THERAPEUTIC IMPASSES AND ITS INTERVENTION Therapeutic impasses are blocks in the progress of the nurse-Patient relationship.

They arise for variety of reasons and may take many different forms, but they all create stalls in the therapeutic relationship. Impasses provoke intense feelings in both the nurse and the patient that may range from anxiety and apprehension to frustration, love, or intense anger. Five specific therapeutic impasses and ways to overcome are to be learnt to develop therapeutic nurse-patient relationship Therapeutic impasses are five 1. Resistance 2. Transference 3. Counter transference 4. Gift giving 5. Boundary violations. Resistance Resistance is the patient's attempt to remain unaware of anxiety- producing aspects within

JOHARI WINDOW Therapeutic nurse-patient relationship is a mutual learning experience and a corrective emotional experience for the patient. In this relationship. the nurse uses personal qualities and clinical techniques in working with the patient to bring about insight and behavioral change. One such quality is self awareness. The nurse who cares for the biological, psychological and socio-cultural needs of the patient sees a broad range of human experiences; she must learn to deal with anxiety, anger, sadness and patients at all intervals of health illness continuum. Self awareness is a key component of the psychiatric nursing experience. To promote self awareness Johari Window" could be illustrated . It is based on the concept of No one ever completely knows his/her inner self. Quadrant 1.is the open quadrant; it includes the behaviors, feelings, and thoughts known to the individual and those around him. Quadrant 2. Behind quadrant ; because it includes all those things that others know but the individual does not know. Quadrant 3. Hidden quadrant; it includes those things that only the individual knows about himself. Quadrant 4. Unknown quadrant; containing aspects of the self, unknown to the individual others. Taken together, these quadrants represent the total self. The following Three Principles May Help Clarify How the Self Functions in this Representation: 1. A change in anyone quadrant affects all other quadrants. 2. The smaller the first quadrant, the poorer the communication. 3: Interpersonal learning means that a change has taken place, so that quadrant is larger and one or more of the other quadrants are smaller. The goal of increasing self-awareness is to enlarge the area of quadrant 1, while reducing the size of the other three quadrants.To increase knowledge of self, one begins by listening to one self. This means allowing oneself to experience genuine emotions, identify and accept personal needs, and move .one's body in free, joyful and spontaneous-ways. It includes exploring one's own thoughts, feelings, memories and impulses.

The next step in the process is to reduce the size of quadrant by listening to and Iearning from others. This requires active listening and openness to the feedback others provide. The final step involves reducing the size of quadrant3 by self - disclosing, or revealing others important aspects of one self. Self-disclosure is a symptom of personality, health and a means of achieving healthy personality. To achieve therapeutic nurse-patient relationship, a firm understanding and acceptance of self, based on self-awareness is required to acknowledge a patient' differences and uniqueness. Campbell has identified a holistic nursing model of self-awareness. This model consists of four interconnected parts- the psychological, physical, environmental and philosophical components. 1. The psychological component of self awareness includes knowledge of one's own emotions, motivation, self concept and personality. Being Psychologically self aware means being sensitive to one's feelings and to external elements that affect those feelings' 2. The physical component of self is the knowledge of personal and general psychology, ones bodily sensations, one's body image, and one's physical potential. 3. The environmental aspect of the self consists of one's environment, relationship with others and knowledge of the relationship between humans and nature. 4.The philosophical component refers to the sense that one's life has meaning. One's personal philosophy of life and death may or may not include a formulation of a superior being, but it the world in which one lives and the ethics of one's behavior. Together these components provide a model that can be used to promote the self-awareness and self growth of both nurses and the patients for whom they care. Johari window helps us to review the important techniques of IPR- listening to oneself, listening to others and learning from others and finally the self disclosure.