THERAPEUTIC COMMUNICATION TECHNIQUES
Therapeutic Communication
Techniques
Accepting—indicating that nurse has
heard and is willing to hear what client
has to say
Assessing relationship—exploring
client's relationship with another
person. Asking client to describe rela-
tionship between self and others is a
helpful way to gather information.
Broad openings—using open-ended
questions that provide opportunity for
client to introduce topic
Consensual validation—two or more
people achieving agreement of
interpretation of an event, behavior or
issue
Encouraging comparison—helping
client understand by looking at
similarities and differences. Create
exhaustive list of similarities, then
differences.
Encouraging description of
perceptions—-Having client describe
his or her view of an event or
experience.
Encouraging evaluation—asking client
to appraise the quality of his or her
experiences (discuss one at a time)
Encouraging expression – asking client “What are your feelings in regard to …?”
to appraise the quality of his or her “Does this contribute to distress?”
experiences
Exploring – delving further into a
subject or idea
Focusing—concentrating on a single,
important point
Examples of Techniques
Nurse: "Yes." Nodding. "I follow what you said." "It is OK to tell me."
Client: "I went home with Joan."
Nurse: "Tell me about you and Joan."
"What's new?"
"What are you thinking about?" "What's been happening in your
life?" "How has life been treating you?"
Client: "The atmosphere here is scary."
Nurse: 'Yes, it is like being in a dark cellar.
Client: "My sister passed last year."
Nurse: "Give me your definition of the word 'passed'." Or
"Help me understand what 'passed' means."
Nurse: "You had said you were worried about your visit from your wife after
the way you had behaved before admission. I did see you holding hands dur-
ing your visit. How did things go?"
"Tell me about another time you had a similar experience."
"What's one way I look like your daughter?" "What's another way I look like
your daughter?" "What's one way I look different from your daughter?"
"Describe this fear of driving over bridges."
"Tell me when you feel anxious."
"Start at the beginning and describe what happened."
"You threatened to hit John. What's that about?"
"You're smiling, but I sense you're very angry at me."
"What are your thoughts about the way you asked Joe not to wear your coat
anymore?"
"What are your feelings in regard to Mark's behavior when he said he was
angry?"
"What have you learned from this experience?"
Client: "This world is rotten."
Nurse: "What's one thing that is rotten about this world?"
“Tell me more about that.”
“Would you describe it more fully?”
“What kind of work?”
Client: "I hate all doctors."
Nurse: "Who is one doctor you hate?"
Client: "Everyone hates me."
Nurse: "Who is one person who has told you he or she hates you?"
“This point seems worth looking at more closely.”
“Of all the concerns you’ve mentioned, which is most troublesome?”
Formulating a plan of action—
planning appropriate resolution of a
problem in graded steps. Always use
nouns instead of pronouns to clarify
who is involved.
General leads—encouraging
continuation
Giving information – making
available the facts that the client
needs.
Giving recognition—objective
acknowledgment
Making observation – verbalizing what
the nurse perceives.
Offering self – making oneself
available.
Placing event in time or sequence –
clarifying the relationship of events in
time.
Presenting reality – offering for
consideration that which is real.
Reflecting – directing client actions,
thoughts, and feelings back to client.
Restating – repeating the main idea
expressed.
Seeking information – seeking to make
clear that which is not meaningful or
that which is vague.
"Next time you argue with Donna, what is one way you can handle your anger,
in an appropriate manner?"
"How can you tell Terry you are upset that he ignored you,
without hitting him?"
“What could you do to let your anger out harmlessly?”
“Next time this comes up, what might You do to handle it?”
"And then... ?"
"Continue."
"Tell me about the accident."
“Go on.” 0r Tell me about it.”,
“My name is . . . “, “Visiting hours are . . . “, “ My purpose in being here
is . . .”
"Hello, Mr. Thomas."
"I notice you've combed your hair."
"You-walked the length of the hall."
