Therapeutic Communication Techniques

Therapeutic Communication Techniques Techniques Using Silence

Description Accepting pauses or silence that may extend for several seconds or minute without interjecting any verbal response.

Examples Sitting quietly (or walking the client) and waiting to put thoughts and feelings into words.

Providing general leads

Using statement or questions that (a) encourage the client to verbalize (b) choose a topic of conservation; and (c) facilitate continued verbalization.

“Perhaps you would like to talk about…” “Would it help to discuss your feelings?” “Where would you like to begin?” “And then what?” “I follow what you are saying.”

Being specific and tentative

Making that are specific rather than general, and tentative rather than absolute.

“You scratched my arm.” (specific statement) “You are as clumsy an as ox” (general statement)”You seem unconcerned about Mary.”(tentative statement)”You don’t give a damn about Mary and you never will.”(absolute statement)

Using open-ended question

Asking broad question that lead or invite the client to explore (elaborate, clarify, describe compare, or illustrate) thoughts or

“I’d like to hear more about that.” “Tell me about…” “How have you been feeling lately?” “What brought you to

feelings. Open-minded questions specify only the topic to be discussed and invite answers that are longer than one or two words. Using touch

Restating or paraphrasing

Seeking clarification

Providing appropriate forms if touch to reinforce caring feelings. Because tactile contracts vary considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self. Actively listening for the client’s basic message and then repeating those thoughts and or feeling in similar word. This conveys that the nurse has listened and understood the client’s basic message and also offers clients a clearer idea of what they have said.

the hospital?” “What is your opinion?” “You said you were frightened yesterday. How do you feel now?” Putting an arm over the clients shoulder. Placing the hand over the client’s hand.

Client: “I couldn’t mange to eat any dinner last night not even the desert. Nurse: “You had difficultly eating yesterday.” Client: “Yes, I was very upset after family left.” Client: “I have trouble talking the stranger.” Nurse: “You find it difficult talking to people you do not know?”

“I’m puzzled.” A method of making the “I’m not sure I client’s broad overall understand that.” meaning of the message “Would you please say more that again?”

understandable. It is “Would you tell me used when the more?” communication is rambling or garbled. To the clarify the message, the nurse can restate the basic message or confess confusion and ask the client to repeat or restate the message. “I meant this rather than Nurse can also clarify that.” their own message with “I guess I didn’t make statement. that clear – I’ll go over it again.” Perception checking or seeking consensual validation

Offering self

A method similar to clarifying that verifies the meaning of specific words rather than the over all meaning of message.

Suggesting one’s presence, interest, or wish to understand the client without making any demands

Client: “My husband never gives me any presents.” Nurse: “you mean he has never given you a present for your birthday or Christmas.” Client: “Well – not ever. He does get me something for my birthday and Christmas, but he never thinks of giving me anything at any other time.” “I’ll stay with you until your daughter arrives.” “We can sit here quietly for a while; we don’t need to talk unless you would like to.” “I’ll help you to dress to go home.”

Giving information

Acknowledging

Clarifying time or sequence

Presenting reality

“Your surgery is Providing, in a simple scheduled for 11 AM and direct manner, tomorrow.” specific factual; “You will feel a pulling information the client sensation when the tube may or may not request. is removed from your When information is abdomen.” not known, the nurse “I don’t know the states this and indicates answer to that, but I will who has it or when the find out from Mrs. nurse will obtain it. King, the nurse in charge.” Giving recognition, in a nonjudgmental way, of a change in behavior, an effort the client has made, or contribution to a communication. Acknowledgement may be with or without understanding, verbal or nonverbal. Helping the client clarify an event, situation, or happening in relationship to time.

Helping the client to differentiate the real from the unreal.

