Therapeutic Communication Techniques

Techniques
Using Silence

Description
Accepting pauses or
silence that may extend
for several seconds or
minute without
interjecting any verbal
response.

Examples
Sitting quietly (or
walking the client) and
waiting to put thoughts
and feelings into words.

Providing general leads

Using statement or
questions that (a)
encourage the client to
verbalize (b) choose a
topic of conservation;
and (c) facilitate
continued verbalization.

Perhaps you would

like to talk about
Would it help to
discuss your feelings?
Where would you like
to begin?
And then what?
I follow what you are
saying.

Being specific and

tentative

Making that are specific

rather than general, and
tentative rather than
absolute.

You scratched my
arm.
(specific statement)
You are as clumsy an
as ox (general
statement)You seem
unconcerned about
Mary.(tentative
statement)You dont
give a damn about Mary
and you never
will.(absolute
statement)

Using open-ended
question

Asking broad question

that lead or invite the
client to explore
(elaborate, clarify,
describe compare, or
illustrate) thoughts or

Id like to hear more

about that.
Tell me about
How have you been
feeling lately?
What brought you to

feelings. Open-minded
questions specify only
the topic to be
discussed and invite
answers that are longer
than one or two words.
Using touch

Restating or
paraphrasing

Seeking clarification

Providing appropriate
forms if touch to
reinforce caring
feelings. Because tactile
contracts vary
considerably among
individuals, families,
and cultures, the nurse
must be sensitive to the
differences in attitudes
and practices of clients
and self.
Actively listening for
the clients basic
message and then
repeating those
thoughts and or feeling
in similar word. This
conveys that the nurse
has listened and
understood the clients
basic message and also
offers clients a clearer
idea of what they have
said.

the hospital?
What is your opinion?
You said you were
frightened yesterday.
How do you feel now?
Putting an arm over the
clients shoulder. Placing
the hand over the
clients hand.

Client: I couldnt
mange to eat any dinner
last night not even the
desert.
Nurse: You had
difficultly eating
yesterday.
Client: Yes, I was very
upset after family left.
Client: I have trouble
talking the stranger.
Nurse: You find it
difficult talking to
people you do not
know?

Im puzzled.
A method of making the Im not sure I
clients broad overall
understand that.
meaning of the message Would you please say
more
that again?

understandable. It is
Would you tell me
used when the
more?
communication is
rambling or garbled. To
the clarify the message,
the nurse can restate the
basic message or
confess confusion and
ask the client to repeat
or restate the message.
I meant this rather than
Nurse can also clarify
that.
their own message with I guess I didnt make
statement.
that clear Ill go over
it again.
Perception checking or
seeking consensual
validation

Offering self

A method similar to
clarifying that verifies
the meaning of specific
words rather than the
over all meaning of
message.

Suggesting ones
presence, interest, or
wish to understand the
client without making
any demands

Client: My husband
never gives me any
presents.
Nurse: you mean he
has never given you a
present for your
birthday or Christmas.
Client: Well not ever.
He does get me
something for my
birthday and Christmas,
but he never thinks of
giving me anything at
any other time.
Ill stay with you until
your daughter arrives.
We can sit here quietly
for a while; we dont
need to talk unless you
would like to.
Ill help you to dress to
go home.

Giving information

Acknowledging

Clarifying time or
sequence

Presenting reality

Your surgery is
Providing, in a simple
scheduled for 11 AM
and direct manner,
tomorrow.
specific factual;
You will feel a pulling
information the client
sensation when the tube
may or may not request. is removed from your
When information is
abdomen.
not known, the nurse
I dont know the
states this and indicates answer to that, but I will
who has it or when the find out from Mrs.
nurse will obtain it.
King, the nurse in
charge.
Giving recognition, in a
nonjudgmental way, of
a change in behavior, an
effort the client has
made, or contribution to
a communication.
Acknowledgement may
be with or without
understanding, verbal or
nonverbal.
Helping the client
clarify an event,
situation, or happening
in relationship to time.

Helping the client to

differentiate the real
from the unreal.

You trimmed your

beard and mustache and
washed your hair.
I noticed you keep
squinting your eyes. Are
you having difficulty
seeing?
You walked twice as
far today with your
walker.
Client: I vomited this
morning.
Nurse: was that after
breakfast?
Client: I feel that I
have been asleep for
weeks.
Nurse: You had your
operation Monday, and
today is Tuesday.
That telephone ring
came from the program
on television.
Thats not a dead
mouse in the corner; it

is a discarded
washcloth.
Your magazine is here
in the drawer. It has not
been stolen.
Focusing

