THERAPEUTIC COMMUNICATION TECHNIQUES

 Using silence - allows client to take control of the discussion, if he or she so

desires
-How are you feeling today sir? If huminto po si pt, iallow po natin siya & bigyan
siya ng time to fully undertand what he is feeling right now.
 Accepting - conveys positive regard
-Do not reject yung mga sinasabi ni pt.
-Conveys an attitude of reception & regard.
EXAMPLE:
"Yes, I understand what you said."
Eye contact; nodding.
-rationale:
 Giving recognition - acknowledging, indicating awareness
- Which nursing statement is a good example of the therapeutic communication
technique of giving recognition?

A. "You did not attend group today. Can we talk about that?"
B. "I'll sit with you until it is time for your family session."
C. "I notice you are wearing a new dress and you have washed your hair."
D. "I'm happy that you are now taking your medications. They will really help."
ANS: C
This is an example of the therapeutic communication technique of giving recognition.
Giving recognition acknowledges and indicates awareness. This technique is more
appropriate than complimenting the client which reflects the nurse's judgment.

-Acknowledging; indicating awareness; better than complimenting, which reflects the nurse's judgement
.
EXAMPLE:
"Hello, Mr. J. I notice that you made a ceramic ash tray in OT."
"I see you made your bed."

 Offering self - making oneself available

- Which nursing statement is a good example of the therapeutic communication
technique of offering self?

A. "I think it would be great if you talked about that problem during our next group
session."
B. "Would you like me to accompany you to your electroconvulsive therapy treatment?"
C. "I notice that you are offering help to other peers in the milieu."
D. "After discharge, would you like to meet me for lunch to review your outpatient
progress?"
 ANS: B
This is an example of the therapeutic communication technique of offering self. Offering
self makes the nurse available on an unconditional basis, increasing client's feelings of
self-worth. Professional boundaries must be maintained when using the technique of
offering self.

-THERAPEUTIC: Making oneself available on an unconditional basis, increasing client's feelings of self-
worth
EXAMPLE:
"I'll stay with you awhile."
"We can eat our lunch together."
"I'm interested in you."
 Giving broad openings - allows client to select the topic
- A client diagnosed with post-traumatic stress disorder is admitted to an inpatient
psychiatric unit for evaluation and medication stabilization. Which therapeutic
communication technique used by the nurse is an example of a broad opening?

A. "What occurred prior to the rape, and when did you go to the emergency
department?"
B. "What would you like to talk about?"
C. "I notice you seem uncomfortable discussing this."
D. "How can we help you feel safe during your stay here?"
ANS: B
The nurse's statement, "What would you like to talk about?" is an example of the
therapeutic communication technique of giving broad openings. Using a broad opening
allows the client to take the initiative in introducing the topic and emphasizes the
importance of the client's role in the interaction.

-THERAPEUTIC: Allows the client to take the initiative in introducing the topic; emphasizes the
importance of the client's role in the interaction.
EXAMPLE:
"What would you like to talk about today?"
"Tell me what you are thinking?"
 Offering general leads - encourages client to continue
- The nurse is interviewing a newly admitted psychiatric client. Which nursing statement
is an example of offering a "general lead"?

A. "Do you know why you are here?"

B. "Are you feeling depressed or anxious?"
C. "Yes, I see. Go on."
D. "Can you chronologically order the events that led to your admission?"
ANS: C
The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic
 communication technique of a general lead. Offering a general lead encourages the
client to continue sharing information.
R:

 Placing the event in time or sequence - clarifies the relationship of events

in time
-Clarifies the relationship of events in time so that the nurse & client can view them in perspective.
EXAMPLE:
"What seemed to lead up to...?"
"Was this before or after...?"
"When did this happen?"
 Making observations - verbalizing what is observed or perceived
- A nurse is assessing a client diagnosed with schizophrenia for the presence of
hallucinations. Which therapeutic communication technique used by the nurse is an
example of making observations?