“You’ve finished your list of things to do.”
“You appear tense.”
“Are you uncomfortable when . . .?”
“I notice that you’re biting your lip.”
“I’ll sit with you awhile.”
“I’ll stay here with you.”
“I’m interested in what you think.”
“What seemed to lead up to . . .?”
“Was this before or after . . . ?”
“When did this happen?”
“I see no one else in the room.”
“That sound was a car backfiring.”
“Your mother is not here, I am a nurse.”
Client: “Do you think I should tell the Doctor . . . .?”
Nurse: “Do you think you should?”
Client: “My brother spends all my money and then has nerve to ask for more.”
Nurse: “This causes you to feel angry?”
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping.”
Client: “I’m really mad, I’m really upset.”
Nurse: “You’re really mad and upset.”
I’m not sure that I follow.”
“Have I heard you correctly?”
Silence—absence of verbal
communication provides time for the
client to put actions, thoughts, or feel-
ings into words and slows pace of
interaction. Gives client time to
develop insights. Silence is helpful
when client seems to be considering
whether to share additional
information. Client may need this
unspoken "permission" to take the time
to share this information. Conversely,
client anxiety may be increased by
silence and client might blurt out the
issue to fill the silence.
Suggestion collaboration—offering to
work together with the client
Summarizing—organizing key issues
that have been discussed
Theme identification - identifying
recurring issues or problems
Translating into feelings—attempting
to verbalize client's feelings expressed
only indirectly
Verbalizing the implied—voicing what
has been suggested or hinted at
Voicing doubt—gently questioning the
reality client's perceptions
Nurse says nothing but continues to maintain eye contact and conveys interest.
"Perhaps you can discuss what thoughts, behaviors, or feelings increase your
anxiety.
“Perhaps you and I can discuss and discover the triggers for your anxiety.”
“Let’s go to your room, and I’ll help you find what your looking for.”
"You've said that...
“During this half-hour, you and I have discussed ..."
“Have in got this straight?”
“You’ve said that . . . .”
“During the past hour, you and I have discussed . . . .”
"I've noticed that in all of the relationships you have discussed, you've been
hurt or rejected when you mention marriage. What do you think this is
about?" "You have mentioned having no one, staying home every weekend,
the phone not ringing. I sense you are lonely."
Client: "I'm dead."
Nurse: "Lifeless?"
Client: "I'm all by myself in this world."
Nurse: "I sense your feeling is one of loneliness."
Client: "I can't talk to you or to anyone. It's a waste of time."
Nurse: "I sense you feel that no one understands."
Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Client: “I’m way out in the ocean.”
Nurse: “You seem to feel lonely or deserted.”
"How can it be that you think you get pregnant and deliver babies in 5 days
when it takes around 280 days for this to happen for other women?"
That's unusual."
Client: “I can’t talk to you or anyone. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”
"Where did you get the idea you were Allah?”
“Isn’t that unusual?”
“Really?”
“That’s hard to believe.”
 NON-THERAPEUTIC TECHNIQUE
Advising—telling the patient what to
solve or how to solve problems
Agreeing—indicating agreement
with client
Approval—sanctioning the patient's
ideas or behavior
Belittling feelings expressed—
misjudging the degree of the
client's discomfort
Challenging—demanding proof
Defending—attempting to protect
someone or some-. thing from verbal
attack
Destructive humor—any humor that
belittles, implies guilt
incompetence, continually refocuses
client on topic selected by nurse, or is
met with client displeasure
Disagreeing—opposing the client's ideas
Nontherapeutic response: "I think you should..." "If I were you, I'd..."
Therapeutic Response: "Let's put our heads together and see how to solve this
problem" or
"What have you already done to try to resolve this situation?"
“I think you should . . .”
“Why don’t you . . . .”
Nontherapeutic responses: "That's right." "I agree."
Therapeutic responses: "What did you think of Fran yelling at you?" or
"What part of this argument did you think was right?"
