Therapeutic communication is a collection of Schizoaffective disorder is a mental illness that can

techniques that prioritize the physical, mental, and affect your thoughts, mood and behavior. You may have
emotional well-being of patients. Nurses provide symptoms of bipolar disorder and schizophrenia.
patients with support and information while
maintaining a level of professional distance and Accepting
objectivity. With therapeutic communication, nurses Explanation: This type of therapeutic communication
often use open-ended statements and questions, repeat technique indicates that the nurse had heard and
information, or use silence to prompt patients to work understood what the client was saying. It’s necessary to
through problems on their own. acknowledge what the client had said and affirm that
they’ve been heard. But it does not mean that the nurse
History of Present illness:
should agree to what the client had said. Remember,
Last 1st week of September 2012, client was acceptance isn’t the same thing as agreement though,
not attending work, client was exhibiting bizarre the nurse must remain nonjudgmental. The nurse could
behavior like shouting at people passerby, splashes simply make eye contact and say “Yes, I understand” to
water to people pass by at her work place, neglecting their clients to make them feel that they are being
house chores and personal hygiene, neglecting work listened to.
and take things that does not belong to her, patient is
also observed to be hoarding things that are unusable, Patient: Those people are saying bad things about me.
They are calling me names and even insulting me. I
this persisted up to the succeeding months.
think they would hurt me. Please, help me.
Second week of November client was seen at
Nurse: *make eye contact*, yes, I understand. I hear
the PNP office with her cousin due to theft at
department store for stealing pants, t- shirts and bags; you.
client was imprisoned at BCJM for theft. Patient was Broad Openings
brought into RRCC for admission and further care and
management. Explanation: Therapeutic communication is all about
exchanging information between the client and the
At present, patient continues to manifest nurse. But it is more effective for the client if they are
inappropriate smiles, exhibit auditory hallucinations and the ones having the initiative or leading the interaction.
delusions. She recalled taking a shirt and a pair of pants It is more effective if they are the ones who will decide
at SM but believed that it was given to her. She also what to talk about. In this type of therapeutic
believed that the people at the mall were communication, nurses could ask the client, “What did
communicating with her through hand signals or you do today?”, or “What would you like to talk about?”
gestures. In the ward, she verbalized suicidal intent in
front of hospital personnel and nursing students. Nurse: What did you actually did today?
Patient is presently being managed as a case of
Patient: I just went to SM all by myself.
Schizoaffective Disorder, characterized by disturbances
in mood associated with symptoms of psychosis such as Nurse: And? Would you like to tell me something about
auditory hallucinations, delusions, unusual gestures and that?
behavior, impaired insight and judgment, suicidal
thoughts and impaired somatic functions. Patient: I was having a great day at the mall. But then,
people started to glare at me, and tell me mean and
Schizoaffective disorder is a mental health disorder that insulting things. They were all around me.
is marked by a combination of schizophrenia symptoms,
such as hallucinations or delusions, and mood disorder Nurse: Okay. What were they saying about you?
symptoms, such as depression or mania.
Patient: They were calling me names, so I shouted at Encouraging expression
them. They said they would only stop if I would jump
from the second floor. Explanation: Encouraging the client to vent out their
emotions would help the nurse to assess the client’s
Encouraging comparisons experiences. This type of therapeutic communication
technique would allow the clients to feel that there is
Explanation: Encouraging comparisons could help nothing wrong with expressing their feelings. The nurse
clients to reflect upon their past experiences so that may ask, “How do you feel whenever we talk about
they would learn how to deal with their present lives or your past experiences?” or “You seem anxious now that
current problems. So, the nurse may ask the client, the topic is about your husband; can you tell me the
“Have you experienced the same problem or situation reason why?”
before?”, or “What did you do when you’ve faced that
kind of struggle in the past?” With this, the client could Nurse: Does the person with the deep voice looked like
also recall how they’ve solved their past struggles that you husband?
could be applied in the present.
Patient: Yes.
Nurse: Have you experienced the same problem
before? Were you hearing these things before? Nurse: You seem anxious now that the topic is about
your husband; can you tell me the reason why?
Patient: Yes.
Patient: It’s because he might hurt me. I am scared that
Nurse: What did you do when you’ve faced that kind of he would beat me.
struggle in the past?
Exploring
Patient: I usually cover my eyes and ears and shout
Explanation: It is important to explore more about the
really loud like calling for help.
topic opened and to dig deeper, as this would allow the
Encouraging description of perceptions nurse to identify more details about the client’s
answers. In addition, in order to fully understand the
Explanation: This type of therapeutic communication client, the nurse must know the whole story to provide
technique encourages clients experiencing sensory an effective advice or solution. But if the client is not
issues or hallucinations to describe what they are comfortable or hesitant in exploring the subject, the
feeling in a non-judgmental way. The nurse may ask, nurse must respect the client’s wishes. The nurse may
“Can you describe to me what you heard or seen?” or ask, “You told me that your husband was beating you,
“What does the voice sounds like?” It is important that can you tell me why?”
the nurse would understand the client’s perspective.
Nurse: You told me that your husband was beating you,
Nurse: Can you describe to me what they looked like? can you tell me why?
Patient: There was a man. He had a deep voice. Then, Patient: He was beating me because I would call him
I’m didn’t saw the others. There were all these voices irresponsible and maybe because his family doesn’t like
telling me to jump from the second floor. me.
Nurse: What does the voice sounds like? Nurse: What was the reason that made you call him
Patient: Deep and scary. irresponsible?