A. "You appear to be talking to someone I do not see."

B. "Please describe what you are seeing."
C. "Why do you continually look in the corner of this room?"
D. "If you hum a tune, the voices may not be so distracting."
ANS: A
The nurse is making an observation when stating, "You appear to be talking to someone
I do not see." Making observations involves verbalizing what is observed or perceived.
This encourages the client to recognize specific behaviors and make comparisons with
the nurse's perceptions.

-verbalizing what is observed or perceived. This encourages the client to recognize specific behaivors &
compare perceptions with the nurse.
EXAMPLE:
"You seem tense."
"I notice you are pacing a lot."
"You seem uncomfortable when you..."
 Encouraging description of perceptions - asking client to verbalize what is
being perceived
-sking the client to verbalize what is being perceived; often used with clients experiencing
hallucinations.
EXAMPLE:
"Tell me what is happening now."
"Are you hearing the voices again?"
"What do the voices seem to be saying?"
 Encouraging comparison - asking client to compare similarities and
differences in ideas, experiences, or interpersonal relationships
 -compares ideas/experiences of the patient to bring out recurring themes. EXAMPLE:
"Was this something like...?"
"How does this compare with the time when...?"
"What was your response the last time this situation occurred?"
 Restating - lets client know whether an expressed statement has or has not
been understood
- Which therapeutic communication technique is being used in this nurse-client
interaction?
Client: "My father spanked me often."
Nurse: "Your father was a harsh disciplinarian."
The nurse is using the therapeutic communication technique of restatement.
Restatement involves repeating the main idea of what the client has said. The nurse
uses this technique to communicate that the client's statement has been heard and
understood.
- A client tells the nurse, "I feel bad because my mother does not want me to return
home after I leave the hospital." Which nursing response is therapeutic?

A. "It's quite common for clients to feel that way after a lengthy hospitalization."
B. "Why don't you talk to your mother? You may find out she doesn't feel that way."
C. "Your mother seems like an understanding person. I'll help you approach her."
D. "You feel that your mother does not want you to come back home?"
ANS: D
This is an example of the therapeutic communication technique of restatement.
Restatement is the repeating of the main idea that the client has verbalized. This lets
the client know whether or not an expressed statement has been understood and gives
him or her the chance to continue, or clarify if necessary.
- A patient with a diagnosis of major depression who has attempted suicide says to the
nurse, "I should have died! I've always been a failure. Nothing ever goes right for me."
Which response demonstrates therapeutic communication?
A "You have everything to live for."
B "Why do you see yourself as a failure?"
C "Feeling like this is all part of being depressed."
D. "You've been feeling like a failure for a while?"
D
Responding to the feelings expressed by a patient is an effective therapeutic
communication technique. The correct option is an example of the use of restating. The
remaining options block communication because they minimize the patient's experience
and do not facilitate exploration of the patient's expressed feelings. In addition, use of
the word "why" is nontherapeutic.
- When the community health nurse visits a patient at home, the patient states, "I
haven't slept the last couple of nights." Which response by the nurse illustrates a
therapeutic communication response to this patient.
 A "I see."
B "Really?"
C. "You're having difficulty sleeping?"
D "Sometimes, I have trouble sleeping too."
C. "You're having difficulty sleeping?"
The correct option uses the therapeutic communication technique of restatement.
Although restatement is a technique that has a prompting component to it, it repeats the
patients major theme, which assists the nurse to obtain a more specific perception of
the problem from the patient. The remaining options are not therapeutic responses
since none encourage the patient to expand on the problem. Offering personal
experiences moves the focus away from the patient and onto the nurse.

-Repeating the main idea in different words. Gives evidence to patient that. That he is understood.
EXAMPLE:
Client: "I can't study. My mind keeps wandering."
Nurse: "You have trouble concentrating."
 Reflecting - directs questions or feelings back to client so that they may be
recognized and accepted
- A mother rescues two of her four children from a house fire. In the emergency
department, she cries, "I should have gone back in to get them. I should have died, not
them." What is the nurse's best response?

