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Effective Communication: (1) Appropriate (2)
Simple (3) Adaptive (4) Concise (5) Credible
Therapeutic Technique
1. Offering Self
 making self-available and showing interest
and concern.
 “I will walk with you”
2. Active listening
 paying close attention to what the patient is
saying by observing both verbal and non-
verbal cues.
 Maintaining eye contact and making verbal
remarks to clarify and encourage further
communication.
3. Exploring
 “Tell me more about your son”
4. Giving broad openings
 What do you want to talk about today?
5. Silence
 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
 verbalizing what is observed in the patient
to, for validation and to encourage
discussion
 “You sound angry”
7. Encouraging comparisons
  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
 asking to identify recurring thoughts,
feelings, and behaviors.
 “When do you always feel the need to check
the locks and doors?”
9. Summarizing
 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…”
10. Placing the event in time or sequence
 asking for relationship among events.
 “When do you begin to experience this
ticks? Before or after you entered grade
school?”
11. Voicing doubt
 voicing uncertainty about the reality of
patient’s statements, perceptions and
conclusions.
 “I find it hard to believe…”
12. Encouraging descriptions of perceptions
 asking the patients to describe feelings,
perceptions and views of their situations.
 “What are these voices telling you to do?”
13. Presenting reality or confronting
 stating what is real and what is not without
arguing with the patient.
 “I know you hear these voices but I do not
hear them”.
 “I am Lhynnelli, your nurse, and this is a
hospital and not a beach resort.
14. Seeking clarification
 asking patient to restate, elaborate, or give
examples of ideas or feelings to seek
clarification of what is unclear.
 “I am not familiar with your work, can you
describe it further for me”.
 “I don’t think I understand what you are
saying”.
15. Verbalizing the implied
 rephrasing patient’s words to highlight an
underlying message to clarify statements.
 Patient: I wont be bothering you anymore
soon.
 Nurse: Are you thinking of killing yourself?
16. Reflecting
 throwing back the patient’s statement in a
form of question helps the patient identify
feelings.
 Patient: I think I should leave now.
 Nurse: Do you think you should leave now?
17. Restating
 repeating the exact words of patients to
remind them of what they said and to let
them know they are heard.
 Patient: I can’t sleep. I stay awake all night.
 Nurse: You can’t sleep at night?
18. General leads
 using neutral expressions to encourage
patients to continue talking.
 “Go on…”
 “You were saying…”
19. Asking question

 using open-ended questions to achieve
relevance and depth in discussion.
 “How did you feel when the doctor told you
that you are ready for discharge soon?”
20. Empathy
 recognizing and acknowledging patient’s
feelings.
 “It’s hard to begin to live alone when you
have been married for more than thirty
years”.
21. Focusing
 pursuing a topic until its meaning or
importance is clear.
 “Let us talk more about your best friend in
college”
 “You were saying…”
22. Interpreting
 providing a view of the meaning or
importance of something.
 Patient: I always take this towel wherever I
go.
 Nurse: That towel must always be with you.
23. Encouraging evaluation
 asking for patients views of the meaning or
importance of something.
 “What do you think led the court to commit
you here?”
 “Can you tell me the reasons you don’t want
to be discharged?
24. Suggesting collaboration
 offering to help patients solve problems.
 “Perhaps you can discuss this with your
children so they will know how you feel and
what you want”.
25. Encouraging goal setting
 asking patient to decide on the type of
change needed.
 “What do you think about the things you
have to change in your self?”
26. Encouraging formulation of a plan of action
 probing for step by step actions that will be
needed.
 “If you decide to leave home when your
husband beat you again what will you do
next?”
27. Encouraging decisions
 asking patients to make a choice among
options.
 “Given all these choices, what would you
prefer to do.
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28. Encouraging consideration of options
 asking patients to consider the pros and cons
of possible options.
 “Have you thought of the possible effects of
your decision to you and your family?”
29. Giving information
 providing information that will help patients
make better choices.
 “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”.
30. Limit setting
 discouraging nonproductive feelings and
behaviors, and encouraging productive ones.
 “Please stop now. If you don’t, I will ask
you to leave the group and go to your room.
31. Supportive confrontation
 acknowledging the difficulty in changing,
but pushing for action.
 “I understand. You feel rejected when your
children sent you here but if you look at this
way…”
32. Role playing
 practicing behaviors for specific situations,
both the nurse and patient play particular
role.
 “I’ll play your mother, tell me exactly what
would you say when we meet on Sunday”.
33. Rehearsing
 asking the patient for a verbal description of
what will be said or done in a particular
situation.
 “Supposing you meet these people again,
how would you respond to them when they
ask you to join them for a drink?”.
34. Feedback
 pointing out specific behaviors and giving
impressions of reactions.
 “I see you combed your hair today”.
35. Encouraging evaluation
 asking patients to evaluate their actions and
their outcomes.
 “What did you feel after participating in the
group therapy?”.
36. Reinforcement
 giving feedback on positive behaviors.

 “Everyone was able to give their options
when we talked one by one and each of
waited patiently for our turn to speak”.
Avoid pitfalls:
1. Giving advise
2. Talking about your self
3. Telling client is wrong
4. Entering into hallucinations and delusions of
client
5. False reassurance
6. Cliché
7. Giving approval
8. Asking WHY?
9. Changing subject
10. Defending doctors and other health team
members.
Non-therapeutic Technique
1. Overloading
 talking rapidly, changing subjects too often,
and asking for more information than can be
absorbed at one time.
 “What’s your name? I see you like sports.
Where do you live?”
2. Value Judgments
 giving one’s own opinion, evaluating,
moralizing or implying one’s values by
using words such as “nice”, “bad”, “right”,
“wrong”, “should” and “ought”.
 “You shouldn’t do that, its wrong”.
3. Incongruence
 sending verbal and non-verbal messages that
contradict one another.
 The nurse tells the patient “I’d like to spend
time with you” and then walks away.
4. Underloading
 remaining silent and unresponsive, not
picking up cues, and failing to give
feedback.
 The patient ask the nurse, simply walks
away.
5. False reassurance/ agreement
 Using cliché to reassure client.
 “It’s going to be alright”.
6. Invalidation
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 Ignoring or denying another’s presence,
thought’s or feelings.
 Client: How are you?
 Nurse responds: I can’t talk now. I’m too
busy.
7. Focusing on self
 responding in a way that focuses attention to
the nurse instead of the client.
 “This sunshine is good for my roses. I have
beautiful rose garden”.
8. Changing the subject
 introducing new topic
 inappropriately, a pattern that may indicate
anxiety.
 The client is crying, when the nurse asks
“How many children do you have?”
9. Giving advice
 telling the client what to do, giving opinions
or making decisions for the client, implies
client cannot handle his or her own life
decisions and that the nurse is accepting
responsibility.
 “If I were you… Or it would be better if you
do it this way…”
10. Internal validation
 making an assumption about the meaning of
someone else’s behavior that is not validated
by the other person (jumping into
conclusion).
 The nurse sees a suicidal clients smiling and
tells another nurse the patient is in good
mood.
Other ineffective behaviors and responses:
1. Defending – Your doctor is very good.
2. Requesting an explanation – Why did you
do that?
3. Reflecting – You are not suppose to talk like
that!
4. Literal responses – If you feel empty then
you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture-crossing arms on
chest
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11. Making false promises – I’ll make sure to

call you when you get home.
12. Ignoring the patient – I can’t talk to you
right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do
those things.