THERAPEUTIC COMMUNICATION TECHNIQUES
Communication Rationale
Technique
Acceptance Positive regard and open to
communication
Asking Direct Questions Tells the client nurse is focused and
attentive to their concerns. Encourages
development of therapeutic
communication.
Challenging distorted Break through denial or fixed belief.
idea/belief system Always done with a question and done
Voicing Doubt gently.
Clarification Assures that nurse did not
misunderstand; encourages further
exploration
Close-ended Questions A close-ended question that elicits a
(when they are “Yes” or “No” Answer. It can be used to
appropriate) (a) gain clarification, (b) expand a
previous statement or (c)
Use to help clarify, initiate, or continue a
conversation in an effort to demonstrate
understanding of the client or client’s
concerns.
Confrontation (of The nurse approaches the client in a
inconsistencies) direct manner, usually because of
perceived discrepancies in the client’s
behavior. Used to help the client develop
an awareness of incongruent behavior.
Needs to be done in an accepting,
nonthreatening manner and only after
rapport has been established.
Encouragement Encourages client to continue
Exploring in detail If it appears a particular topic is
important, then the nurse asks for more
detail. Nurse then takes the lead from the
client (client may resist exploring further)
Focusing Use when a client is covering multiple
topics rapidly (bipolar/anxious) and
needs help focusing
Example
“I hear what you are saying. Yes, uh-huh (full
attention)
“How do you feel about your hospitalization?”
“How do you see your progress?”
“Who told you that you were incompetent?
“Where did you get the idea that you can’t say
no?”
“It’s hard to believe that happened to you”
“This is what I thought you said. . .is that
correct?”
(a) See above: “clarification”
(a) “Have you had any thoughts of harming
yourself?”
(b) Explain something and ask, “did you
understand what was just said?” Then, if
appropriate, ask client, to repeat what they
heard or what they think they understood.
(c) A client tells the nurse, “I don’t think I’ll
ever get out of here.” A therapeutic response,
“You don’t think you are making progress?”
invites a “Yes” or “No” answer that may lead to
the
nurse stating, “Tell me more.”
“You said you would regularly attend the self-
care-management group sessions, but you
failed to show up for group today without a
good reason.”
“Tell me more …uh huh . . . and then?”
“This is the first time I’ve heard you talk about
your sister; would you like to tell me more
about her?”
“A lot is going on, but let’s discuss the issue of
your job loss, as I would like to hear more about
that.”
Making observations Helps client recognize feelings he/she Every time we talk about your father you
may not be aware of and connect with become very sad.
behaviors
Communication Rationale Example
Technique
Metaphors/symbols Sometimes clients speak to us in symbolic Client: The sky is just so grey today and night
ways and need translation comes so early now.
Nurse: Sounds like you are feeling somber.
Open-ended-broad Encourages client to take responsibility “What would like to deal with in this session?”
questions for direction of session; avoids yes/no
responses
Paraphrasing Restating using different words to assure Client: My grandkids are coming over today and
you have understood the client; helps I don’t feel well.
clarify Nurse: Your grandkids are coming over, but you
wish they weren’t, because you are not well. Is
that what you are saying?
Recognizing Reinforces interest in client and positive “I noticed that you were able to start our
change/recognition reinforcement (this is not a compliment) session today rather than just sit there.”
Reflecting Reflects back to clients their emotions, Client: John never helps with the housework.
using their own words. Nurse: John never helps you with the
housework?
Reframing Presenting same information from Client: I lost my keys, couldn’t find the report,
another perspective (more positive) and barely made it in time to turn my report in.
Nurse: In spite of all that, you did turn your
report in.
Silence Allows client to explore all Professional nods with some vocal cues from
thoughts/feelings; prevents cutting time to time so client knows nurse is listening,
conversation at a critical point or missing but does not interject.
something important.
Summarizing Commenting at the end of a therapeutic “During the past hour we talked about your
interaction or a nurse-client therapeutic plans for the future. They include the
session to briefly identify issues following.”
discussed. “You’ve explained several issues that resulted in
your job loss.”

NONTHERAPEUTIC COMMUNICATION TECHNIQUES

Nontherapeutic Technique Examples
Reassuring (falsely) “I wouldn’t worry about that now.”
“Everything will be all right”
“You’re coming along fine.”
Giving unwarranted approval “It sounds good to me.”
“I’m glad that you did that.”
Rejecting “Let’s not discuss that right now.”
“I don’t want to hear about that.”
Disapproving unnecessarily “That’s bad.”
“I’d rather you wouldn’t.”
Agreeing against better judgment “That’s right.”
“I agree with you.”

Disagreeing unnecessarily “That’s wrong.”

“I definitely disagree with that.”
“I don’t believe that.”
Advising without giving alternatives “I think you should do this.”
“Why don’t you do that?”
Probing for nontherapeutic reasons “Tell me your life history.”

