Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional
wellbeing of a patient. This kind of communication has three general purposes: collecting information to determine illness, assessing and modifying behavior, and providing health education. By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness. To accomplish this learning, both the sender and the receiver must be consciously aware of the con- fidentiality of the information disclosed and received during the communication process. You must always have a therapeutic reason for invading a patient s privacy. When used to collect information, therapeutic communication requires a great deal of sensitivity as well as expertise in using interviewing skills. To ensure the identification and clarification of the patient s thoughts and feelings, you, as the interviewer, must observe his behavior. Listen to the patient and watch how he listens to you. Observe how he gives and receives both verbal and nonverbal responses. Finally, interpret and record the data you have observed. As mentioned earlier, listening is one of the most difficult skills to master. It requires you to maintain an open mind, eliminate both internal and external noise and distractions, and channel attention to all verbal and nonverbal messages. Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance. This cry for help sounds very different from the call for assistance you might make when requesting help in transcribing a physician s order. The ability to recognize and interpret nonverbal responses depends upon consistent development of observation skills. As you continue to mature in your role and responsibilities as a member of the healthcare team, both your clinical knowledge and understanding of human behavior will also grow. Your growth in both knowledge and understanding will contribute to your ability to recognize and interpret many kinds of nonverbal communication. Your sensitivity in listening with your eyes will become as refined as if not better than listening with your ears. The effectiveness of an interview is influenced by both the amount of information and the degree of motivation possessed by the patient (interviewee). Factors that enhance the quality of an interview consist of the participant s knowledge of the subject under consideration; his patience, temperament, and listening skills; and your attention to both verbal and nonverbal cues. Courtesy, understanding, and nonjudgmental attitudes must be mutual goals of both the interviewee and the interviewer. Finally, to function effectively in the therapeutic communication process, you must be an informed and skilled practitioner. Your development of the required knowledge and skills is dependent upon your commitment to seeking out and participating in continuing education learning
experiences across the entire spectrum of healthcare services. Therapeutic Technique 1. Offering Self y y making self-available and showing interest and concern. I will walk with you
2. Active listening y paying close attention to what the patient is saying by observing both verbal and nonverbal cues. Maintaining eye contact and making verbal remarks to clarify and encourage further communication.
3. Exploring y Tell me more about your son
4. Giving broad openings y What do you want to talk about today?
5. Silence y Planned absence of verbal remarks to allow patient and nurse to think over what is being discussed and to say more.
6. Stating the observed y verbalizing what is observed in the patient to, for validation and to encourage discussion You sound angry
7. Encouraging comparisons y · asking to describe similarities and differences among feelings, behaviors, and events. · Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?
8. Identifying themes y y asking to identify recurring thoughts, feelings, and behaviors. When do you always feel the need to check the locks and doors?
9. Summarizing y y reviewing the main points of discussions and making appropriate conclusions. During this meeting, we discussed about what you will do when you feel the urge to hurt your self again and this include
Verbalizing the implied y y y rephrasing patient s words to highlight an underlying message to clarify statements. I don t think I understand what you are saying . Encouraging evaluation y y y asking for patients views of the meaning or importance of something. It s hard to begin to live alone when you have been married for more than thirty years . Nurse: Are you thinking of killing yourself?
24. Asking question y y using open-ended questions to achieve relevance and depth in discussion. Encouraging descriptions of perceptions y y asking the patients to describe feelings. General leads
. elaborate. I find it hard to believe
25. Let us talk more about your best friend in college You were saying
22. I know you hear these voices but I do not hear them . What do you think about the things you have to change in your self?
17. What are these voices telling you to do?
13. What do you think led the court to commit you here? Can you tell me the reasons you don t want to be discharged?
15. Nurse: You can t sleep at night?
21. Patient: I always take this towel wherever I go. How did you feel when the doctor told you that you are ready for discharge soon?
11. Patient: I can t sleep. can you describe it further for me . perceptions and views of their situations. Interpreting 14. Encouraging formulation of a plan of action y probing for step by step actions that will be needed. I am not familiar with your work. Reflecting y throwing back the patient s statement in a form of question helps the patient identify feelings. Suggesting collaboration 16.
12. perceptions and conclusions. Nurse: That towel must always be with you. Patient: I wont be bothering you anymore soon. or give examples of ideas or feelings to seek clarification of what is unclear. Presenting reality or confronting y y y stating what is real and what is not without arguing with the patient.10. and this is a hospital and not a beach resort. Focusing y y y pursuing a topic until its meaning or importance is clear.
