NON-THERAPEUTIC COMMUNICATION TECHNIQUES

1. Advising: telling the client what to do

Rationale
Giving advice implies that only the nurse knows what is best for the client.

Example
 “I think you should do this”
 “Why don’t you do that.”

2. Agreeing: indicating accord with the client

Rationale
Approval indicates the client is “right” rather than “wrong.” This gives the client the
impression that he or she is “right” because of agreement with the nurse. Opinions and
conclusions should be exclusively the client’s. When the nurse agrees with the client, there
is no opportunity for the client to change his or her mind without being “wrong.”

Example
 “That’s right.”
 “I agree.”

3. Belittling feelings expressed: Misjudging the degree of the client’s discomfort

Rationale
When the nurse tries to equate the intense and overwhelming feelings the client has
expressed to “everybody” or to the nurse’s own feelings, the nurse implies that the
discomfort is temporary, mild, self-limiting, or not very important. The client is focused
on his or her own worries and feelings; hearing the problems or feelings of others is not
helpful.

Example

 Client: “I have nothing to live for . . . I wish I was dead.”

Nurse: “Everybody is going to die”

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4. Challenging: demanding proof from the client

Rationale
Often the nurse believes that if he or she can challenge the client to prove unrealistic
ideas, the client will realize there is no “proof” and then will recognize reality. Actually
challenging causes the client to defend the delusions or misperceptions more strongly
than before.

Example
 “But how can you be the king, everyone knows who the king is?”
 “If you’re dead, why do you still breathing?”

5. Defending: attempting to protect someone or something from verbal attack

Rationale
Defending what the client has criticized implies that he or she has no right to express
impressions, opinions, or feelings. Telling the client that his or her criticism is unjust or
unfounded does not change the client’s feelings but only serves to block further
communication.

Example
 “This hospital has a fine reputation.”
 “I’m sure your doctor has your best interests in mind.”

6. Disagreeing: opposing the client’s ideas

Rationale
Disagreeing implies the client is “wrong.” Consequently the client feels defensive about
his or her point of view or ideas.

Example
 “That’s wrong.”
 “I definitely disagree with . . .”
 “I don’t believe that.”

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7. Disapproving—denouncing the client’s behavior or ideas

Rationale
Disapproval implies that the nurse has the right to pass judgment on the client’s
thoughts or actions. It further implies that the client is expected to please the nurse.
“That’s bad.”

Example
 “I would prefer if you do not do that”

8. Giving approval: sanctioning the client’s behavior or ideas

Rationale
Saying what the client thinks or feels if “good” implies that the opposite is “bad.”
Approval, then, tends to limit the client’s freedom to think, speak, or act in a certain way.
This can lead to the client’s acting in a particular way just to please the nurse.

Example
 “That’s good.” “I’m glad you finally taking your meds”

9. Giving literal responses: responding to a figurative comment as though it were a

statement of fact

Rationale
Often the client is at a loss to describe his or her feelings, so such comments are the best
he or she can do. Usually it is helpful for the nurse to focus on the client’s feelings in
response to such statements.

Example
 Client: “They’re looking in my head with a television camera.”
Nurse: “Try not to watch television.” OR “What channel?”

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10.Indicating the existence of an external source: attributing the source of thoughts,
feelings, and behavior to others or to outside influences

Rationale
The nurse can ask, “What happened?” or “What events led you to draw such a
conclusion?” But to question “What made you think that?” implies that the client was
made or compelled to think in a certain way. Usually the nurse does not intend to
suggest that the source is external but that is often what the client thinks

Example
 “What made you do that?”
 “Who told you that you were a prophet?”

11.Interpreting: asking to make conscious that which is unconscious; telling the client
the meaning of his or her experience

Rationale
The client’s thoughts and feelings are his or her own, not to be interpreted by the nurse or
for hidden meaning. Only the client can identify or confirm the presence of feelings.

Example
 “What you really mean is . . .”
 “Unconsciously you’re saying . . .”

12. Introducing an unrelated topic: changing the subject

Rationale
The nurse takes the initiative for the interaction away from the client. This usually
happens because the nurse is uncomfortable, doesn’t know how to respond, or has a
topic he or she would rather discuss.

Example
 Client: “I’d like to die.”
Nurse: “Did you have visitors last evening?”

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13.Making stereotyped comments: offering meaningless clicheé s or trite comments

Rationale
Social conversation contains many clicheé s and much meaningless chit-chat. Such
comments are of no value in the nurse–client relationship. Any automatic responses will
lack the nurse’s consideration or thoughtfulness.

Example
 “It’s for your own good.”
 “Keep your chin up.”
 “Just have a positive attitude and you’ll be better in no time.”

14.Probing: persistent questioning of the client

Rationale
Probing tends to make the client feel used or invaded. Clients have the right not to talk
about issues or concerns if they choose. Pushing and probing by the nurse will not
encourage the client to talk.

Example
 “Now tell me about this problem. You know I have to find out.”
 “Tell me your psychiatric history.”

15.Reassuring: indicating there is no reason for anxiety or other feelings of discomfort

Rationale
Attempts to dispel the client’s anxiety by implying that there is not sufficient reason for
concern completely devalue the client’s feelings. Vague reassurances without
accompanying facts are meaningless to the client.

Example
 “Everything will be all right.”
 “You’re coming along just fine.”

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16.Rejecting: refusing to consider or showing contempt for the client’s ideas or
behaviors

Rationale
When the nurse rejects any topic, he or she closes it off from exploration. In turn, the
client may feel personally rejected along with his or her ideas.

Example
 “Let’s not discuss this subject . . .”
 “I don’t want to hear about that anymore”

17.Requesting an explanation: asking the client to provide reasons for thoughts,

feelings, behaviors, events

Rationale
There is a difference between asking the client to describe what is occurring or has
taken place and asking him to explain why. Usually a “why” question is intimidating. In
addition, the client is unlikely to know “why” and may become defensive trying to
explain him or herself.

Example
 “Why do you think that?”
 “Why do you feel that way?”

18.Testing: appraising the client’s degree of insight

Rationale
These types of questions force the client to try to recognize his or her problems. The
client’s acknowledgement that he or she doesn’t know these things may meet the
nurse’s needs but is not helpful for the client.

Example
 “Do you know what kind of hospital this is?”
 “Do you still have the idea that you are a king . . . ?”

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19.Using denial: refusing to admit that a problem exists

Rationale
The nurse denies the client’s feelings or the seriousness of the situation by dismissing
his or her comments without attempting to discover the feelings or meaning behind
them.

Example
 Client: “I’m nothing.”
Nurse: “Of course you’re something—everybody’s something.”
 Client: “I’m dead.”
Nurse: “Don’t be silly.”

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