Nurse: Do you always hear these voices? Patient: Because he was always at home and I’m the
one who’s always working.
Patient: Not always, but when I do, it’s really scary.
Nurse: How about the reason his family doesn’t like Patient: I think not.
you?
General Leads
Patient: Maybe because he’s saying mean things about
General leads is a technique wherein the patient would
me that gives me a bad image to his family.
feel that the nurse is really encouraging them to
Focusing continuously express their feelings without any pressure
to do so. They would feel that they still have the
Explanation: As the client is venting out a lot of stories initiative to lead the interaction. The nurse should say,
and emotions, the nurse must remain focused on the “Please, go on”.
central cause of why the patient is acting in a psychotic
breakdown. The nurse must ask a question in a nice Patient: These voices, I think they are not real. But…
manner wherein the client won’t feel that their feelings
are being ignored. The nurse may ask, “Of all the Nurse: I know you are uncomfortable with the topic, but
know that I am here to listen. So please, go on.
concerns you’ve shared with me, which of them
troubles you the most?” or “I understand that there are Patient: But, they seem real. It’s really bothering me.
a lot of things troubling your mind, but I want to know
which of them is the reason of your breakdown at the Giving information
mall?” This way, it would prevent the client from
Ensure that the client is aware with the all the needed
opening another topic that would even cause the
information regarding her health, schedule of doctor’s
patient to feel overwhelmed.
visits, medication, daily activities, and even the names
Nurse: I understand that there are a lot of things of the healthcare professionals she would interact with.
bothering your mind, but I want to know which of these This way, the patient would be more encouraged in
reasons is troubling you the most taking care of her health and would know what to
expect or the outcome would be.
Patient: The voices I keep on hearing and the way they
tell me to kill myself. Nurse: My name is. And then these are the people who
are going to help you.
Formulating plan of action
Nurse: The medication you will be taking are Olanzapine
Explanation: This type of therapeutic communication (Zyprexia) 10mg, Valproic Acid (Valpros) 500mg tab,
technique is essential as well as this would provide the Clonazepam (Rivotril) 200 mg ½ tab, Sertraline (Zoloft)
client solutions or ways on how to act more appropriate 100 mg tab, Riperidone (Risdin) 2mg tab, and Biperiden
in future situations. The client must be aware on his or (Akineton) 20mg.
her wrongful actions to obtain a changed behavior and
for them to understand that they could be held Giving recognition
accountable. The nurse may ask, “What do you think
Giving recognition is a technique in which it is all about
you should do if you ever hear these things again?” or
acknowledging the patient’s positive traits and efforts in
“What behavior should you manifest if situations like
order to make the patient feel that their efforts of
this would happen again?”
changing are being recognized. In performing this
Nurse: What do you think you should do if you ever technique, the nurse must be careful in giving
hear these things again? compliments. It should always be an honest remark; not
just something that could flatter the person. Because,
Patient: I think I should call for help. lying is not therapeutic.
Nurse: What about your behavior? Should you get mad Nurse: Good morning Ms. I noticed that you often call
and shout at them when it happens again? for help whenever you hear voices.
Patient: Yes, I do. events, the specific time and date, and may prompt
them to remember something they otherwise wouldn’t.
Nurse: It is also good that you can control your temper The nurse may ask, “What do you think happened
sometimes. next?”
Making observations Nurse: You said that your husband was beating you,
This type of therapeutic communication technique is what happened next?
performed by verbalizing what a nurse perceives in a Patient: He always leaves the house after that. Then
patient. Observations about the appearance, demeanor, after that, I will go to my parents.
or behavior of patients can help draw attention to areas
that might pose a problem for them. Making Nurse: Do you remember the last time it happened?
observations from the small details to big ones are very
much appreciated by the client because they would feel Patient: I think it was the day before I went to the mall.
that the nurse is really interested in listening, Presenting Reality
understanding, and helping them to get better.
Presenting Reality is a technique wherein the nurse
Nurse: I could see that your bruises are starting to must introduce the client into reality. The client could
lighten. Does it still hurt? say things that aren’t real to us but perceived by them,
so the nurse must indicate what is real in a
Patient: No, but yes I think the bruises are healing
already. nonjudgmental way or without belittling their feelings.

