Therapeutic  

communication  is defined as the participating   in continuing education learning

face-to-face process of interacting that focuses   on experiences across the entire spectrum of
advancing   the   physical   and   emotional well- healthcare services.
being of a patient.   This kind of communication has
three general purposes:   collecting information to Therapeutic Technique
determine illness, assessing and modifying
behavior, and providing health education.  By using 1. Offering Self
therapeutic communication, we attempt to learn as
much as we can about   the   patient   in   relation
 making self-available and showing interest
to   his   illness. To accomplish  this  learning,  both
and concern.
the  sender  and  the receiver  must  be
 “I will walk with you”
consciously  aware  of  the  con- fidentiality of the
information disclosed and received during the
communication process.  You must always have  a 2. Active listening
therapeutic  reason  for  invading  a  patient’s
privacy. When  used  to  collect  information,  paying close attention to what the patient is
therapeutic communication requires a great deal of saying by observing both verbal and non-
sensitivity as well  as  expertise  in  using verbal cues.
interviewing  skills.     To ensure  the  identification  Maintaining eye contact and making verbal
and  clarification  of  the patient’s thoughts and remarks to clarify and encourage further
feelings, you, as the interviewer, must observe his communication.
behavior.   Listen to the patient and watch how he
listens to you. Observe how he gives and receives 3. Exploring
both verbal and nonverbal responses.  Finally,
interpret and record the data you have observed.  “Tell me more about your son”
As mentioned earlier, listening is one of the most
difficult skills to master.  It requires you to maintain 4. Giving broad openings
an open mind, eliminate both internal and external
noise and distractions, and channel attention to all
 What do you want to talk about today?
verbal and nonverbal messages.  Listening involves
the ability to recognize pitch and tone of voice,
evaluate vocabulary and  choice  of  words,  and 5. Silence
recognize  hesitancy  or intensity of speech as part
of the total communication attempt.  The patient  Planned absence of verbal remarks to allow
crying aloud for help after a fall is communicating a patient and nurse to think over what is
need for assistance. This cry for help sounds very being discussed and to say more.
different from the call for assistance you might
make  when  requesting  help  in  transcribing  a 6. Stating the observed
physician’s order. The  ability  to  recognize  and
interpret  nonverbal responses  depends  upon  verbalizing what is observed in the patient
consistent  development  of observation skills.  As to, for validation and to encourage
you continue to mature in your role and discussion
responsibilities as a member of the healthcare  “You sound angry”
team, both your clinical knowledge and
understanding of human behavior will also grow. 7. Encouraging comparisons
Your growth in both knowledge and understanding
will contribute to your ability  to  recognize  and
 · asking to describe similarities and
interpret  many  kinds  of nonverbal
differences among feelings, behaviors, and
communication. Your   sensitivity   in listening with
events.
your eyes will become as refined as—if not better
 · “Can you tell me what makes you more
than—listening with your ears. The effectiveness of
comfortable, working by yourself or
an interview is influenced by both  the  amount  of
working as a member of a team?”
information  and  the  degree  of motivation
possessed  by  the  patient  (interviewee). Factors
that enhance the quality of an interview consist of 8. Identifying themes
the  participant’s  knowledge  of  the  subject
under consideration;   his   patience,  asking to identify recurring thoughts,
temperament,   and listening skills; and your feelings, and behaviors.
attention to both verbal and nonverbal   cues.  “When do you always feel the need to
Courtesy,   understanding,   and nonjudgmental check the locks and doors?”
attitudes must be mutual goals of both the
interviewee and the interviewer. Finally, to function 9. Summarizing
effectively in the therapeutic communication
process, you must be an informed and skilled  reviewing the main points of discussions
practitioner.  Your development of the required and making appropriate conclusions.
knowledge   and   skills   is   dependent   upon
your commitment   to   seeking   out   and
  “During this meeting, we discussed about  Patient: I can’t sleep. I stay awake all
what you will do when you feel the urge to night.
hurt your self again and this include…”  Nurse: You can’t sleep at night?

10. Placing the event in time or sequence 18. General leads

 asking for relationship among events.  using neutral expressions to encourage

 “When do you begin to experience this patients to continue talking.
ticks? Before or after you entered grade  “Go on…”
school?”  “You were saying…”

11. Voicing doubt 19. Asking question

 voicing uncertainty about the reality of  using open-ended questions to achieve

patient’s statements, perceptions and relevance and depth in discussion.
conclusions.  “How did you feel when the doctor told you
 “I find it hard to believe…” that you are ready for discharge soon?”

12. Encouraging descriptions of perceptions 20. Empathy

 asking the patients to describe feelings,  recognizing and acknowledging patient’s

perceptions and views of their situations. feelings.
 “What are these voices telling you to do?”  “It’s hard to begin to live alone when you
have been married for more than thirty
13. Presenting reality or confronting years”.

 stating what is real and what is not without 21. Focusing

arguing with the patient.
 “I know you hear these voices but I do not  pursuing a topic until its meaning or
hear them”. importance is clear.
 “I am Lhynnelli, your nurse, and this is a  “Let us talk more about your best friend in
hospital and not a beach resort. college”
 “You were saying…”
14. Seeking clarification
22. Interpreting
 asking patient to restate, elaborate, or give
examples of ideas or feelings to seek  providing a view of the meaning or
clarification of what is unclear. importance of something.
 “I am not familiar with your work, can you  Patient: I always take this towel wherever I
describe it further for me”. go.
 “I don’t think I understand what you are  Nurse: That towel must always be with
saying”. you.