“That’s right.”
“I agree.”
Nontherapeutic response:
"You were good to have done that..”
"I’m glad that you..."
Therapeutic response:
"Tell me how you think you performed when you told Lucy you were sorry for
hurting her feelings."
"What do you see as the best part of giving a present to Denise?
Nontherapeutic response: "Everybody gets down into the dumps." "I've
felt that way sometimes."
Therapeutic response: "Tell me about being down in the dumps." "You
have the right to your own feelings."
Client: “I have nothing to live for . . .I wish I was dead.”
Nurse: “Everybody gets down in the dumps.”
“I’ve felt that way myself.”
Nontherapeutic response: "But how can you have cancer when all your
tests are negative?" "Why?"
Therapeutic response' "I hear you saying you are still concerned that
you have cancer. Tell me about that." "What went into your choice to
break the window?"
“But how can you be President of the United States?”
“If you’re dead, why is your heart beating?”
Nontherapeutic response: "No one here would lie to you." "Miss ___ is
a very capable nurse."
Therapeutic response: "Who is one person you think lied to you?" "I
can't speak for Miss ___, but I see you are upset. Tell me your
concerns."
“This hospital has a fine reputation.”
“I’m sure your doctor has your best interests in mind.”
or.
Nontherapeutic responses: "That's wrong." "I don't believe that."
Therapeutic responses: "What do you think would happen to you if you

Disapproving—denouncing the client's
actions, thoughts, feelings, or needs
Egocentric focus—occurs in two ways:
1)nurse enjoys being center of attention and
answering questions about self and winds up
being interviewed by the client; 2) nurse is
focused on thinking what to ask next instead
of actively processing client's message.
Giving approval – sanctioning the client’s
behavior or ideas.
Giving literal responses – responding to
figurative comments as though it were a
statement of fact.
Indicating the existence of an external
source— attributing to a source outside the
patient
Interpreting—seeking to make conscious that
which is unconscious
Introducing an unrelated topic—changing Client: "I wish I were dead."
the subject. Nontherapeutic response: "Did you have visitors?"
Therapeutic responses: "Tell me about wishing you were dead." "What
is going on that you wish to be dead?" "Are you planning to commit
jumped off the roof?" "Where did you get the idea you were President
Clinton?"
“That’s wrong.”
“I definitely disagree with . . . .”
“I don’t believe that.”
Nontherapeutic responses: "How can you consider divorce when you
have four children?" "How can having a baby fix your relationship
when you're not even married?" "That's not living by the Golden
Rule." "Get a life." "Shape up." "You need to start a new
relationship."
Therapeutic responses; "What is one reason you are considering
divorce?" "What is one way you believe having a baby would save
your relationship?" "How do you see yourself handling this
problem?"
Nontherapeutic responses: "It is silly to think people want to hurt you."
"You're crazy." You hate to hear the truth."
Therapeutic responses: "Who is one person you believe wants to hurt
you?" "You seem upset." "What is the most difficult concern you have
about your job?"
“That’s bad.”
“I’d rather you wouldn’t . . . “
Nurse: "Tell me about yourself."
Client: "What is to tell. What about you?"
Nontherapeutic response by nurse: "My girlfriend and I love to go
camping. We have been to 36 states so far. We dance and make
stained glass, too."
Therapeutic response: "What is one of your hobbies?”
“That’s good.”
“I’m glad that . . . “
Client: “They’re looking in my head with a television camera.”
Nurse: “Try not to watch television.”
“What channels?”
Nontherapeutic response: "What causes you to feel that way?" "What
makes you say that?"
Therapeutic responses: "Tell me about feeling sad." Where did you get
the idea...."
“What makes you say that?”
“What made you do that?”
“Who told you that you were a prophet?”
Nontherapeutic response: "What you really mean is..." "Unconsciously
you're saying..,"
Therapeutic responses: "Your conversation evolves around Sam's
getting the scholarship. What do you think this is about?"

