1|Basic Concepts in Nursing – LEC
words; that is, words and feelings are
Therapeutic Communication
in the Helping Relationship
OUTLINE:
1. Introduction
2. Characteristics of the Helping Relationship
3. Goals of the Helping Relationship
4. Phases of the Helping Relationship
5. Developing Therapeutic Communication
Skills
6. Therapeutic Communication Techniques
INTRODUCTION
• Therapeutic Communication – promotes
understanding and can help establish a
constructive relationship between the nurse
and the client.
• Helping Relationship – exists among people
who provide and receive assistance in meeting
human needs.
- It sets the climate for the participants
to move towards common goals.
• Nurse-Patient Relationship – when a nurse
(helper) and the patient (person being helped)
are involved in a helping relationship.
- The quality of the relationship
between these individuals is the most
significant element in determining
helping effectiveness.
• Communication – the means used to
establish rapport and helping trust
relationships.
• Unlike a social relationship, the therapeutic
helping relationship is client and goal
directed.
• Nurses need to respond not only to the content
of a client’s verbal message but also to the
feelings expressed. It is important to
understand how the client views the situation
and feels about it before responding.
Sometimes, the nurse may need to know more
about the client and her resources for coping
with these feelings.
• Sometimes people can convey a thought in
words while their emotions contradict the
incongruent.
» Example: A client says, “I am glad he
has left me; he was very cruel.”
However, the nurse observes that the
client has tears in her eyes as she says
this. To respond to the client’s words,
the nurse might simply rephrase,
saying, “You are pleased that he has
left you.” To respond to the client’s
feelings, the nurse would need to
acknowledge the tears in the client’s
eyes, saying, for example, “You seem
saddened by all this.”
• In some instances, clients need time to deal with
their feelings. People usually need to deal with
feelings before they can cope with other matters,
such as learning new skills or planning for the
future.
» Example: Clients with terminal illness
• It is of great importance to remember that helping
relations are professional relationships.
• Nurse can communicate a clear sense of
professionalism through their appearance,
demeanor and behavior.
• Patients and the public are more likely to trust and
value nurses who appear competent and
confident and who are focused on the patients
entrusted to their care.
CHARACTERISTICS OF THE HELPING
RELATIONSHIP
The helping relationship is intangible and,
therefore, difficult to describe. Most authorities
agree, however, that it has at least the following
three basic characteristics:
1. Dynamic
- Both the person providing the
assistance and the person being
helped are active participants to the
extent each is able.
2. Purposeful
Prepared by: GROUP 3 – BSN 1-6
2|Basic Concepts in Nursing – LEC
3. Time-limited
- Both purposeful and time-limited
means there are specific goals that
are intended to be met within a certain
period.
• The person providing the assistance is
professionally accountable for the outcomes of
the relationship and the means used to attain
them.
• The helping person should present his or her
helping abilities as honestly as possible and
not promise to provide more assistance than
he or she can offer.
GOALS OF THE HELPING RELATIONSHIP
• The goals of a helping relationship between a
nurse and a patient are determined
cooperatively and are defined in terms of the
patient’s needs.
• Common Goals might include:
» Increased independence for the
patient
» Greater feelings of worth
» Improved health and well-being
• Selected nursing interventions will help the
person move toward the goal. As the patient’s
needs and goals change, so do the nursing
care interventions implemented to attain the
patient’s goals.
• In the helping relationship between the nurse
and the patient, the focus is on the patient’s
needs.
• Although the nurse might also have many
needs to be met, those are sometimes
temporarily set aside.
PHASES OF THE HELPING RELATIONSHIP
In the helping relationship, the communication
process follows the sequence of the nursing
process. Both processes are continuous and
reciprocal. More often (e.g., in hospital settings),
there are different nurses at different times
implementing different phases of the relationship.
1. Pre-Interaction Phase
- begins when the nurse is assigned to
a patient to develop a therapeutic
relationship with him or her till, she
goes to him or her for interaction.
- it occurs before the actual interaction
with the patient.
2. Introduction/ Orientation Phase
- the tone and guidelines for the
relationship are established.
- the nurse and the patient meet and
learn to identify each other by name.
- it is important to introduce yourself to
the patient; writing your name for the
patient might even be helpful to avoid
confusion and mistrustful of the
patient.
- The following activities generally
occur during this phase:
a. The roles of both people in the
relationship are clarified.
b. An agreement or contract about
the relationship is established.
c. The patient is provided with an
orientation to the healthcare
facility, its services, admission
routines, and any pertinent
information the patient requires
to decrease anxiety.
- Development of a trusting
relationship is critical to the
development of the nurse–patient
relationship.
- During this phase, the patient might
engage in behavior to test the nursing
and healthcare staff especially those
who previously had negative
healthcare experience.
- Exhibiting openness and interest in
the concerns of the patient paves the
way for developing trust and
communicating care and respect.
Prepared by: GROUP 3 – BSN 1-6
3|Basic Concepts in Nursing – LEC
3. Working Phase
- usually the longest phase of the
helping relationship.
- during this phase, you will work
together with the patient to meet the
patient’s physical and psychosocial
needs.