A. "The smoke was too thick. You couldn't have gone back in."
B. "You're feeling guilty because you weren't able to save your children."
C. "Focus on the fact that you could have lost all four of your children."
D. "It's best if you try not to think about what happened. Try to move on."
ANS: B
The best response by the nurse is, "You're experiencing feelings of guilt because you
weren't able to save your children." This response utilizes the therapeutic
communication technique of reflection which identifies a client's emotional response and
reflects these feelings back to the client so that they may be recognized and accepted
- A client on an inpatient psychiatric unit tells the nurse, "I should have died because I
am totally worthless." In order to encourage the client to continue talking about feelings,
which should be the nurse's initial response?

A. "How would your family feel if you died?"

B. "You feel worthless now, but that can change with time."
C. "You've been feeling sad and alone for some time now?"
D. "It is great that you have come in for help."
ANS: C
This nursing statement is an example of the therapeutic communication technique of
 reflection. When reflection is used, questions and feelings are referred back to the client
so that they may be recognized and accepted.

-Directs back questions feelings ideas so they are recognized and accepted.
EXAMPLE:
Client: "What do you think I should do about my wife's drinking problem?"
Nurse: "What do you think you should do?"
 Focusing - taking notice of a single idea or even a single word
- Which nursing statement is a good example of the therapeutic communication
technique of focusing?

A. "Describe one of the best things that happened to you this week."
B. "I'm having a difficult time understanding what you mean."
C. "Your counseling session is in 30 minutes. I'll stay with you until then."
D. "You mentioned your relationship with your father. Let's discuss that further."
ANS: D
This is an example of the therapeutic communication technique of focusing. Focusing
takes notice of a single idea or even a single word and works especially well with a
client who is moving rapidly from one thought to another.

-Taking notice of a single idea or even a single point giving it importance and worth
EXAMPLE:
"This point seems worth looking at more closely. Perhaps you & I can discuss it together."
 Exploring - delving further into a subject, idea, experience, or relationship
- The nurse asks a newly admitted client, "What can we do to help you?" What is the
purpose of this therapeutic communication technique?

A. To reframe the client's thoughts about mental health treatment

B. To put the client at ease
C. To explore a subject, idea, experience, or relationship
D. To communicate that the nurse is listening to the conversation
ANS: C
This is an example of the therapeutic communication technique of exploring. The
purpose of using exploring is to delve further into the subject, idea, experience, or
relationship. This technique is especially helpful with clients who tend to remain on a
superficial level of communication.
- A client states, "You won't believe what my husband said to me during visiting hours.
He has no right treating me that way." Which nursing response would best assess the
situation that occurred?

A. "Does your husband treat you like this very often?"

B. "What do you think is your role in this relationship?"
 C. "Why do you think he behaved like that?"
D. "Describe what happened during your time with your husband."
ANS: D
This is an example of the therapeutic communication technique of exploring. The
purpose of using exploring is to delve further into the subject, idea, experience, or
relationship. This technique is especially helpful with clients who tend to remain on a
superficial level of communication.

-delving further into a subject, idea, experience, or relationship patient brings up

EXAMPLE:
"Please explain that situation more fully"
"Tell me more about that particular situation."

 Seeking clarification and validation - striving to explain what is vague and

searching for mutual understanding
-
 Presenting reality - clarifying misconceptions that client may be expressing
- Which therapeutic communication technique should the nurse use when
communicating with a client who is experiencing auditory hallucinations?

A. "My sister has the same diagnosis as you and she also hears voices."
B. "I understand that the voices seem real to you, but I do not hear any voices."
C. "Why not turn up the radio so that the voices are muted."
D. "I wouldn't worry about these voices. The medication will make them disappear."
ANS: B
This is an example of the therapeutic communication technique of presenting reality.
Presenting reality is when the client has a misperception of the environment. The nurse
defines reality or indicates his or her perception of the situation for the client.

-Offering what is real and what is not without arguing

EXAMPLE:
"I understand that the voices seem real to you, but I do not hear any voices."
"There is no one else in the room but me & you."
 Voicing doubt - expressing uncertainty as to the reality of client’s
perception
-expressing uncertainty as to the reality of the client's perceptions; doesn't agree or disagree.
EXAMPLE:
"I understand that you believe that to b e true, but I find it hard to accept."
"I find that hard to believe."
"That seems rather doubtful to me."
 Verbalizing the implied - putting into words what client has only implied
 - A client is struggling to explore and solve a problem. Which nursing statement would
verbalize the implication of the client's actions?

