A symbolic image of a nurse and patient connecting in a mental health setting.

Building Bridges in Mental Health: How Empathy and Connection Improve Inpatient Care

Jordan Keane in Health & Wellness June 2025 • 4 min read.

"Discover how a participatory approach can transform the therapeutic relationship between nurses and patients, leading to better outcomes in psychiatric units."

In the demanding environment of mental health nursing, the therapeutic relationship (TR) stands as one of the most vital instruments. This bond, evolving alongside the professionalization of nursing, is now recognized as the cornerstone of effective psychiatric and mental health support. Whether referred to as the helping relationship, the nurse-patient connection, or the therapeutic alliance, its essence lies in the collaborative dynamic established between caregiver and patient.

A strong TR has been shown to amplify the effectiveness of nursing interventions within acute mental health settings. Mental health nurses understand the concept and how important it is but know that TR requires specific skills to maintain. The factors of consistency, empathy, the ability to listen, making a positive first impression, a safe and comfortable environment and team work are the basic pillars that TR is based on.

However, the complexity of TR means there are few evaluation instrument. The Working Alliance Inventory (WAI) measures the therapeutic alliance, constructed through the connection between the professional and the patient. It is an agreement on objectives and activities. Empathy is regarded as the ability to understand the patient and is a critical component of the therapeutic nurse-client relationship in psychiatric nursing.

Boosting Therapeutic Alliances: The Power of Participatory Action Research

A symbolic image of a nurse and patient connecting in a mental health setting.

A recent study published in "Perspectives in Psychiatric Care" explored how participatory action research (PAR) can improve therapeutic relationships in inpatient psychiatric care. The study addressed how evidence-based practices influenced both the therapeutic alliance and the degree of empathy displayed by psychiatric nurses. The research underscores that implementing structured approaches can significantly enhance the quality of care and the connections formed between nurses and patients.

The researchers employed a quasi-experimental design across two psychiatric units. The key difference was the active implementation of evidence-based practices in one unit, specifically those designed to strengthen the therapeutic alliance. The comparison unit continued with its standard practices. The intervention involved several key strategies:

Individual Patient Care: Allocating dedicated time each day for nurses to engage in one-on-one interactions with patients. The goal was to foster understanding, agree on objectives, and collaboratively plan interventions.
Reflective Groups: Facilitating group sessions where nurses could openly discuss their concerns, share experiences, and provide constructive feedback on challenging situations related to therapeutic relationships.
Evidence-Based Learning: Providing nurses with carefully selected scientific articles on therapeutic relationships, encouraging them to critically analyze and integrate these insights into their practice.

The findings revealed that nurses in the intervention group demonstrated a notable improvement in their degree of empathy. They also became more adept at establishing agreement on objectives and tasks with their patients. This highlights the tangible benefits of actively integrating evidence-based practices into mental health care settings.

Measuring and Improving: A Path Forward

This study confirms that therapeutic relationships in psychiatric care are not only measurable but also improvable. By embracing evidence-based strategies and participatory action research, mental health units can foster stronger alliances between nurses and patients, ultimately leading to more effective and compassionate care. The study underscores the importance of continuous learning, reflective practice, and collaborative approaches in the field of mental health nursing.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1111/ppc.12238, Alternate LINK

Title: Improving The Therapeutic Relationship In Inpatient Psychiatric Care: Assessment Of The Therapeutic Alliance And Empathy After Implementing Evidence-Based Practices Resulting From Participatory Action Research

Subject: General Medicine

Journal: Perspectives in Psychiatric Care

Publisher: Wiley

Authors: Antonio R. Moreno-Poyato, Pilar Delgado-Hito, Raquel Suárez-Pérez, Teresa Lluch-Canut, Juan F. Roldán-Merino, Pilar Montesó-Curto

Published: 2017-09-13

Everything You Need To Know

What is a therapeutic relationship and why is it so important in mental health nursing?

The therapeutic relationship (TR) is the connection and collaborative dynamic between a mental health nurse and a patient. It's also known as the helping relationship or nurse-patient connection. It is vital because it's considered the cornerstone of effective psychiatric and mental health support and can amplify the effectiveness of nursing interventions in acute mental health settings. It is important to establish consistency, empathy, active listening, and a safe environment in order to maintain a strong therapeutic relationship.

What is the Working Alliance Inventory and how does it relate to therapeutic relationships?

The Working Alliance Inventory (WAI) is an instrument used to measure the therapeutic alliance. It assesses the connection between the professional and the patient, specifically their agreement on objectives and activities. While the WAI is useful, there are few evaluation instruments, partly due to the complexity of the therapeutic relationship itself. Using the WAI can help in understanding the strengths and weaknesses of a therapeutic relationship and identify areas for improvement.

What is participatory action research and how can it improve therapeutic relationships?

Participatory action research (PAR) is a research approach where researchers and participants (in this case, mental health nurses) collaborate to address a problem or improve a situation. In the context of mental health, PAR can be used to enhance therapeutic relationships by involving nurses in the process of identifying, implementing, and evaluating evidence-based practices. This collaborative approach fosters a sense of ownership and empowers nurses to improve patient care.

What are evidence-based practices and how can they be used to improve therapeutic alliances?

Evidence-based practices in mental health refer to interventions and strategies that have been shown to be effective through scientific research. Implementing these practices, such as allocating dedicated time for one-on-one patient interactions, conducting reflective group sessions, and providing access to relevant scientific articles, can significantly improve the therapeutic alliance between nurses and patients. This ultimately leads to more effective and compassionate care. Continuous learning and reflective practice are essential elements of using evidence-based practice.

Why is empathy important in mental health nursing?

Empathy is the ability to understand and share the feelings of another person. In mental health nursing, empathy is a critical component of the therapeutic relationship. When nurses demonstrate empathy, they can better connect with their patients, build trust, and create a more supportive environment. This improved understanding allows for better agreement on objectives, tasks and plans for interventions.