The psychiatric mental health nurse practitioner (PMHNP) is responsible for creating and maintaining a therapeutic environment with established boundaries and a trusting therapeutic alliance. The boundaries and rules of the therapeutic relationship are known as the frame. Common elements of the frame include the process for contacting the provider, what to do in case of an emergency, adherence to a schedule, fees, confidentiality, and boundaries of the therapeutic relationship. Other elements of the frame may include minor details such as whether eating and drinking during the session are appropriate, whether session interruptions are allowed, whether phone calls between sessions are acceptable, and starting and stopping on time.

Imagine you are establishing a frame for a therapeutic relationship with clients.

1. Describe at least TWO elements your frame would include. Provide support from at least one scholarly source.
2. Describe how your frame might be altered for ONE of the following situations:
   1. your client is receiving court-mandated therapy
   2. your client is a minor
   3. you are providing therapy via telehealth
   4. your client has a history of making threats against their former therapist
3. Identify at least TWO strategies that meet the ethical and legal requirements for a client who frequently misses appointments without notice and has failed to pay for the last four sessions. The client has received psychotherapy for six months.