Reflecting

Summarizing and
Planning

Client: My wife say

Helping the client
she will look after me,
expand on and develop but I dont think she
a topic of importance
can, what with the
for the nurse to wait
children to take care of,
until the clients think
and theyre always after
they have talked about
her about something
the main concerns
clothes, homework,
before attempting to
whats for dinner that
focus. The focus may
night.
be an idea or feeling,
Nurse: You are
however the nurse often worried about how well
emphasizes a feeling to she can manage.
help the client
recognize an emotion
disguised behind words.
Client: What can I
Directing ideas,
do?
feelings, question, or
Nurse: What do you
content back to clients
think be helpful?
to enable them to
Client: Do you think I
explore their own ideas should tell my
and feelings about a
husband?
situation.
Nurse: You seem
unsure about telling
your husband?
Stating the main points
of a discussion to
clarify the relevant
points discussed. This
technique is useful at
the end of an interview

During the past half

hour we have talked
about
Tomorrow afternoon
we may explore this
further.
In a few days Ill

or to review a healthteaching session. It

often acts as an
introduction to future
care planning.

review what you have

learned about the
actions and effects of
your insulin.

BARRIERS OF THERAPEUTIC COMMUNICATION

Technique
Stereotyping

Description
Offering generalized
and oversimplified
beliefs about groups of
people that are based on
experience categories
clients and negate their
uniqueness as
individuals.

Examples
Two-years olds are
brats
Women are
complainers
Men dont cry
Most people dont
have any pain after this
surgery.

Agreeing and
disagreeing

Akin to judgmental
responses, agreeing and
disagreeing imply that
the client is either right
or wrong and that the
nurse is in a position to
judge this. These
responses deter clients
from thinking through
their position and may
cause client to become
defensive.

Client: I dont think

Dr. Broad is a very
good doctor. He doesnt
seem interested in his
patients.
Nurse: Dr. Broad is
head of the Department
of Surgery and is an
excellent surgeon.

Being defensive

Attempting to protect a
person or health care
services from negative
comments. These
responses prevent the
client from expressing
true concerns. The
nurse is saying, You
have no right to
complain. Defensive
response protects the
nurse from admitting
weaknesses in the
health care services,

Client: Those night

nurses must just sit
around and talk all
night. They didnt
answer my light for
over an hour.
Nurse: Ill have you
know we literally run
around on nights.
Youre not the only
client, you know.

including personal
weaknesses.
Challenging

Giving a response that

makes client prove the
statement or point of
view. These responses
indicate that the nurse is
failing to consider the
clients feelings, making
the client feel it
necessary to defend a
position.

Client: I felt nauseated

after that red pill.
Nurse: Surely you
dont think I gave the
wrong pill?
Client: I believe my
husband doesnt love
me.
Nurse: You cant say
that; why, he visits you
every day.

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 clients
privacy. Often asking
why is probing and
places the client in a
defensive position.

Client: I was speeding

along the street and
didnt see the stop
sign.
Nurse: Why were you
speeding?
Client: I didnt ask the
doctor when he was
here.
Nurse: Why didnt
you?

Testing

Asking question that

make the client admit to
something. These
responses permit the
client only limited
answers and often meet
the nurses need rather
than the clients.

Who do you think you

are? (enforce people to
admit their status is
only that of client)
Do you think I am not
busy? (forces the client
to admit that the nurse
really is busy)

Rejecting

Refusing to discuss
certain topics with the
client. These responses
often make clients feel

I dont want to
discuss that.
Lets discuss other
areas of interest to your

that the nurse is

rejecting not only their
communication but also
the clients themselves.

rather than the two

problems you keep
mentioning.
I cant talk now. Im
on may way for coffee
break.

Changing topics and

subject

Directing the
communication into
areas of self-interest
rather than considering
the clients concerns
often arises as a selfprotecting response
imply that what the
nurse considers
important will be
discussed and that
clients are not capable
of helping themselves.

Client: Im separated
from my wife. Do you
think I should have
sexual relation with
another woman?
Nurse: I see that
youre 36 and that you
like gardening. This
sunshine is good for my
roses. I have a beautiful
rose garden.

Unwarranted
reassurance

Using clichs or
comforting statements
of advices a means to
reassure the client.
These responses block
the fears, feelings, and
other thoughts of the
client.

Youll feel better

soon.
Im sure everything
will turn out all right.
Dont worry.

Giving opinions and

approving of
disapproving responses,
moralizing, or implying
ones own values. These
responses imply that the
client must think as the
nurse thinks, fostering
the client dependence.

Thats good (bad).

You shouldnt do that.
Thats not good
enough.
What you did was
wrong (right).

Passing judgment

Telling the client what

Giving common advice do it. These responses
deny the clients right to
be an equal partner.
Note than giving expert
rather than common
advice is therapeutic.

Client: Should I move

from my home to a
nursing home?
Nurses: If I were you,
Id go to a nursing
home, where youll get
your meals cooked for
you.