Judging—rejecting the client's actions,
thoughts, or feelings because they do not
agree with your moral code or life choices.
Requesting an explanation—demanding the Nontherapeutic responses: "Why can't you sleep?" "Why do you feel
rationale for an action, thought, or feeling this way?"
Therapeutic responses: "What do you think is going on that you are
unable to sleep?" "What is one thing your mother does that drives you
up the wall'?"
Testing—appraising the patient's degree of
insight or knowledge unrelated to topic
Using denial—refusing to admit that a problem
exists. Closes off avenue for discussion.
Literal response—dealing with abstract
symbols or metaphors in a concrete manner
Probing—persistent questioning of the client
or asking about unrelated topics
Value statements—judging the actions or
feelings of clients and implying they are good
or bad; making biased statements
suicide?"
Nontherapeutic responses: "You don't need to call your mother at
midnight." 'Don't ever let me hear you are thinking about running
away again."
Therapeutic responses; "What's going on that you feel like running
away?" "Your mom says she gets frightened when you call her at
night. Tell me what you are experiencing so we can work together on
helping you to wait till the morning to call Mom."
Nontherapeutic responses: "What are you here in the hospital for?"
"What day is this?"
Therapeutic responses: "We have been talking about your
disagreement with your son and how he is ungrateful. What have you
learned about yourself in relation to this disagreement?"
Client: "I'm dead."
Nontherapeutic response: "You can't mean that."
Therapeutic responses: "What is one aspect of yourself that has
withered and died?" "What is going on that you say you are dead?"
Client: "My head is going around and around."'
nontherapeutic response: "You're lying perfectly still."
Therapeutic response: "You might be dizzy. When did this start?"
Client: "My head is full of snakes."
Nurse's nontherapeutic response: "Snakes can't live there."
Therapeutic response "Sounds like you have many thoughts squirming
around there. What is the most difficult thought?" Making stereotyped
comments—offering meaningless cliches when client is sad or upset
Nontherapeutic nurse responses: "He'll be a vegetable." "Tomorrow
brings sunshine." "It's all for the best."
Therapeutic responses: "Three tests have revealed no brain activity.
This means his brain has stopped working and he is being kept alive
by the ventilator." "Put your sadness into words." "Tell me thing
you'll miss the most about your brother."
Client: "And so my wife and I split up."
Nontherapeutic response: "Now tell me about your mother."
Therapeutic response: "Tell me about you and your wife splitting
up." Reassuring—trying to make the client feel better superficially
and not to worry or be anxious
Nontherapeutic responses: "Don't worry about your test results. They'll
be alright." "You'll be fine and home soon."
Therapeutic responses: "Tell me your greatest concern at this
moment." "Put your anxiety into words to help me understand."
Rejecting—an angry or punitive response to client’s action, thoughts,
or feelings
Nontherapeutic responses: "That was good of you to pour the coffee."
"Scary movies upset every-one." "That must make you feel horrible to
hear your mother does not want you back home."
Therapeutic responses: "I see you poured the coffee. Thank you."
"What upset you about this scary movie?" "What was your first

Volatile verbiage—harsh, negative, and often
judgmental words, causing client to fee!
increased anxiety and shame
"Yes/no" questions—allows client to give
one-word, dead-end responses that show no
thoughts or emotions
response to hearing your mom did not want you to move back home?”
Nontherapeutic responses: "That was a pretty hostile answer." "You
took the battering-ram approach."
Therapeutic responses: "I could hear you were upset when you
answered. Tell me about that." "What was your feeling just before
you broke the door to your mom's house?"
Nontherapeutie questions: "Will you take your medicine?" "Are you
going out?" "Can you ask for more help?" "Do you worry a lot?"
Therapeutic questions: "When will you be taking your medicine?"
"Where are you going now?" "Whom could you ask to help you with
this situation?" "What causes you to worry?"