A. "You seem to be motivated to change your behavior."

B. "How will these changes affect your family relationships?"
C. "Why don't you make a list of the behaviors you need to change."
D. "The team recommends that you make only one behavioral change at a time."
ANS: A
This is an example of the therapeutic communication technique of verbalizing the
implied. Verbalizing the implied puts into words what the client has only implied or said
indirectly.
- A client slammed a door on the unit several times. The nurse responds, "You seem
angry." The client states, "I'm not angry." What therapeutic communication technique
has the nurse employed and what defense mechanism is the client unconsciously
demonstrating?

A. Making observations and the defense mechanism of suppression

B. Verbalizing the implied and the defense mechanism of denial
C. Reflection and the defense mechanism of projection
D. Encouraging descriptions of perceptions and the defense mechanism of
displacement
ANS: B
This is an example of the therapeutic communication technique of verbalizing the
implied. The nurse is putting into words what the client has only implied by words or
actions. Denial is the refusal of the client to acknowledge the existence of a real
situation, the feelings associated with it, or both.

-Putting into words what the client has only implied. Reading between the lines. Rephrase to
highlight an underlining message
EXAMPLE:
Client: "It's a waste of time to be here. I can't talk to you or anyone."
Nurse: "Are you feeling that no one understands?"
Client: (Mute)
Nurse: "It must have been very difficult for you when your husband died in the fire."

 Attempting to translate words into feelings - putting into words the

feelings the client has expressed only indirectly
-Seeks To go past content to the feelings of a patients words. Makes patient feel deeply understood and
enables him/her to further express feelings
EXAMPLE:
Client: "I'm way out in the ocean."
Nurse: "You must be feeling very lonely right now."
 -Help develop step by step actions needed to make changes and solve problems
EXAMPLE:
"What could you do to let your anger out harmlessly?"
"Next time this comes up, what might you do to handle it more appropriately?"
 Formulating plan of action - striving to prevent anger or anxiety escalating
to unmanageable level when stressor recurs
- Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids."
Nurse: "I notice that you are smiling as you talk about this physical violence."
-The nurse is using the therapeutic communication technique of making observations when noting that
the client smiles when talking about physical violence. The technique of making observations
encourages the client to compare personal perceptions with those of the nurse.
- A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes
hands continually. This behavior prevents unit activity attendance. Which nursing
statement best addresses this situation?

A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors."

B. "It is important for you to discontinue these ritualistic behaviors."
C. "Why are you asking for help if you won't participate in unit therapy?"
D. "Let's figure out a way for you to attend unit activities and still wash your hands."
ANS: D
The most appropriate statement by the nurse is, "Let's figure out a way for you to attend
unit activities and still wash your hands." This statement reflects the therapeutic
communication technique of formulating a plan of action. The nurse attempts to work
with the client to develop a plan without damaging the therapeutic relationship or
increasing the client's anxiety.

THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING

Goals are often achieved through use of the problem-solving model:
  Identify the client’s problem.
  Promote discussion of desired changes.
 Discuss aspects that cannot realistically be changed and ways to cope with
them more adaptively.
  Discuss alternative strategies for creating changes the client desires to
make.
  Weigh benefits and consequences of each alternative.
  Help client select an alternative.
  Encourage client to implement the change.
  Provide positive feedback for client’s attempts to create change.
 Help client evaluate outcomes of the change and make modifications as
required.
 LISTENING TO THE PATIENT
 To listen actively is to be attentive to what client is saying, both verbally and
nonverbally.
Several nonverbal behaviors have been designed to facilitate attentive listening.

 S – Sit squarely facing the client.

 O – Observe an open posture.
- A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is
reflective of which letter of the SOLER acronym for active listening?