- The main essence of this phase is
interaction.
- The following activities are
generally seen during this phase:
a. Nurse provides whatever
assistance might be needed to
achieve each goal.
» Example: If an older patient has a
poor appetite and the goal is to
increase food intake, the nurse
discusses the idea of small, more
frequent meals with the patient.
With the patient’s approval, the
nurse makes the necessary
arrangements.
b. Nurse as caregiver provides the
patient with whatever
assistance might be needed to
perform activities of daily living.
» Example: If a patient with
impaired mobility is unable to get
out of bed except to use a
bedside commode, the nurse
needs to help with daily hygiene.
c. Nursing roles of teacher and
counselor are performed
primarily to motivate the patient
to learn and to implement health
promotion activities, to facilitate
the patient’s ability to execute
the plan of care, and to express
feelings about health problems,
nursing care, any progress or
setbacks, and any other areas
of concern.
- This phase is where the nurse’s
interpersonal skills are used to their fullest.
- A breakdown of the helping relationship on
one of these levels could result in serious
consequences.
» Example: a patient begins to
break clinic appointments,
although he previously seemed to
be interested in his health when
he visited the clinic. “The nurse at
the clinic seems too busy; she
doesn’t seem to care if I come or
go to that clinic.”
(the lack of satisfactory
interaction between the
nurse and the patient
discouraged him from
continuing the relationship,
even at the expense of his
health)
- Satisfactory interaction preserves people’s
integrity while promoting an atmosphere
characterized by minimal fear, anxiety,
distrust, and tension.
- People will tend to feel harmonious and
contented with each other as they work
cooperatively to reach common goals.
4. Termination Phase
- occurs when the conclusion of the initial
agreement is acknowledged.
- happens at change of-shift time, when
the patient is discharged, or when a
nurse leaves on vacation or for
employment elsewhere.
- During this phase, the nurse will
examine with the patient the goals of
the helping relationship for indications
of their attainment or for evidence of
progress toward them.
» If the goals/outcomes have been
reached, this fact should be
acknowledged that results in a
feeling of satisfaction for the
patient and nurse.
» If the goals/outcomes have not
been reached, the progress can
be acknowledged and either the
patient or the nurse might make
suggestions for future efforts.
Prepared by: GROUP 3 – BSN 1-6
4|Basic Concepts in Nursing – LEC
- Emotions are usually associated in this phase.
» If the goals have been met, there
is often regret about ending a
satisfying relationship, even
though a sense of
accomplishment persists.
» If the goals have not been
achieved, the patient might
experience anxiety and fear
about the future.
- Preparing for the termination of the helping
relationship can be done in various ways:
a. Set the stage for the patient to establish
a helping relationship with another
nurse, if appropriate.
b. Assist the patient transferring from one
agency to another or from one unit in an
agency to another by offering
explanations concerning the transfer.
- This phase occasionally causes a negative
emotional reaction such as the patient might
feel angry or depressed and helpless.
However, these are less likely to occur if the
patient has been involved in establishing goals
and has been helped to anticipate termination
of the helping relationship.
DEVELOPING THERAPEUTIC
COMMUNICATION SKILLS
Although humans communicate during virtually all
waking moments, the therapeutic use of
communication requires training and practice.
1. Conversation Skills
- Conversation or the exchange of verbal
communication, is constantly learned over
time. However, as a nurse, improving their
communications with patients is essential to
achieve a more effective helping relationship.
- This can be improved in the following ways:
a. Control the tone of your voice so that you
are conveying exactly what you mean to
say and not a hidden message.
b. Be knowledgeable about the topic of
conversation and have accurate
information. If the topic is unfamiliar, it is
best to tell the patient and family and to
direct them to other resources.
c. Be flexible.
d. Be clear and concise, and make
statements as simple as possible.
e. Avoid words that might have different
interpretations.
f. Be truthful.
g. Keep an open mind.
h. Take advantage of available opportunities.
2. Listening Skills
- Listening is a skill that involves both hearing
and interpreting what the other says. It
requires attention and concentration to sort
out, evaluate, and validate clues to better
understand the true meaning of what is being
said.
- The following recommended techniques
might help to improve listening skills:
a. When possible, sit when
communicating with a patient. Do not
cross your arms or legs because that
body language conveys a message of
being closed to the patient’s comments.
b. Be alert and relaxed and take sufficient
time so that the patient feels at ease
during the conversation.
c. Keep the conversation as natural as
possible, and avoid sounding overly
eager.
d. If culturally appropriate, maintain eye
contact with the patient, without staring,
in a face-to-face pose. This technique
conveys interest in the conversation
and willingness to listen.
e. Indicate that you are paying attention to
what the patient is saying by using
appropriate facial expressions and
body gestures. Be attentive to both your
own and the patient’s verbal and
nonverbal communication.
f. Think before responding to the patient.
g. Do not pretend to listen.
h. Listen for themes in the patient’s
comments.
> What are the repeated themes in the
person’s speech and behavior?
> What topics does the patient tend to
avoid?
Prepared by: GROUP 3 – BSN 1-6
5|Basic Concepts in Nursing – LEC
> What subjects tend to make the
patient shift the conversation to other
subjects?
> What inconsistencies and gaps
