Apply Therapeutic Relationship Practices to Leadership in Healthcare

April 1, 2021
April 1, 2021

By: Mary Griffin Strom, MSN, RN, Consultant, Creative Healthcare Management 

In the inspirational new book, See Me As A Person, authors Mary Koloroutis and Michael Trout define the practices that make up a truly authentic connection to patients and families. These practices are the essence of a therapeutic relationship. Koloroutis and Trout define a therapeutic relationship as one in which “the clinician offers care, touch, compassion, presence, and any other act or attitude that would foster healing, and expects nothing in return.” (Koloroutis & Trout, 2012.)

The “expects nothing in return” segment of that definition is what differentiates the therapeutic relationships we form with patients and their families from all other relationships. However, the elements that comprise the therapeutic relationship—presence through attunement, wondering, following, and holding—apply to all authentic relationships, personal or professional.

The therapeutic relationship practices that create authentic relationships with patients and families are something that we can think about, talk about, study, and DO. It takes intentionality, practice, reflection, and effort to move those practices from a way of thinking, to a way of doing, to a way of being.

The same holds true for servant leadership or caring leadership. We can talk about how important it is to be in service to those we lead or how important it is to be caring, but we seldom define those actions in a way that moves us to a new way of being a leader. Let’s explore what it looks like when we apply the therapeutic relationship practices to leadership.


Presence through attunement is the container that holds the three essential practices. If we are not present and giving our undivided attention to the other, then wondering, following, and holding are not likely to be experienced by the receiver. First, we must be attuned.

As leaders, when we “round” on staff, are we attuned to them, focused on them, present for them, and with them? In other words, how do we show up? Are we working to meet our agenda or theirs? Are we with them to listen or to tell? If we are servant leaders, we might need to entertain how to set our agenda aside and be open to whatever their agenda is for that moment.


Wondering begins then as soon as we are attuned. Wondering involves openness, curiosity, using wide eyes, and open ears. And perhaps most importantly, it means suspending conclusions. It means knowing that knowledge comes not from what we already know, but from what we might learn about our staff, the climate of the unit, and the staff response, as well as about the patients/families in our care that day on our unit.


Following means we consciously decide to be guided in our discussions and our interactions with patients, families, and colleagues by whatever happens in the moment. It truly helps to know our staff as individuals, so that when they mention someone or something that has resonance to us, we pick up on that part of the dialogue and show respect and understanding of whatever conversation transpires. They are leading, and therefore, naturally you are the follower. This requires giving special attention to body language, tone of voice, choice of words.


Holding is the conscious decision to lift up, affirm, and dignify what you are hearing and learning from those who know the work the best: your team. Even if you encounter a strong emotional response in the moment, holding helps you as a leader to be a steady and nonjudgmental presence. Holding might mean that you convey that you have heard what was said, that you might need to get back to someone, and that you respect them enough to honor their concern. Holding also means that you keep your promise and return to them with an answer to their raised concern.

Just as these practices must be defined, practiced, and reflected on in order to be true elements of the therapeutic relationship with patients and families, the same holds true for these practices in our role as caring servant leaders. They do not come easily; they often come through trial and error and learning from our mistakes. Formal leaders would benefit from group/peer discussions centered on exploring these practices, putting them into practice, and then reflecting on how they worked and how it might become a way of leading. Staff will learn from you as they witness your steady intentional presence, your openness to their dialogue, your willingness to follow their train of thought and discussion threads, and your holding of their contribution as something valuable to you and to the organization.

I invite you to suggest at your next formal leadership meeting that you set aside some time to use See Me as a Person as part of your learning agenda for each of your meetings. As a leadership team, you will learn the language and definitions of its therapeutic practices and be able to role model the behaviors and practices such that caring servant leadership is demonstrated in actions more than words.

Throughout her career, both as a nurse at the point of care and as an administrator, Mary has seldom used the word “patient” without the word “family” following right behind it.  Currently, Mary is a consultant at Creative Health Care Management, where she partners with health care organizations on team building, patient safety and quality, leadership development at all levels, physician engagement, and patient experience. Mary can be contacted at