“You trimmed your beard and mustache and washed your hair.” “I noticed you keep squinting your eyes. Are you having difficulty seeing?” “You walked twice as far today with your walker.” Client: “I vomited this morning.” Nurse: “was that after breakfast?” Client: “I feel that I have been asleep for weeks.” Nurse: “You had your operation Monday, and today is Tuesday.” “That telephone ring came from the program on television.” “That’s not a dead mouse in the corner; it

is a discarded washcloth.” “Your magazine is here in the drawer. It has not been stolen.” Focusing

Reflecting

Summarizing and Planning

Client: “My wife say Helping the client she will look after me, expand on and develop but I don’t think she a topic of importance can, what with the for the nurse to wait children to take care of, until the clients think and they’re always after they have talked about her about something the main concerns clothes, homework, before attempting to what’s for dinner that focus. The focus may night.” be an idea or feeling, Nurse: “You are however the nurse often worried about how well emphasizes a feeling to she can manage.” help the client recognize an emotion disguised behind words. Client: “What can I Directing ideas, do?” feelings, question, or Nurse: “What do you content back to clients think be helpful?” to enable them to Client: “Do you think I explore their own ideas should tell my and feelings about a husband?” situation. Nurse: “You seem unsure about telling your husband?” Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview

“During the past half hour we have talked about…” “Tomorrow afternoon we may explore this further.” “In a few days I’ll

or to review a healthteaching session. It often acts as an introduction to future care planning.

review what you have learned about the actions and effects of your insulin.”

BARRIERS OF THERAPEUTIC COMMUNICATION Technique Stereotyping

Description Offering generalized and oversimplified beliefs about groups of people that are based on experience categories clients and negate their uniqueness as individuals.

Examples “Two-years olds are brats” “Women are complainers” “Men don’t cry” “Most people don’t have any pain after this surgery.”

Agreeing and disagreeing

Akin to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this. These responses deter clients from thinking through their position and may cause client to become defensive.

Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his patients.” Nurse: “Dr. Broad is head of the Department of Surgery and is an excellent surgeon.”

Being defensive

Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns. The nurse is saying, “You have no right to complain.” Defensive response protects the nurse from admitting weaknesses in the health care services,

Client: “Those night nurses must just sit around and talk all night. They didn’t answer my light for over an hour.” Nurse: “I’ll have you know we literally run around on nights. You’re not the only client, you know.”

including personal weaknesses. Challenging

Giving a response that makes client prove the statement or point of view. These responses indicate that the nurse is failing to consider the clients feelings, making the client feel it necessary to defend a position.

Client: “I felt nauseated after that red pill.” Nurse: “Surely you don’t think I gave the wrong pill?” Client: “I believe my husband doesn’t love me.” Nurse: “You can’t say that; why, he visits you every day.”

Probing

Asking for information chiefly out of curiosity rather than with the intent to assist the client. These responses are considered prying and violate the clients privacy. Often asking “why” is probing and places the client in a defensive position.

Client: “I was speeding along the street and didn’t see the stop sign.” Nurse: “Why were you speeding?” Client: “I didn’t ask the doctor when he was here.” Nurse: “Why didn’t you?”

Testing

Asking question that make the client admit to something. These responses permit the client only limited answers and often meet the nurse’s need rather than the client’s.

“Who do you think you are?” (enforce people to admit their status is only that of client) “Do you think I am not busy?” (forces the client to admit that the nurse really is busy)

Rejecting

Refusing to discuss certain topics with the client. These responses often make clients feel

“I don’t want to discuss that. “Lets discuss other areas of interest to your

that the nurse is rejecting not only their communication but also the clients themselves.

rather than the two problems you keep mentioning.” “I can’t talk now. I’m on may way for coffee break.’

Changing topics and subject

Directing the communication into areas of self-interest rather than considering the clients concerns often arises as a selfprotecting response imply that what the nurse considers important will be discussed and that clients are not capable of helping themselves.

Client: “I’m separated from my wife. Do you think I should have sexual relation with another woman?” Nurse: “I see that you’re 36 and that you like gardening. This sunshine is good for my roses. I have a beautiful rose garden.

Unwarranted reassurance

Using clichés or comforting statements of advices a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client.

“You’ll feel better soon.” “I’m sure everything will turn out all right.” Don’t worry.”

Giving opinions and approving of disapproving responses, moralizing, or implying one’s own values. These responses imply that the client must think as the nurse thinks, fostering the client dependence.

“That’s good (bad).” “You shouldn’t do that.” “That’s not good enough.” “What you did was wrong (right).”

Passing judgment

Telling the client what Giving common advice do it. These responses deny the clients right to be an equal partner. Note than giving expert rather than common advice is therapeutic.

Client: “Should I move from my home to a nursing home?” Nurses: “If I were you, I’d go to a nursing home, where you’ll get your meals cooked for you.”