appear in the patient’s conversations?
3. Silence
- The nurse can use this appropriately by
taking the time to wait for the patient to
initiate or to continue speaking.
- During this period, reflect on what has
already been shared and observe the
patient without having to concentrate
simultaneously on the spoken word.
- Periods of silence can carry the following
meanings:
a. The patient might be comfortable and
content in the nurse–patient
relationship. Continuous talking is
unnecessary.
b. The patient might be trying to
demonstrate stoicism and the ability to
cope without help.
c. The patient might be exploring his or her
inner thoughts or feelings, and
conversation would disrupt this. In
effect, the patient is really saying, “I
need some time to think.”
d. The patient might be fearful and use
silence as an escape from a threat.
e. The patient might be angry and use
silence to display this emotion.
4. Touch
- Touch a powerful means of communication
with multiple meanings.
- It can connect people; provide affirmation,
reassurance, and stimulation; decrease
loneliness; increase self-esteem; and share
warmth, intimacy, approval, and emotional
support.
- It can also communicate frustration, anger,
aggression, and punishment; invade
personal space and privacy; and convey a
negative (e.g., subservient) type of
relationship with another.
- Many situations require touching the patient
while implementing nursing care. Therefore,
every nurse needs to become comfortable
with the judicious use of this nonverbal
communication technique so that a sense of
security, rather than anxiety, results.
- Therapeutic Touch involves “unruffling,” or
clearing, congested areas of energy in the
body and redirecting this energy. After this,
it uses therapeutic touch to promote
comfort, relaxation, healing, and a sense of
well-being.
5. Humor
- Humor is increasingly valued as both an
interpersonal skill for the nurse and a
healing strategy for patients.
- Nurses have a valuable tool when they can
use humor effectively to maintain a
balanced perspective in their work and to
encourage patients to do the same.
- Nurses with a sense of humor are able to
laugh at themselves and accept their
failures, confront the absurdities of
everyday practice without falling apart, and
challenge patients to situate their current
dilemma within the context of their larger life
experiences.
- When used inappropriately, however, it can
be destructive so you’ll need an awareness
of how various cultures perceive the use of
humor in the presence of an illness
(Facente, 2006).
6. Assertiveness Skills
- Assertive Behaviors are one hallmark of
professional nursing relationships, need to
be distinguished from aggressive (i.e.,
harsh, injurious, or destructive) behaviors.
- The key to assertiveness is open, honest,
and direct communication.
- “I” statements— “I feel . . .” and “I think . .
.”—play an important role in assertive
statements.
- Four Basic Components of the Assertive
Response or Approach
a. Having empathy
b. Describing one’s feelings or the situation
c. Clarifying one’s expectations
d. Anticipating consequences
» Example:
A student who is feeling overwhelmed by
her weekly clinical assignments might
communicate the following to her
instructor:
Prepared by: GROUP 3 – BSN 1-6
6|Basic Concepts in Nursing – LEC
Empathy: “I guess it must be hard for
you to make our clinical assignments
each week and to know what each
one of us needs.”
Description: “I have to share with you
that right now I feel so overwhelmed
that I go home from clinical in tears
each week.”
Expectation: “I am wondering if we
could talk about this. I am willing to
work hard, but I seem to need some
help pulling everything together.”
Consequences: “I expect to do well in
clinical but I am afraid that if things
continue the way they are right now, I
might not last the semester. I would
appreciate any help you can give me.”
- Characteristics of the Assertive Nurse’s
Self-presentation
a. Confident
b. Open body posture
c. Eye contact
d. Use of clear
e. Concise “I” statements
f. Ability to share honestly one’s
thoughts, feelings, and emotions
- Characteristics of the Assertive Nurse’s
Attitude toward Work
a. Working to capacity with or without
supervision
b. Ability to remain calm under
supervision
c. Freedom to ask for help when
necessary
d. Ability to give and accept compliments
e. Honesty in admitting mistakes and
taking responsibility for them.
THERAPEUTIC COMMUNICATION
TECHNIQUES
Every nurse needs to become proficient in the use
of the communication techniques described
previously as well as interviewing techniques
designed to gather and validate information.
• The following techniques are useful in nearly
all nurse–patient interactions, especially during
the assessment step of the nursing process.
1. Using Silence
- Acknowledging pauses or silences that
may last several seconds or minutes
without a spoken response.
» Example: Sitting quietly (or walking
with the client) and waiting
attentively until the client is able to
put thoughts and feelings into
words.
2. Providing General Leads
- Using remarks or inquiries that encourage
the client to verbalize, selecting a topic of
discourse, and facilitating ongoing
articulation.
» Example:
“Can you tell me how it is for you?”
“Perhaps you would like to talk
about. .”
“Would it help to discuss your
feelings?”
“Where would you like to begin?”
“And then what?”
3. Being specific and tentative
- Presenting specific statements rather than
generic remarks, as well as tentative rather
than absolute assertions.
» Example:
“Rate your pain on a scale of zero to
ten.” (specific statement)
“Are you in pain?” (general
statement)
“You seem unconcerned about your
diabetes.” (tentative statement)”
4. Using open-ended questions
- Broad inquiries that lead or invite the
client to explore thoughts or feelings
(elaborate, elucidate, define, contrast,
or demonstrate).
- Open-ended questions merely identify
the topic to be discussed and invite
responses that are more than one or
two sentences long.
Prepared by: GROUP 3 – BSN 1-6
7|Basic Concepts in Nursing – LEC

