laughed from the heart with Diana and Armand and in those moments of laughter we not only experienced a humorous perspective but shared sanity as well. What can be more therapeutic? (The names of the 2 patients have been fictionalized.
Gloria F. Donnelly, PhD, RN, FAAN
Editor-in-Chief