A. S
B. O
C. L
D. E
E. R
ANS: B
The nurse should identify that maintaining an uncrossed arm and leg posture is
nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The
acronym SOLER includes sitting squarely facing the client (S), open posture when
interacting with the client (O), leaning forward toward the client (L), establishing eye
contact (E), and relaxing (R).

 L – Lean forward toward the client.

 E – Establish eye contact.
 R – Relax.

NONTHERAPEUTIC COMMUNICATION TECHNIQUES

 Giving reassurance - may discourage client from further expression of
feelings if client believes the feelings will only be downplayed or ridiculed
- A nurse states to a client, "Things will look better tomorrow after a good night's sleep."
This is an example of which communication technique?

A. The therapeutic technique of "giving advice"

B. The therapeutic technique of "defending"
C. The nontherapeutic technique of "presenting reality"
D. The nontherapeutic technique of "giving false reassurance"
 ANS: D
The nurse's statement, "Things will look better tomorrow after a good night's sleep." is
an example of the nontherapeutic technique of giving false reassurance. Giving false
reassurance indicates to the client that there is no cause for anxiety, thereby devaluing
the client's feelings.
- Indicating there is no reason for anxiety or other feelings of discomfort
"I wouldn't worry about that."
"Everything will be all right"
"You're coming along just fine"--False Reassurance

-When a patient is seriously ill or distressed, you may be tempted to offer hope to the
patient.
"Don't worry, everything will be ok"

 Rejecting - refusing to consider client’s ideas or behaviour

- Refusing to consider or showing contempt for the client's ideas or behaviors
"Lets not discuss..."
"I don't want to hear about..."
 Approving or disapproving - implies that the nurse has the right to pass
judgment on the “goodness” or “badness” of client’s behaviour
- After assertiveness training, a formerly passive client appropriately confronts a peer in
group therapy. The group leader states, "I'm so proud of you for being assertive. You
are so good!" Which communication technique has the leader employed?

A. The nontherapeutic technique of giving approval

B. The nontherapeutic technique of interpreting
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observations
ANS: A
The group leader has employed the nontherapeutic technique of giving approval. Giving
approval implies that the nurse has the right to pass judgment on whether the client's
ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the
client.
- Denouncing the clients behavior or ideas
"That's bad"
"I'd rather you would't"

- Sanctioning the client's behavior or ideas

"That's good"
"I'm glad that..."

-Do not impose you own attitudes, values, beliefs and moral standards on others while in the
professional helping role.
"You shouldn't even think about assisted suicide; it's not right"
 Agreeing or disagreeing - implies that the nurse has the right to pass
judgment on whether client’s ideas or opinions are “right” or “wrong”
- Indicating accord with the client
"That right"
"I agree"
- Opposing the client's ideas
"That's wrong"
"I definitely disagree with..."
"I don't believe that"
 Giving advice - implies that the nurse knows what is best for client and that
client is incapable of any self-direction
- Telling the client what to do
"I think you should..."
"Why don't you..."
 Probing - pushing for answers to issues the client does not wish to discuss
causes client to feel used and valued only for what is shared with the nurse
- Persistent questioning of the client
"Now tell me about this problem. You know I have to find out."
"Tell me your psychiatric history"
 Defending - to defend what client has criticized implies that client has no
right to express ideas, opinions, or feelings
- Attempting to protect someone or something from verbal attack
"This hospital has a fine reputation"
""I'm sure your doctor has your best interests in mind"
 Requesting an explanation - asking “why” implies that client must defend
his or her behavior or feelings
- Asking the client to provide reasons for thoughts, feelings, behaviors, events
"What do you think about that"
"Why do you feel that way"
-Some nurses are tempted to ask the other person to explain why the person believes, feels, or has
acted in a certain way
"Why are you so anxious"

-"Are you not understanding the explanation I provided?" This nursing statement is an example
of the nontherapeutic communication block of requesting an explanation. Requesting an
explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors,
and events.
 Indicating the existence of an external source of power - encourages
client to project blame for his or her thoughts or behaviors on others
-
 Belittling feelings expressed - causes client to feel insignificant or
unimportant
- During a nurse-client interaction, which nursing statement may belittle the client's
feelings and concerns?

