THERAPEUTIC COMMUNICATION

COMMUNICATION - exchange of information, ideas, or feelings between or among

people

THERAPEUTIC COMMUNICATION -- interpersonal interaction between the nurse and the

client
to promote effective exchange of information in which the nurse focuses on the client’s specific
needs

PURPOSES OF THERAPEUTIC COMMUNICATION

B – uilding trust
E – xplore clients
feelings
D – eveloping therapeutic relp.

PURPOSES OF THERAPEUTIC COMMUNICATION

Providing support and comfort
Encouraging and facilitating growth and change
Guide client in problem-solving

Categories of Non - Verbal

1.KINESICS - includes body movements or language, facial expressions, eye
contact, gestures, postures
2. PARALANGUAGE - tone of voice
3. PROXEMICS - territorial space or distance

 Territorial Distance
INTIMATE ZONE (0 – 18 INCHES)
Comfortable space for intimate contacts

PERSONAL ZONE 18 – 36 inches)

Comfortable space between family and friends who are talking

SOCIAL ZONE (4 – 12 feet)

Comfortable space for social and business settings

PUBLIC ZONE ( 12 feet and above)

Acceptable distance between speaker and an audience, small groups and other informal
groups

THERAPEUTIC COMMUNICATION TECHNIQUES

BEST RESPONSES are those that:( F U RISE & CARE)

F – Focusing to concentrate on a single point
Ex: N – “This topic seems worth looking at more closely”
U – Use open ended questions
Ex: P – “What are you feeling right now”
R – Restate or Feedback on what the client has said
Ex: Ex: P – “Do you think I should tell my husband what happened?”
N – Do you think you should tell your husband?”
I – Inform and present reality
Ex: P - “Eggs are flying saucer”
N – “Eggs are food to be eaten

S – Silence but expresses being there

- nurse says nothing but continues to maintain eye contact and convey interest
E – Encourage expression of feelings
P – “I want to kill myself”
N – “Tell me of you’re feeling of wanting to kill yourself”

C – Clarify and validate client’s statement

Ex: P - “I’m crazy”
 N- “What do you mean you are
crazy”
P – “I can’t sleep. I stay awake
all night”
N – “You have difficulty
sleeping
A – Acknowledge client’s non-verbal communication
R – Reflects on the feelings expressed
P – “No one wants me.”
N - “You mean you feel rejected?”
E – Encourage hope but not false reassurance

OTHERS (USE GOMA)

U - Using broad opening
Allowing the client to take initiative in introducing the topic
Ex: Where would you like to begin
S – Summarizing
Reviewing main points and conclusions
Ex: Let’s see, so far you have said ……
E – Exploring
Delving further into a subject or idea
Ex:
Tell me more about that …
Would you describe it more fully
G - Giving information
Making available facts that client need
Ex: My name is ……
My purpose in being here is …..

Giving recognition
- Acknowledging behavioral changes or indicating awareness
- Ex: You’ve comb your hair today
O - Offering self
Making oneself available
Ex: I’ll sit with you for awhile

O - Offering general lead

- Giving encouragement to continue
- Ex: Go on
And then?
Tell me about it
M - Making observation
- Verbalizing what the nurse perceives
- Ex: You appear tense
I’ve notice that you’re biting your lips
A – Accepting
Conveying that nurse hears or is interested in what the client is saying
“yes” or simply nodding head

NON-THERAPEUTIC COMMUNICATION TECHNIQUES

Agreeing/Disagreeing
Ex: “That’s right…” / “I don’t believe that”
Approving/Disapproving
Ex: “I like the way you comb your hair”
“ It’s not nice to look the way you comb your hair
Advising
Ex: “I think you should…?
Asking why questions– asking client to provide reasons for thoughts, feelings, behaviors
and events and patient may become defensive
Ex: “Why do you think that you are crazy?”
“Why do you feel that way?”
Belittling feeling expressed – misjudging the degree of the client’s discomfort
 Ex: P - “I have nothing to live for… I wish I was dead”
N – “I’ve felt that way before”
Challenging – demanding proof for the client
Ex: N- “But how can you be president of the United States?”
Changing topic
Ex: P – “I really want to die”
N – “Your mother did not visit you this week?”
Defending – attempting to protect someone or something
Ex: P – “ My doctor is mean and uncaring
N – “I’m sure your doctor has your best interest in mind”
False reassurance – indicating there is no reason to worry or other feelings of discomfort
Ex: N – “Everything will be alright”
Testing – appraising the client’s degree of insight
Ex: “Do you know what kind of hospital this is?”
Using denial – refusing to admit that a problem exists
Ex: P – “I’m nothing”
N – “Of course you’re something – everybody’s something”
 • Empathy (not sympathy)
• Acceptance of person, not necessarily his
or her behavior
• Positive regard (unconditional, nonjudgmental attitude)
• Self-Awareness and Therapeutic Use of Self
Self-awareness is a process of understanding one’s own values, beliefs, thoughts,
feelings, attitudes, motivations, strengths, and limitations and how one’s thoughts and
behaviors affect others.
Therapeutic use of self is when the nurse uses aspects of his or her personality,
experience, values, feelings, intelligence, needs, coping skills, and perceptions to
establish relationships with clients that are beneficial to clients.

Patterns of Knowing
There are several patterns of knowing (ways of observing and understanding client
interactions):
• Empirical (from nursing science)
• Personal (from life experiences)
• Ethical (from moral nursing knowledge)
• Aesthetic (from art of nursing)
• Unknowing is when the nurse admits he or she does not know the client or
understand the client’s subjective world
• Establishing the Therapeutic Relationship
Therapeutic relationships are focused on the needs, experiences,
feelings, and ideas of the client, not the nurse.
The therapeutic relationship consists
of three phases.
• Establishing the Therapeutic Relationship
(cont’d)
In the orientation phase, the nurse and client meet, roles are established, the purposes
and parameters of future meetings are discussed, expectations are clarified, and the
client’s problems are identified.
• Establishing the Therapeutic Relationship
(cont’d)
The working phase involves problem identification, where the client identifies
issues or concerns causing problems, and exploitation, when the nurse guides the client
to examine his or her feelings and responses, develop better coping skills and a more
positive self-image, change behavior, and develop independence.
• Establishing the Therapeutic Relationship
(cont’d)
In the working phase the nurse must be acutely aware that two common elements can
arise:
• Transference is when clients unconsciously transfer feelings they have for
significant persons in their life onto the nurse
• Countertransference is when the nurse responds to the client based on his or her
own unconscious needs and conflicts

• Establishing the Therapeutic Relationship

(cont’d)
The termination or resolution phase begins when the client’s problems are resolved
and ends when the relationship is ended. It is important to deal with feelings of anger or
abandonment that may occur.
• Behaviors That Diminish Therapeutic Relationships
• Inappropriate boundaries (relationship becomes social or intimate)
• Feelings of sympathy and encouraging client dependency rather than promoting
independence
• Nonacceptance of client as a person because of his or her behaviors, leading to
avoidance of the client
Self-awareness on the nurse’s part is crucial to developing therapeutic relationships.
Values clarification, journaling, group discussions, and reading will assist with this
process.
Developing self-awareness is a continual, ongoing process; the nurse needs to plan for
self-growth.