23. I stay awake all night. Seeking clarification y y asking patient to restate. Nurse: Do you think you should leave now? y y offering to help patients solve problems. Go on You were saying
19. your nurse. Voicing doubt y voicing uncertainty about the reality of patient s statements. When do you begin to experience this ticks? Before or after you entered grade school?
y y y
using neutral expressions to encourage patients to continue talking. Perhaps you can discuss this with your children so they will know how you feel and what you want . Encouraging goal setting y y asking patient to decide on the type of change needed. y y providing a view of the meaning or importance of something. Placing the event in time or sequence y y asking for relationship among events. Patient: I think I should leave now. Empathy y y recognizing and acknowledging patient s feelings. I am Lhynnelli. Restating y repeating the exact words of patients to remind them of what they said and to let them know they are heard.
33. Reinforcement y y giving feedback on positive behaviors. 8. Encouraging consideration of options y y asking patients to consider the pros and cons of possible options. Please stop now. not picking up cues. 3. Where do you live?
31. Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore . I ll play your mother.
36. and asking for more information than can be absorbed at one time. Given all these choices. moralizing or implying one s values by using words such as nice . What did you feel after participating in the group therapy? . wrong .
34. The patient ask the nurse. and encouraging productive ones. Underloading y remaining silent and unresponsive. tell me exactly what would you say when we meet on Sunday .
32. its wrong . right . Role playing y practicing behaviors for specific situations. 7. how would you respond to them when they ask you to join them for a drink? . Limit setting y discouraging nonproductive feelings and behaviors. I understand.
35. 9. 6. should and ought . I will ask you to leave the group and go to your room. Value Judgments y giving one s own opinion. changing subjects too often. You shouldn t do that. Supportive confrontation y y acknowledging the difficulty in changing.
27. Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak . What s your name? I see you like sports. evaluating. Giving information y y providing information that will help patients make better choices. Rehearsing y y asking the patient for a verbal description of what will be said or done in a particular situation.
29. You feel rejected when your children sent you here but if you look at this way y
If you decide to leave home when your husband beat you again what will you do next?
I see you combed your hair today . bad . what would you prefer to do. The nurse tells the patient I d like to spend time with you and then walks away. Feedback y pointing out specific behaviors and giving impressions of reactions. both the nurse and patient play particular role. 2. and failing to give feedback. False reassurance/ agreement
. Giving advise Talking about your self Telling client is wrong Entering into hallucinations and delusions of client False reassurance Cliché Giving approval Asking WHY? Changing subject Defending doctors and other health team members. simply walks away.
30. Encouraging evaluation y y asking patients to evaluate their actions and their outcomes. Supposing you meet these people again.
28. Overloading y talking rapidly. but pushing for action. If you don t. 10. Have you thought of the possible effects of your decision to you and your family?
Avoid pitfalls: 1.
Non-therapeutic Technique 1. Encouraging decisions y y asking patients to make a choice among options.
4. 5. Incongruence y sending verbal and non-verbal messages that contradict one another. 4.
Client: How are you? Nurse responds: I can t talk now. Requesting an explanation Why did you do that? 3. Arguing and telling the client is wrong 10. giving opinions or making decisions for the client.
6. 8. Avoiding sensitive topics 9. I have beautiful rose garden . This sunshine is good for my roses. Literal responses If you feel empty then you should eat more.
13. The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood. Internal validation y making an assumption about the meaning of someone else s behavior that is not validated by the other person (jumping into conclusion). I m too busy. Making false promises I ll make sure to call you when you get home. Looking too busy. Ignoring the patient I can t talk to you right now
8. Showing disapproval You should not do those things.y y
Using cliché to reassure client.
7. The client is crying. If I were you Or it would be better if you do it this way
10. when the nurse asks How many children do you have?
9. Focusing on self y y responding in a way that focuses attention to the nurse instead of the client. 6. 12. 7. Giving advice y telling the client what to do. 2. Defending Your doctor is very good. Invalidation y y y Ignoring or denying another s presence. Laughing nervously 15.
Other ineffective behaviors and responses: 1. Changing the subject y y y introducing new topic inappropriately. It s going to be alright . 5. Being opinionated. Reflecting You are not suppose to talk like that! 4. Having a closed posture-crossing arms on chest 11. Making sarcastic remarks 14. Appearing uncomfortable in silence. thought s or feelings. implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility. a pattern that may indicate anxiety.