A. "Don't worry. Everything will be alright."

B. "You appear uptight."
C. "I notice you have bitten your nails to the quick."
D. "You are jumping to conclusions."
ANS: A
This nursing statement is an example of the nontherapeutic communication block of
belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the
client's discomfort, thus a lack of empathy and understanding may be conveyed.
- Misjudging the degree of the clients discomfortClient: "I have nothing to live for...I wish
I was dead"
Nurse""Everybody gets down in the dumps," or "I've felt that way myself

 Making stereotyped comments, clichés, and trite expressions - these are

meaningless in a nurse-client relationship
- Offering meaningless cliches or trite comments
"It's for your own good:
"Keep your chin up"
"Just have a positive attitude and you'll be better in no time"

 Using denial - blocks discussion with client and avoids helping client
identify and explore areas of difficulty
-
 Interpreting - results in the therapist’s telling client the meaning of his or
her experience
- Asking to make conscious that which is unconscious; telling the client the meaning of his or her
experience.
"What you really mean is..."
"Unconsciously you're saying..."
 Introducing an unrelated topic - causes the nurse to take over the direction
of the discussion
- Changing the subject
Client: " I'd like to die"
Nurse: " Did you have visitors last evening?"

Giving literal response

Responding to a figurative comment as though it were a statement of fact
Client: "They're looking in me with a television camera"
Nurse: "Try not to watch television

nON-T: Vague with little or no meaning, nit based on facts. Belittles and devalues the
client's feelings. Communicates lack of understanding and empathy. Blocks expression
of feeling
EXAMPLE:
"I wouldn't worry about that if I were you."
"Everything will be all right."
Better To Say: "We will work on that together."

False Reassurance (reassuring)

NON-T: Refusing to consider or showing contempt for the client's ideas or behavior.
EXAMPLE:
"Let's not discuss..."
"I don't want to hear about..."
Better To Say: "Let's look at that a little closer."

Rejecting
NON-T: Involves judgement on nurses part. Leads patient to strive for praise not
progress.
EXAMPLE:
"That's good. I'm glad that you..."

Giving Approval
NON-T: Giving patient impression they are right because opinion is the same as the
nurse
EXAMPLE:
"That's right. I agree."
Agreeing
NON-T: Telling the client what to do or how to behave implies that the nurse knows
what is best & that the client is incapable of any self-direction.
EXAMPLE:
"I think you should..."
"Why don't you..."
Better To Say: "What do you think would be best for you to do?"

Giving Advice
do not do
NON-T: Persistent questioning of the client; makes patient feel valued for info the give.
Places patient on defensive.
EXAMPLE:
"Tell me how your mother abused you when you were a child."
"Tell me about your life history

Probing
don't use why
NON-T: Attempting to protect someone or something from verbal attack. Defending self,
staff, hospital. No listening to patient concerns. Communicates a non-accepting attitude.
EXAMPLE:
"No one here would lie to you."
"I'm sure he only has your best interest in mind"

Defending
NON-T: Makes pt invent a reason, Asking the client to provide the reasons for thoughts,
feelings, behavior, and events. Asking why the client did something. Often patient
doesn't know what the reason is.
EXAMPLE:
"Why did you think that?"
"Why do you feel this way?"
"Why did you do that?"

Why questions

Requesting an Explanation
NON-T: Attributing the source of thoughts, feelings, and behavior to to others or to
outside influences. Relieves patient of responsibility. Encourages to use projection to
alleviate anxiety.
EXAMPLE:
"What/who makes you say that?"
"What/who made you do that?"
"What/who made you so angry last night"

Indicating the Existence of an External Source

NON-T: Putting down/devaluing patient feelings. Telling patient others have felt the
same. Saying feelings are not unusual. a lack of empathy & understanding may be
conveyed.
EXAMPLE:
Client: "I have nothing to live for. I wish I were dead."
Nurse: "Everybody gets down in the dumps at times. I feel that way myself sometimes."

Belittling Feelings Expressed

NON-T: cliches & trite expressions are superficial/meaningless. Keeps distance in a
nurse-client relationship. Scripted, automatic. And impersonal.
EXAMPLE:
"I'm fine, & how are you?"
"Hang in there. It's for your own good."
"Keep your chin up."