- The nurse might rephrase the core

message or admit misunderstanding
» Example:
and ask the client to repeat or restate
“I’d like to hear more about that.”
the message to clarify the message.
“Tell me more. . . .”
- Nurses can also use remarks to explain
“How have you been feeling lately?”
their own message.
“What brought you to the hospital?”
“What is your opinion?”
» Example:
“You said you were frightened
“I’m not sure I understand that.”
yesterday. How do you feel now?”
“Would you please say that again?”
“Would you tell me more?”
5. Using touch
“I meant this rather than that.”
- Using suitable types of contact to foster
“I’m sorry that wasn’t very clear. Let me
sentiments of compassion.
try to explain another way.”
- Because tactile encounters vary greatly
amongst persons, families, and
8. Perception checking or seeking
cultures, the nurse must be aware to
consensual validation
variances in client and self-attitudes
- An approach similar to clarifying in
and practices.
which the meaning of single words is
verified rather than the overall meaning
» Example: Putting an arm over the
of a communication.
client’s shoulder. Placing your hand
over the client’s hand.
» Example:
Client: “My husband never gives me
6. Restating or paraphrasing
any presents.”
- Actively listening for the fundamental
Nurse: “You mean he has never
message from the client and then
given you a present for your birthday
echoing those ideas and/or feelings in
or Christmas?”
comparable wording.
Client: “Well—not never. He does
- This indicates that the nurse has get me something for my birthday
listened to and comprehended the and Christmas, but he never thinks
client's core message, as well as of giving me anything at any other
providing clients with a greater time.”
understanding of what they have
stated. 9. Offering Self
- Suggesting one's presence, curiosity,
» Example:
or desire to comprehend the client
Client: “I couldn’t manage to eat any
without making any demands or
dinner last night— not even the
attaching conditions to gain the nurse's
dessert.”
attention.
Nurse: “You had difficulty eating
yesterday.”
» Example:
Client: “Yes, I was very upset after
“I’ll stay with you until your daughter
my family left.”
arrives.”
“We can sit here quietly for a while;
7. Seeking clarification
we don’t need to talk unless you
- A technique for making the client's would like to.”
overall understanding of the content “I’ll help you to dress to go home, if
more understandable. you like.”
- When paraphrase is difficult or when
communication is meandering or
jumbled, it is utilized.

