CORE CONCEPTS ON THERAPEUTIC COMMUNICATION • Communication is an ___________

• Communication is an ___________
I - COMMUNICATION • Communication is a ____________
It is the interchange of _____________ between two or more people
It is the ____________ of ideas or thoughts. COMMUNICATION IS AN ACT
• It is something that a person is _________ to another person (example:
ELEMENTS OF COMMUNICATION person A talks to person B)
- ____________ • There is an attempt to __________ the thoughts or ideas of one person into
Originator of the information someone else’s head.
- ___________ • It suggests that the receiver plays a _________ role and does not affect the
Information being transmitted communicator
- ___________ • When misunderstandings occur, either the communicator is faulted for failing
Recipient of information to send the correct message or the receiver is faulted for having allowed
- ___________ something to interfere with the transmission of a correct message
Mode of communication
- ___________ COMMUNICATION IS AN INTERACTION
Return response • It takes into account the process of __________ influence.
- ___________ • When two people interact, they put themselves into each other’s shoes.
The setting of the communication • It is a _________ process in which the participants take turns at being
communicator and receiver
VARIABLES THAT INFLUENCE COMMUNICATION
- ____________ COMMUNICATION IS A TRANSACTION
Experience of sensing, interpreting, and comprehending the world in • It is viewed as a process of _____________ mutual influence rather than as
which the person lives a turn-taking event.
- ____________ • No one is labeled either as a communicator or receiver.
Principles, standards of quality considered worthwhile or desirable • The symbolic interactionist model views human communication on the social,
- ___________ interpersonal level and accounts for the whole persons involved in the
The totality of socially transacted behavior patterns, arts, beliefs, process.
institutions, products of human work characteristic of a community or
population MODES OF COMMUNICATION
• __________ Communication
LEVELS OF COMMUNICATION
• __________ Communication
- _____________
Occurs when a person communicates within himself
VERBAL COMMUNICATION: THE ____________ WORD
- _____________
• _____________
Takes place within dyads (groups of two persons) and in small
o The meaning that is in general used by most persons who share a
groups.
common language; the particular, explicit, literal meaning of the
The level of person-to-person communication is the heart of
word.
psychiatric nursing
- _____________
Communication between a person and several other people • _____________
o Usually arises from a person’s personal experience
MODELS OF COMMUNICATION o Suggests or implies something in addition to the literal meaning
 • _____________ II - THERAPEUTIC COMMUNICATION
o For communication to take place, meanings must be shared. • An _______________ interaction between the nurse and client during which
o People labeled schizophrenic may use language in an idiosyncratic the nurse focuses on the client’s specific needs to promote an effective
way or may use a private, unshared language called neologisms. exchange of information
• Skilled use of therapeutic communication techniques helps the nurse
NON-VERBAL MESSAGES understand and empathize with the client’s experience
• They carry more meaning than verbal messages and involves the following:
o Body movement or ______ GOALS OF THERAPEUTIC COMMUNICATION
o __________ (pitch and range) and non-language sounds (sobbing or • Establish a therapeutic nurse-client relationship
laughing) • Identify the most important client concern at the moment (the client-centered
o ____________ – use of personal or social space goal)
▪ Intimate Distance – actual contact to _______ feet • Assess the client’s perception of the problem as it unfolded.
▪ Personal Distance – 1.5 to 4 feet or _______ feet for • This includes detailed actions (behaviors and messages) of the people
interviews involved and the client’s thoughts and feelings about the situation, others,
▪ Social Distance – ________ feet and self
▪ Public Distance – 12 feet and beyond • Facilitate the client’s expression of emotions
o _____________________ – items in contact with interacting persons • Teach the client and family necessary self-care techniques
that may act as non-verbal stimuli (i.e., clothes, cosmetics, jewelry, • Recognize the client’s needs
cars)
• Implement interventions designed to address the client’s needs
• Guide the client toward identifying a plan of action to a satisfying and socially