Nontherapeutic Technique Examples

Challenging “But how can you possibly be president of the United States?”
“If you’re dead, how come you’re talking?”
Testing unnecessarily “What day is this?”
“Do you know what kind of a hospital this is?”
“Do you still have the idea that you’re president?”
Defending “This hospital has a fine reputation.”
“No one here would ever lie to you.”
“Dr. S. is a very able psychiatrist. I’m sure that he has your welfare in
mind when he did that.”
Requesting an explanation “Why do you think that?”
“Why do you feel this way?”
“Why did you do that?”
Indicating the existence of an external “What makes you say that?”
source “Who told you that you were Jesus?”
“What made you do that?”
Belittling expressed feelings Client: “I have nothing to live for…I wish I was dead.”
Nurse: “Everybody gets down in the dumps. (or) “I’ve felt that way
before.”
Making stereotyped comments ”Nice weather we’re having.”
“I’m fine, how are you?”
“It’s for your own good.”
“Keep your chin up.”
“Just listen to your doctor and join the activities. You’ll be home in
no time.”
Giving literal responses Client: “I’m the Wizard of Oz.”
Nurse: “You don’t look like him. He’s much older than you.”

Client: “Those people on television are talking to me.”

Nurse: “Try not to watch television.” (or) “On which channel?”
Ignoring the client’s feelings or thoughts Client: “I’m nothing.”
Nurse: “Of course you’re something. Everybody is somebody.”
Interpreting “What you really mean is that you’re somebody special.”
“Unconsciously, you’re saying this.”
Introducing an unrelated topic (ignoring Client: “I’d like to die.”
client’s message) Nurse: “Did you have visitors this weekend?”
 Words Count: Strengths Based
Language

Deficit-based Language Strengths-based, Recovery-oriented Alternative

A schizophrenic, a borderline A person diagnosed with schizophrenia who experiences the

following…
An addict/junkie **A person diagnosed with an addiction that experiences
the following…
Clinical Case Manager Recovery Coach/Recovery Guide (I’m not a case, and you’re not
my manager!)
Front-line staff/in the trenches Direct care/support staff providing compassionate care

Substance abuse/abuser Person with an addiction to substances; substance use

interferes with person’s life

Suffering from Working to recover from; experiencing; living with

Treatment Team Recovery Team, Recovery Support System

LMHA Local Mental Health AUTHORITY Recovery and Wellness Center

High-functioning vs. Low Functioning Person’s symptoms interfere with their relationship (work
habits, etc.) in the following way…
Acting-out Person disagrees with Recovery Team and prefers to use
alternative coping strategies
Self-help Recovery support groups/mutual aid groups

Unrealistic Person has high expectations for self and recovery

Denial, unable to accept illness, lack of insight Person disagrees with diagnosis; does not agree that they have a
mental illness pre-contemplative stage of recovery

Weaknesses Barriers to change; needs

Unmotivated Person is not interested in what the system has to offer; interests
and motivating incentives unclear; preferred options not
available
Resistant Not open to… Chooses not to…Has own ideas…

Clinical decompensation, relapse, failure Person is re-experiencing symptoms of illness/addiction; an

opportunity to develop and/or apply coping skills and to
draw meaning from managing an adverse event: Re-
occurrence

Content of table derived from the following sources: Tondora and Davidson, 2006; White, 2001; and Meta
Services, 2005.
Deficit-based Language Strengths-based, Recovery-oriented Alternative

Content of table derived from the following sources: Tondora and Davidson, 2006; White, 2001; and Meta
Services, 2005.
Maintaining clinical stability/abstinence Promoting and sustaining recovery

Untreated alcoholics People not yet in recovery; pre-

contemplative/contemplative stage of recovery
Prevent suicide Promote life

Puts self/recovery at risk Takes chances to grow and experience new things

Non-compliant with medications/treatment Prefers alternative coping strategies (e.g., exercise, structures
time, spends time with family) to reduce reliance on
medication; Has a crisis plan for when meds should be used;
beginning to think for oneself
Minimize risk Maximize growth

Consumer (in addictions community) Person in recovery, person working on recovery

Patient (in mental health community) Individual, consumer, person receiving services

Treatment works Person uses treatment to support his/her recovery

Treatment system Recovery Community

Discharged to aftercare Connected to long-term recovery management

Enable Empower the individual through empathy, emotional

authenticity, and encouragement
Frequent Flyer Takes advantage of services and supports as necessary

Dangerous Specify behavior

Manipulative Resourceful; really trying to get help

Entitled Aware of one’s rights

DTO/DTS/GD Describe behaviors that render one danger to self/others, etc

Baseline What a person looks like when they are doing well

Helpless Unaware of capabilities

Hopeless Unaware of opportunities

Grandiose Has high hopes and expectations of self

User of the system Resourceful; good self-advocate

Content of table derived from the following sources: Tondora and Davidson, 2006; White, 2001; and Meta
Services, 2005.