Patient: I can’t say it. My husband is right behind you.

Nurse: Do you feel anxious when talking to me? Please
let me know what I could do to make you comfortable. Nurse: I don’t see your husband here. It’s just me, your
Or is there anything you want to tell me? nurse.
Offering self Reflecting
It is not easy for the patient to be alone in hospitals or Patients also seek advice from nurses about what they
centers. They may feel lonely or even depressed. In should do in particular circumstances or in response to
order to avoid this, the nurse could offer their time and specific problems. Nurses should ask patients what they
presence. This way, the patients would feel someone is think they should do, helping them to take
willing to give them time and attention. But once this responsibility for their decisions and assisting them in
technique is performed, the nurse must stay committed coming up with ideas on their own.
to their words. The nurse could say, “In case you want
someone to talk to, know that I’m here” or “Do you Patient: Do you think I should talk my parents?
want me to stay for lunch?”
Nurse: Do you think you should?
Nurse: In case you want someone to talk to, know that
Patient: But I think they might get angry at me? Do you
I’m here.
think they’ll be?
Patient: Okay, thank you.
Nurse: Is that what causes you to feel nervous at the
Placing event in time or sequence moment?

Asking questions about when certain events occurred in Restating

relation to other events can help patients and even
This type of therapeutic communication technique is
nurses get a clearer sense of the whole picture. It
restating what the patient had said to let them know
encourages patients to think about the sequence of
that their ideas were communicated effectively. It could
be repeated with the exact same words with a question
mark at the end or repeated in different words but with
the same idea. This technique is also when the client is
being misunderstood, she would be encouraged to
explain her thoughts furthermore.

Patient: I feel happy now that I got to talk to my

parents.

Nurse: Oh, you feel happy?

Patient: Yes, it’s because they told me that they

understand me and they will be here for me through my
whole journey.

Nurse: They are very supportive and they must really

love you.

Seeking information

It is essential to seek patients for clarification when they

said something confusing or not that clear but is
considered as important to them. Asking questions like
"I'm not sure I understand." “Could you please explain it
to me” helps  nurses in ensuring that they understand
what is being said and can support patients in fully
processing their thoughts.

Silence

At times, it’s useful to not speak at all. Silence can give

both nurses and patients an opportunity to think
through and process what comes next in the
conversation. It can provide patients with the time and
space they need to bring up a new topic. Nurses should
also allow the patients to initiate the conversation in
order to break the silence.

Suggesting collaboration

The aim of this type of therapeutic communication

technique is offering help to the client in terms of
building a relationship wherein the client would know
how to identify their own problems and find solutions in
improving their health. The nurse may ask, “Would you
want to discuss and discover with me the triggering
factors on hearing those voices?”