acceptable resolution.
CHARACTERISTICS OF SUCCESSFUL COMMUNICATION
1) Feedback (return response)
THERAPEUTIC COMMUNICATION TECHNIQUES
If effective, may result in extension, clarification or alteration of the original
communication • Accepting
• Broad Openings
2) Appropriateness • Consensual validation
The reply is fitting and relevant to the communication; it is neither too much • Encouraging Comparison
nor too little • Encouraging Description of Perceptions
• Encouraging Expression
3) Efficiency • Exploring
The language used is understood • Focusing
• Formulating a Plan of Action
4) Flexibility • General Leads
The absence of over-control or under-control • Giving Information
• Giving Recognition
ESSENTIAL INGREDIENTS TO FACILITATE COMMUNICATION • Making Observations
• Respond with ____________ • Offering self
• Respond with ____________ • Placing Event in Time or Sequence
• Respond with ____________ • Presenting Reality
• Respond with ____________ • Reflecting
• Respond with ____________ • Restating
 • Seeking Information • Avoid focus on the nurse (use of the word “I”); or focus on the doctor. Focus
• Silence on the patient instead.
• Suggesting Collaboration • Use direct questions for suicidal cases
• Summarizing • Avoid the ‘Authoritarian Answer’
• Translating into Feelings
• Verbalizing the Implied GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
• Voicing Doubt EXAM: LOOK FOR THERAPEUTIC PHRASES
The following are therapeutic phrases utilized by the nurse:
NON-THERAPEUTIC COMMUNICATION TECHNIQUES • “It seems…”
• These responses cut off communication and make it more difficult for the • “It sounds…”
interaction to continue • “I will sit with you…”
• It takes practice for the nurse to avoid making these typical comments • “I will stay with you…”
• “I will check…”
NON-THERAPEUTIC COMMUNICATION TECHNIQUES • “Tell me…”
• Advising
• Agreeing GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
• Belittling Feelings Expressed EXAM: LOOK FOR NON-THERAPEUTIC PHRASES
• Challenging • The use of ‘_________’ is non-therapeutic
• Defending o “That’s good!”
• Disagreeing o “That’s bad!”
• Disapproving o “You’re the best!”
• Giving Approval o “You’re the worst!”
• Giving Literal Responses
• The use of ‘__________’ is non-therapeutic
• Indicting the Existence of an External Source
o “Always…”
• Interpreting
o “Never…”
• Introducing an Unrelated Topic o “None…”
• Making Stereotyped Comments o “All….”
• Probing
• Reassuring • The use of ‘___________’ is non-therapeutic
• Rejecting o “You need to…”
• Requesting an Explanation o “You must…”
• Testing o “You should…”
• Using Denial
GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD EXAM: USE OF OPEN-ENDED QUESTIONS
EXAM • “Tell me, how do you feel,” then follow it up with “I understand how you feel. I
• Identify therapeutic and non-therapeutic phrases will stay with you for a while.’
• Open-ended or Closed-ended question?
• Avoid ‘why’ questions and instead use ‘what’ questions GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
• Avoid false reassurances EXAM: USE OF CLOSED-ENDED QUESTIONS
Use of Closed-ended questions is therapeutic when dealing with:
• Manic patients
 o This would discourage them from over-control of the conversation o Therapeutic Communication is always client-centered, it is never
• Rape or Crisis Victims nurse-centered.
o With their unstable condition, they may misconstrue use of open-
ended questions as ‘prying’. GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
EXAM: USE OF THE WORD ‘YOU’
GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD Examples
EXAM: USE OF ‘WHY’ QUESTIONS • Client: “I am dead.”
The use of the question ‘why’ is non-therapeutic • Nurse: “Are you suggesting that you feel lifeless?”
• Example:
o Client: “I was speeding along the street and did not stop at the sign” • Client: “I am way out in the ocean.”
o Nurse: “Why were you speeding?” • Nurse: “You seem to feel lonely or deserted.”
• Rationale
o Responses to why questions are considered prying, violate the • Rationale:
client’s privacy and places the client in a defensive position o Therapeutic Communication is always client-centered, it is never
nurse-centered.
GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
EXAM: USE OF ‘WHAT’ QUESTIONS
• The use of the question ‘what’ is therapeutic GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
o “What is happening?” EXAM: USE OF DIRECT QUESTIONS FOR SUICIDAL PATIENTS
o “What does the voice seem to be saying?” Example
o “What transpired after that?” • Nurse: “Do you have any plans of killing yourself?”

GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
EXAM: AVOID FALSE REASSURANCES EXAM:
• Examples: AVOID THE ‘AUTHORITARIAN ANSWER’
o “I would not worry about that.” Authoritarian Answer
o “Everything would be alright.” • Avoid statements like “I think you should. . I should know, I am the nurse”
o “You are coming along just fine.”
• Rationale
• Rationale o Giving authoritarian answers implies that only the nurse knows what
o This response blocks the fears, feelings and other thoughts of the is best for the client
client. Furthermore, vague reassurances without accompanying
facts are meaningless to the client WHAT TO REMEMBER IN THERAPEUTIC COMMUNICATION
• Be empathetic and not just sympathetic!
GUIDELINES FOR IDENTIFYING THERAPEUTIC RESPONSES IN THE BOARD
EXAM: USE OF THE WORD ‘I’
Example:
• Client: “Should I move from my home to a nursing home?”
• Nurse: “If I were you, I’d go to a nursing home, where you’ll get your meals
cooked for you”

• Rationale:
THERAPEUTIC RELATIONSHIPS
KEYNOTE THERAPEUTIC USE OF SELF
• The ability to establish _____________ relationships with clients is one of
KEYNOTES
the most important skills a nurse can develop
• By developing self-awareness and beginning to understand his or her
• Although important in all nursing specialties, the therapeutic relationship is
attitudes, the nurse can begin to use aspects of his or her personality,
especially crucial to the ____________ of interventions with clients requiring
experiences, values, feelings, intelligence, needs, coping skills, and
psychiatric care, because the therapeutic relationship and the
perceptions to _____________ relationships with clients. This is called
communication within it serve as the under-pinning for treatment and
therapeutic _______________.
success.
• Nurses use _____________ as a therapeutic tool to establish the
therapeutic relationship with clients and to help clients grow, change, and
COMPONENTS OF A THERAPEUTIC RELATIONSHIP heal.
• Peplau, who described this therapeutic use of self in the nurse–client
G___________________ relationship, believed that nurses must clearly understand themselves to
R__________________ promote their clients’ growth and to avoid limiting clients’ choices to
E_________________ those that nurse's value.
A________________ • They need to ___________ such accepted ways of responding or
T_______________ behaving and evaluate how they help or hinder the therapeutic
relationship.
SELF - AWARENESS
• It is the process of developing an ______________ of one’s ______ TYPE OF RELATIONSHIPS
values, beliefs, thoughts, feelings, attitudes, motivations, prejudices,
strengths, and limitations and how these qualities affect _________. _____________ RELATIONSHIP
• Self-awareness allows the nurse to __________, pay _________ to, and • A social relationship is primarily initiated for the purpose of friendship,
____________ the subtle responses and reactions of clients when socialization, companionship, or accomplishment of a task.
interacting with them. • Communication, which may be superficial, usually focuses on sharing
ideas, feelings, and experiences and meets the basic need for people to
KEYNOTES interact.
• The nurse should re-evaluate and readjust _________ and • Advice is often given.
___________ periodically as he or she gains experience and wisdom. ______________RELATIONSHIP
• _____________ self-awareness allows the nurse to accept values, • A healthy intimate relationship involves two people who are emotionally
attitudes, and beliefs of others that may differ from his or her own. committed to each other.
• A person who does not assess personal attitudes and beliefs may hold a • The relationship may include sexual or emotional intimacy as well as
____________ (hostile attitude) toward a group of people because of sharing of mutual goals.
preconceived ideas or stereotypical images of that group. • Evaluation of the interaction may be ongoing or not. The intimate
• But by letting new experiences and other people become part of our view relationship has no place in the nurse– client interaction.
of the world, we can ___________ our beliefs and attitudes and
expanded our understanding of people and the world. ______________ RELATIONSHIP
• The therapeutic relationship differs from the social or intimate
relationship in many ways because it focuses on the needs, experiences,
feelings, and ideas of the client only.
 • The nurse and client agree about the areas to work on and evaluate the • Major task is to develop a __________ ______________ contract
outcomes.
• In the therapeutic relationship, the parameters are clear: the focus is the Working / Therapeutic Phase:
client’s needs, not the nurses.
• The nurse must guard against allowing the therapeutic relationship to slip • It is highly _______________
into a more social relationship. • More ______________ than the orientation phase
• The nurse must constantly focus on the client’s needs, not his or her • The ____________ and most _____________ phase
own. • _______________ nmust be employed
• The nurse’s level of self-awareness can either benefit or hamper the • Tasks: planning and implementation
therapeutic relationship. • Major Tasks: ________________ and _______________ of the patient's
problems

NURSE – PATIENT RELATIONSHIP Problems Encounter:

• ________ of ___________ between the nurse and the patient in which • _________________
the nurse assists the patient to attain positive behavioral change o the development of an emotional attitude towards the nurse
• _____________________
o experienced by the nurse / therapist
CHARACTERISTICS OF THE NURSE-PATIENT RELATIONSHIP • Resistance
• G______________
• Focused on the needs of the patient
• P___________ Termination Phase
• T___________
• Professional • It is a ______________ weaning process
• It is a _________ agreement
• It involves feelings of _________, _______ and ________
Pre-Interaction Phase • It should be recognized in the _____________ phase
• Tasks include evaluation
• It begins when the nurse is assigned/chooses a patient • Major task is to assist patient to ___________ what has been learned
• Patient is __________ as an active participant and to ___________ his learning to his relationship with others
• _____________ feels certain degree of _________
• It includes all of what the nurse thinks and does before interacting with
the patient How to terminate?
• Tasks: data ___________, planning for first __________ • Gradually ____________ interaction time
• Major Task: develop _________________ • Focus on ___________ oriented topics but avoiding opening ____
problem
Orientation phase • Encourage ___________ of feelings
• Make the necessary ________
• Begins when the nurse and the patient interacts for the first time
• _____________ of the relationship are to be laid
• Nurse begins to know about the patient
• Tasks include establishing ___________, developing ________,
assessment (and formulation of a nursing diagnosis).