THERAPEUTIC COMMUNICATION TECHNIQUES

Technique Description Examples

Using silence Accepting pauses or silences that may extend for Sitting quietly or walking with the
several seconds or minutes without interjecting any client.
verbal response.
Providing general Using statements or questions that encourage the “Can you tell me how it is for you?”
leads client, choose a topic of conversation, and facilitate “Where would you like to begin?”
continued verbalization.
Being Specific and Making statements that are specific rather than the “Rate you pain on a scale of 0-10.”
tentative general, and tentative rather than absolute. “You seem concerned about your
diabetes.”
Using open-ended Asking broad questions that lead or invite the client to “I’d like to hear more about that.”
questions explore (elaborate, clarify, describe, compare or “How have you been feeling lately?”
illustrate) thoughts or feelings. Open-ended questions
specify only the topic to be discussed and invite
answers that are no longer than one or two words.
Using touch Providing appropriate forms of touch to reinforce Putting an arm over the client’s
caring feelings. shoulder.
Restating or Active listening for the client’s basic message and Client: “I couldn’t manage to eat last
paraphrasing then repeating those thoughts and feelings in similar night.”
words. Nurse: “You had difficulty eating
yesterday.”
Seeking clarification A method of making the client’s broad overall “Would you tell me more?”
meaning of the message more understandable. It is “I’m not sure I understand that.”
used when paraphrasing is difficult or when
communication is rambling or garbled.
Perception checking or A method similar to clarifying that verifies the Client: “My husband never gives me
seeking consensual meaning of specific words rather than the overall any presents.”
validation meaning of the message. Nurse: “You mean he has never given
you a present for your birthday or
Christmas?”
Offering self Suggesting one’s presence, interest, or wish to “I’ll stay with you until your daughter
understand the client without making any demands or arrives.”
attaching conditions that the client must comply with
to receive the nurse’s attention.
Giving information Providing, in a simple and direct manner, specific “Your surgery is scheduled 11 am
factual information the client may or may not request. tomorrow.”
Acknowledging Giving recognition, in a non judgmental way, of a “I noticed that you got a new hair
change in behavior, en effort the client has made, or a cut.”
contribution to a communication.
Clarifying time and Helping the client clarify an event, situation, or Client: “I vomited this morning.”
sequence happening in relationship to time. Nurse: “Was that before breakfast?”
Presenting reality Helping the client to differentiate the real from the “Your magazine is here in the drawer.
unreal. It has not been stolen.”
Focusing Helping the client expand on and develop a topic of Client: “My wife says she will look
importance. after me, but I don’t think she can.”
Nurse: “Sounds like you are worried
about how she can manage.”
Reflecting Directing ideas, feelings, questions, or content back to Client: “What can I do?”
clients to enable them to explore their own ideas and Nurse: “What do you think will be
feelings about a situation. helpful?”
Summarizing and Stating the main points of a discussion to clarify the “During the past half hour we have
planning relevant points discussed. talked about...”

BARRIERS TO COMMUNICATION
Technique Description Examples
Stereotyping Offering generalized and oversimplified beliefs about “Men don’t cry.”
groups of people that are based on experiences too
limited to be valid. These responses categorize clients
and negate their uniqueness as individuals.
Agreeing and This implies that the client is either wrong or right and Client: “I don’t think he is a good
disagreeing that the nurse is in a position to judge this. These doctor. He doesn’t seem interested in
responses deter clients from thinking through their his patients.”
position and may cause a client to become defensive. Nurse: “He is the head of the
Department of Medicine and is an
excellent physician.”
Being defensive Attempting to protect a person from negative Client: “Last night, the nurses were
comments. These responses prevent the client from only sleeping because nobody came
expressing true concerns. when I buzzer.”
Nurse: “We worked all night and
you’re not my only client.”
Challenging Giving a response that makes clients prove their
statement of point of view.
Probing Asking for information chiefly out of curiosity rather
than with the intent to assist the client. These
responses are considered prying and violate the
client’s privacy.
Testing Asking questions that that make the client admit
something. These responses permit the client only
limited answers and often meet the nurse’s need rather
than the client’s.
Rejecting Refusing to discuss certain topics with the client.
These responses often make clients feel that the nurse
is rejecting not only their communication but also the
clients themselves.
Changing topics and Directing the communication into areas of self-interest
subjects rather than considering the client’s concerns.
Unwarranted Using clichés or comforting statements of advice as a
reassurance means to reassure the client. These responses block
the fears, feelings, and other thoughts of the client.
Passing judgment Giving opinions and approving or disapproving
responses, moralizing, or implying one’s own values.
These responses imply that the client must think as the
nurse thinks, fostering client dependence.
Giving common Telling the client what to do. These responses deny
advice the client’s right to be an equal partner.
TASKS & SKILLS FOR EACH PHASE OF THE WORKING PHASE
Phase Tasks
Preinteraction phase The nurse reviews pertinent assessment data, Organized data gathering; recognizing
knowledge, considers potential areas of concern, and limitations and seeking assistance as
develops plans for interaction. required.
Introductory phase
1. Opening the Both client and nurse identify each other by name. it
relationship is important to explain the nurse’s roles to give the
client an idea of what to expect.
2. Clarifying the The nurse helps the client clarify the problem.
problem
3. Structuring and Nurse and client develop a degree of trust and
formulating the verbally agree about location, frequency, and length
contract of meetings; overall purpose of the relationship;
confidentiality; tasks to be accomplished, and
duration and indications for termination of the
relationship.
Working phase Nurse and client accomplish that tasks outlined in the
introductory phase, enhance trust and rapport, and
develop caring.
1. Exploring and The nurse assists the client to explore thoughts and
understanding feelings and acquires an understanding of the client.
thoughts and
feelings
2. Facilitating The nurse plans programs within the client’s
and taking capabilities and considers long and short-term goals.
action
Termination phase Nurse and client accept feelings of loss. The client
accepts the end of the relationship without feelings of
anxiety or dependence.
Client: “I feel that I’m dying.”
Nurse: “How can you say that when
your pulse is 60?”
Client: “I didn’t ask the doctor when
he will be coming back.”
Nurse: “Why didn’t you?”
“Who do you think you are?”
“I don’t want to discuss that. Let’s
talk about…”
Client: “I’m separated from my wife.
Do you think I should have sexual
relations with another woman?”
Nurse: “I see that you like gardening
and you have a beautiful garden.”
“You’ll feel better soon.”
“You shouldn’t do that.”
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.”
Skills
A relaxed, attending attitude to put the
client at ease.
Attentive listening, paraphrasing,
clarifying, and other effective
communication techniques. Focus on
priorities.
Communication skills and the ability to
overcome resistive behaviors.
Listening and attending skills,
empathy, respect, genuineness,
concreteness, self-disclosure, and
confrontation.
Decision-making and goal-setting
skills.
For the nurse: summarizing skills.
For the client: ability to handle
problems independently.