# Situation: A nurse at a community mental health clinic begins weekly one-to-one sessions with a 45-year-old man who is in recovery from alcohol use disorder. In the first session they agreed to meet for 10 sessions of 45 minutes each. He arrives 20 minutes late to the second session, then asks where the nurse lives and whether the nurse is married. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630196  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a community mental health clinic begins weekly one-to-one sessions with a 45-year-old man who is in recovery from alcohol use disorder. In the first session they agreed to meet for 10 sessions of 45 minutes each.

He arrives 20 minutes late to the second session, then asks where the nurse lives and whether the nurse is married. What should the nurse do?

## 보기

1. Refer him to another nurse, since he is crossing boundaries
2. Restate the session time and roles, then refocus on goals **✔ 정답**
3. Answer the marriage question only, to build rapport with him
4. End the session at once as a consequence of his late arrival

**정답: 2**

## 해설

Arriving late and asking personal questions are common ways clients test the nurse in the orientation phase to see whether the nurse is consistent and trustworthy. The nurse responds by calmly restating the contract, keeping the original end time and professional role, and returning the focus to the client's goals.

## 심화 해설

Therapeutic relationship in the orientation phase

The second session of a planned 10-session, 45-minute contract still belongs to the orientation phase of the nurse–client relationship. During this phase, the client commonly tests whether the nurse will remain consistent, predictable, and professionally boundaried. Arriving late and asking personal questions are not necessarily signs of manipulation or boundary violation requiring termination; they are more accurately understood as testing behaviors that assess the nurse's reliability and the safety of the therapeutic frame.

The correct response is therefore to restate the agreed session time and the professional roles, and then redirect the conversation toward the client's treatment goals. This preserves the relationship while reinforcing the structure that makes the relationship therapeutic. The nurse should keep the original end time rather than extending the session, because extending it would inadvertently reward lateness and weaken the contract. Answering the marriage question, even partially, shifts the focus onto the nurse's private life and blurs the professional boundary. Referring the client to another nurse would be premature and would communicate that the client's testing behavior is unacceptable rather than understandable. Ending the session immediately as a consequence would be punitive and would damage the alliance before it has been established.

Key point! In the orientation phase, testing behaviors are expected and are managed by calmly re-establishing the contract, not by punishment or self-disclosure.

The broader literature on alcohol use disorder reinforces why a stable, structured therapeutic relationship matters. Integrated biopsychosocial approaches for substance use disorders emphasize that psychosocial and behavioral interventions are most effective when delivered within a consistent, trusting framework [3]. When clients disengage early, it is often because the treatment structure felt unpredictable or because the clinician responded inconsistently to boundary challenges . In community and general health care settings, the therapeutic alliance is a core vehicle for retaining clients in care, particularly for a condition such as alcohol use disorder where ambivalence about treatment is common . A nurse who calmly restates the contract and refocuses on goals is doing precisely what retention-oriented, alliance-building care requires.

| Client behavior | Likely meaning in orientation phase | Appropriate nurse response |
| --- | --- | --- |
| Arriving 20 minutes late | Testing whether the nurse will hold the time boundary | Restate the agreed time; keep the original end time |
| Asking where the nurse lives | Testing the boundary between professional and personal life | Do not answer; gently redirect to the client's own concerns |
| Asking whether the nurse is married | Testing whether the nurse will self-disclose or become personal | Acknowledge the question without answering; refocus on goals |

Watch out! Self-disclosure is not a rapport-building tool in this phase. Even a seemingly harmless answer to the marriage question can shift the relationship away from the client's needs and toward the nurse's personal life. The nurse's consistency, not personal warmth through disclosure, is what builds trust in early sessions.

The nurse's response should be brief, warm, and firm: acknowledge the lateness and the question, restate the practical agreement, and return to the client's stated goals for the 10-session work. This approach maintains the professional role while demonstrating that the nurse is not rejecting the client, only protecting the structure of care.References (research sources)

- [3]Behavioral and Psychosocial Predictors of Treatment Response in Emergency Psychiatric Admissions for Substance Use Disorders in a Socioeconomically Vulnerable Region of Southeastern Romania: A Five-Year Retrospective Study.Research articleRagea IV, Mitincu-Caramfil SD, Magdalena RN, Pleșea-Condratovici C, Ardeleanu V, Roșca RO, Drăguș L, Moroianu LA. (2026) · DOI: 10.3390/bs16091496

## 임상 시나리오

Managing Testing Behaviors in Early SessionsReinforcing the Therapeutic Contract
In the orientation phase, clients with alcohol use disorder often test the nurse's consistency through lateness or personal questions. The nurse should restate the contract—session time, duration, and professional roles—and refocus on treatment goals.

Keep the original 45-minute end time. Do not extend the session, as this would inadvertently reward lateness and weaken the therapeutic frame.

CautionDo not answer personal questions, refer the client to another nurse, or end the session early. These responses are either boundary-blurring, premature, or punitive and can damage the therapeutic alliance.

## 핵심 개념

- **Orientation Phase** — The initial phase of the nurse-client relationship where trust is built and the client may test the nurse's consistency and professional boundaries.
- **Testing Behaviors** — Actions by a client, such as lateness or personal questions, used to assess the nurse's reliability and the safety of the therapeutic frame.
- **Therapeutic Contract** — An agreement between nurse and client outlining the parameters of treatment, including session time, duration, and professional roles.
- **Professional Boundaries** — The limits that define the therapeutic relationship, keeping the focus on the client's needs rather than the nurse's personal life.
- **Therapeutic Alliance** — The collaborative, trusting relationship between nurse and client that is essential for effective treatment outcomes.

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