Making Stereotyped Comments

NON-T: Refusing to acknowledge admit or Denying that a problem exists
EXAMPLE:
Client: "I'm nothing."
Nurse: "Of course your something. Everybody is somebody."

Using Denial
NON-T: seeks to make conscious that which is unconscious. Receive insight. Lack of
validation.
EXAMPLE:
"What you really mean is..."
"Unconsciously your saying"

Interpreting
NON-T: Changing the subject causes the nurse to take over the direction of the
discussion
Negates what patient seems interested in discussing. Changes subject to avoid
discomfort or to initiate a topic the nurse is more interested in.
EXAMPLE:
Client: "I don't have anything to live for."
Nurse: "Did you have visitors this weekend?"

Introducing an Unrelated Topic/ changing the subject

THERAPEUTIC: searching for mutual understanding; clarifying the meaning of what has
been said facilitates & increases understanding for both client & nurse.

seeking clarification (clarifying)

NON-T: tells patient they are sick and needs help. Demands that patient have insight
into lack of insight.
Example:
what day is this?
do you know what kind of hospital this is?

testing
NON-T: responding to highly confused/anxious clients comments as if they were facts.
telling patient the nurse cannot understand when anxiety producing feelings are
described.
Example:
im an easter egg.
you dont look like an easter egg/ what shade?

giving literal responses

NON-T: demands proof. makes patient defend ideas thus reinforcing
Example:
but how can you be the president of the U.s.?
if youre dead why is your heart beating?

challenging
NON-T: judgemental, judgement call. indicates the oatient is bad. denounces patients
behavior/idea.
talking to patients in terms of "shoulds"
infers preconcieved idea about the right thing.
Example:
thats wrong
i definiteky disagree with you
you should have
should would could

moralistic/disapproving
NON-T: opposes patients idea. makes patient defend himself. reinforces idea.
Example:
i dont think thats a good idea

disagreeing
THERAPEUTIC: offer to do things with the patient but not for them or to them.
Example:
perhaps we can discuss and discover what produces your anxiety

suggesting collaboration
THERAPEUTIC: giving facts patient needs available to them
Example:
my name is...
visiting hours are...
im taking you to...

giving info
THERAPEUTIC: brings together important points gives participants awareness of
progress
Example: have i got this straight?
you said that.....
in the past we have discussed

summarizing
THERAPEUTIC: ask for client view of meaning/importance
ask client to evaluate actions and the outcome of those actions
Example:
what are your feelings in regard to...
does this contribute to your discomfort?
whats your ideas to handle this?
encouraging evaluation
looking at alternatives
THERAPEUTIC: serves to confirm what nurse believes was heard or observed.
indicates whether patients needs have been met.
Example: you have been taking a water pill and bp pill everyday. did you take them
today?
i took 1 of each at breakfast.

validating
THERAPEUTIC: presents alternative ideas so hat client can solve problems more
constructively.
Example: many diff weight loss options are available. you can choose which is best for
you.

suggesting
THERAPEUTIC
Silence
Accepting
Giving Recognition
Offering Self
Giving Broad Openings
General Leads
Place Event in Time/Sequence
Making Observations
Encouraging Description of Perceptions
Encouraging Comparison
Restating (Paraphrasing)
Reflecting (Mirroring)
Focusing
Exploring
Giving Info
Seeking Clarification (Clarifying)
Presenting Reality
Voicing Doubt
Seeking Consensual Validation
Verbalizing the Implied
Encouraging Evaluation
Attempting Translate Words to Feelings
Collaboration
Encourage form of plan of Action
Suggesting
Validating

NON-THERAPEUTIC:
Reassuring (False Reassurance)
Giving Approval
Rejecting
Disapproving
Agreeing
Disagreeing
Advising
Probing
Challenging
Testing
Defending
Requesting an Explanation
Existence of external source
Belittling Feelings
Stereotyped Comments
Literal Responses
Denial
Interpreting
Changing Subject (unrelated topic)