Prepared by: GROUP 3 – BSN 1-6

8|Basic Concepts in Nursing – LEC
10. Giving Information
- Providing particular factual information
that the client may or may not desire in
a straightforward and direct manner.
- When information is unavailable, the
nurse informs the patient and tells who
has it or when it will be obtained.
» Example:
“Your surgery is scheduled for 11 am
tomorrow.”
“You will feel a pulling sensation
when the tube is removed from your
abdomen.”
“I do not know the answer to that,
11. Acknowledging
- Recognizing a shift in behavior, an
effort made by the client, or a
contribution to a dialogue in a
nonjudgmental manner.
- Acknowledgment might be vocal or
nonverbal, with or without
comprehension.
» Example:
“You trimmed your beard and
mustache and washed your hair.”
“I notice you keep squinting your
eyes. Are you having difficulty
seeing?”
“You walked twice as far today with
your walker.”
12. Clarifying time or sequence
- Assisting the client in clarifying a time-
related event, circumstance, or
incident.
» Example:
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.”
13. Presenting Reality
- Assisting the client in distinguishing
between the genuine and the
imaginary.
» Example:
“That telephone ring came from the
program on television.”
“Your magazine is here in the
drawer. It has not been stolen.”
14. Focusing
- Assisting the client in expanding on and
developing an important issue.
- Before attempting to focus, the nurse
should wait until the client has finished
presenting the key issues.
- The focus may be a concept or a
sensation; nevertheless, the nurse
frequently stresses a feeling to assist
the client in recognizing an emotion
hidden behind words.
» Example:
Client: “My wife says she will look
after me, but I don’t think she can,
what with the children to take care of,
and they’re always after her about
something—clothes, homework,
what’s for dinner that night.”
Nurse: “Sounds like you are worried
about how well she can manage.”
15. Reflecting
- Returning ideas, sentiments,
questions, or information to clients in
order for them to investigate their own
thoughts and feelings about a problem.
» Example:
Client: “What can I do?”
Nurse: “What do you think would be
helpful?”
Client: “Do you think I should tell my
husband?”
Nurse: “You seem unsure about
telling your husband.”
16. Summarizing and Planning
- To explain the key issues mentioned,
state the major points of a discussion.
- This strategy can be used at the end of
an interview or to go over a health
education session.
- It is frequently used as an introduction
to future care planning.
-
Prepared by: GROUP 3 – BSN 1-6
9|Basic Concepts in Nursing – LEC

» Example:
“During the past half hour we have
talked about. . . .”
“Tomorrow afternoon we may
explore this further.”
“In a few days I’ll review what you
have learned about the actions and
effects of your insulin.”
“Tomorrow, I will look at your
journal.”

REFERENCES:
Berman, A., et. al. (2021). Therapeutic
Communication. In Kozier and Erb's fundamentals
of nursing: Concepts, process and Practice (11th
Edition, pp. 304–307). essay, Pearson Australia.
Taylor, C. (2010). Using Therapeutic
Communication in the Helping Relationship. In
Fundamentals of Nursing: The art and science of
nursing care (7th ed., pp. 445–457). essay,
Wolters Kluwer Health/Lippincott Williams &
Wilkins.

BSN 1-6 Group 3:

Leader: Teodoro, Frances Kay

Members:
Fiedalino, Ralf F.
Garcia, Julianna Clarisse R.
Gole Cruz, Amanda Louisse D.
Hermosa, Jhynne Frix V.
Imbien, Lalaine B.
Lara, King Abel D.
Lipa, Al Rashedy B.
Maravilla, Mira Dianna C.
Ordonio, Linus Reuben B.
Ortega, Akira Antonetter P.

Prepared by: GROUP 3 – BSN 1-6