15. Verbalizing the implied 23. Encouraging evaluation

 rephrasing patient’s words to highlight an  asking for patients views of the meaning or
underlying message to clarify statements. importance of something.
 Patient: I wont be bothering you anymore  “What do you think led the court to commit
soon. you here?”
 Nurse: Are you thinking of killing yourself?  “Can you tell me the reasons you don’t
want to be discharged?
16. Reflecting
24. Suggesting collaboration
 throwing back the patient’s statement in a
form of question helps the patient identify  offering to help patients solve problems.
feelings.  “Perhaps you can discuss this with your
 Patient: I think I should leave now. children so they will know how you feel and
 Nurse: Do you think you should leave now? what you want”.

17. Restating 25. Encouraging goal setting

 repeating the exact words of patients to  asking patient to decide on the type of
remind them of what they said and to let change needed.
them know they are heard.  “What do you think about the things you
have to change in your self?”
26. Encouraging formulation of a plan of 34. Feedback
action
 pointing out specific behaviors and giving
 probing for step by step actions that will be impressions of reactions.
needed.  “I see you combed your hair today”.
 “If you decide to leave home when your
husband beat you again what will you do 35. Encouraging evaluation
next?”
 asking patients to evaluate their actions
27. Encouraging decisions and their outcomes.
 “What did you feel after participating in the
 asking patients to make a choice among group therapy?”.
options.
 “Given all these choices, what would you 36. Reinforcement
prefer to do.
 giving feedback on positive behaviors.
28. Encouraging consideration of options  “Everyone was able to give their options
when we talked one by one and each of
 asking patients to consider the pros and waited patiently for our turn to speak”.
cons of possible options.
 “Have you thought of the possible effects Avoid pitfalls:
of your decision to you and your family?”
1. Giving advise
29. Giving information 2. Talking about your self
3. Telling client is wrong
 providing information that will help patients 4. Entering into hallucinations and delusions
make better choices. of client
 “Nobody deserves to be beaten and there 5. False reassurance
are people who can help and places to go 6. Cliché
when you do not feel safe at home 7. Giving approval
anymore”. 8. Asking WHY?
9. Changing subject
30. Limit setting 10. Defending doctors and other health team
members.
 discouraging nonproductive feelings and
behaviors, and encouraging productive Non-therapeutic Technique
ones.
 “Please stop now. If you don’t, I will ask 1. Overloading
you to leave the group and go to your
room.  talking rapidly, changing subjects too often,
and asking for more information than can
31. Supportive confrontation be absorbed at one time.
 “What’s your name? I see you like sports.
 acknowledging the difficulty in changing, Where do you live?”
but pushing for action.
 “I understand. You feel rejected when your 2. Value Judgments
children sent you here but if you look at
this way…”  giving one’s own opinion, evaluating,
moralizing or implying one’s values by using
32. Role playing words such as “nice”, “bad”, “right”,
“wrong”, “should” and “ought”.
 practicing behaviors for specific situations,  “You shouldn’t do that, its wrong”.
both the nurse and patient play particular
role. 3. Incongruence
 “I’ll play your mother, tell me exactly what
would you say when we meet on Sunday”.  sending verbal and non-verbal messages
that contradict one another.
33. Rehearsing  The nurse tells the patient “I’d like to spend
time with you” and then walks away.
 asking the patient for a verbal description
of what will be said or done in a particular 4. Underloading
situation.
 “Supposing you meet these people again,  remaining silent and unresponsive, not
how would you respond to them when they picking up cues, and failing to give
ask you to join them for a drink?”. feedback.
  The patient ask the nurse, simply walks 10. Having a closed posture-crossing arms on
away. chest
11. Making false promises – I’ll make sure to
5. False reassurance/ agreement call you when you get home.
12. Ignoring the patient – I can’t talk to you
 Using cliché to reassure client. right now
 “It’s going to be alright”. 13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do
6. Invalidation
those things.

 Ignoring or denying another’s presence,

thought’s or feelings.
 Client: How are you?
 Nurse responds: I can’t talk now. I’m too
busy.

7. Focusing on self

 responding in a way that focuses attention

to the nurse instead of the client.
 “This sunshine is good for my roses. I have
beautiful rose garden”.

8. Changing the subject

 introducing new topic

 inappropriately, a pattern that may indicate
anxiety.
 The client is crying, when the nurse asks
“How many children do you have?”

9. Giving advice

 telling the client what to do, giving opinions

or making decisions for the client, implies
client cannot handle his or her own life
decisions and that the nurse is accepting
responsibility.
 “If I were you… Or it would be better if you
do it this way…”

10. Internal validation

 making an assumption about the meaning

of someone else’s behavior that is not
validated by the other person (jumping into
conclusion).
 The nurse sees a suicidal clients smiling
and tells another nurse the patient is in
good mood.

Other ineffective behaviors and responses:

1. Defending – Your doctor is very good.

2. Requesting an explanation – Why did you
do that?
3. Reflecting – You are not suppose to talk
like that!
4. Literal responses – If you feel empty then
you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong