Therapeutic Communication Techniques

The social worker can use many therapeutic communication techniques to interact with clients. The
choice of technique depends on the intent of the interaction and the client’s ability to communicate
verbally. Overall, the social worker selects techniques that facilitate the interaction and enhance
communication between client and social worker.

In contrast, there are many nontherapeutic techniques that social workers should avoid. These
responses cut off communication and make it more difficult for the interaction to continue. Many of
these responses are common in social interaction such as advising, agreeing, or reassuring. Therefore,
it takes practice for the social worker to avoid making these typical comments.

Therapeutic Examples Rationale

Communication
Technique
Accepting - indicating
reception
Broad openings - allowing
the client to take the
initiative in introducing
the topic
Consensual validation -
searching for mutual
understanding, for accord
in the meaning of the
words
Encouraging comparison -
asking the similarities and
differences be noted
“Yes” An accepting response indicates the social worker
“I follow what you has heard and followed the train of thought. It does
said.” not indicate agreement but is nonjudgmental.
Nodding Facial expression, tone of voice, and so forth also
must convey acceptance or the words lose their
meaning.
“Is there Broad openings make explicit that the client has the
something you’d lead in the interaction. For the client who is
like to talk hesitant about talking, broad openings may
about?” stimulate him or her to take the initiative.
“Where would
you like to begin?”
“Tell me whether For verbal communication to be meaningful, it is
my understanding essential that the words being used have the same
of it agrees with meaning for both (all) participants. Sometimes,
yours.” words, phrases, or slang terms have different
“Are you using meanings and can be easily misunderstood.
this word to
convey that . . .?”
“Was it something Comparing ideas, experiences, or relationships
like . . .? bring out many recurring themes. The client
“Have you had benefits from making these comparisons because
similar he or she might recall past coping strategies that
experiences?” were effective or remember that he or she has

Encouraging description
of perceptions - asking
the client to verbalize
what he or she perceives.
Encouraging expression -
asking the client to
appraise the quality of his
or her experiences
Exploring - delving further
into a subject or idea.
Focusing - concentrating
on a single point
Formulating a plan of
action - asking the client
to consider kinds of
behavior likely to be
appropriate in future
situations
General leads - giving
encouragement to
continue
Giving information -
making available the facts
that the client needs
survived a similar situation.
“Tell me when you To understand the client, the social worker must
feel anxious.” see things from his or her perspective. Encouraging
“What is the client to describe ideas fully may relieve the
happening?” tension the client is feeling, and he or she might be
“What does the less likely to take action on ideas that are harmful
voice seem to be or frightening.
saying?”
“What are your The social worker asks the client to consider people
feelings in regard and events in light of his or her own values. Doing
to . . . ?” so encourages the client to make his or her own
“Does this appraisal rather than to accept the opinion of
contribute to your others.
distress?”
“Tell me more When clients deal with topics superficially,
about that.” exploring can help them examine the issue more
“Would you fully. Any problem or concern can be better
describe it more understood if explored in depth. If the client
fully?” expresses an unwillingness to explore a subject,
“What kind of however, the social worker must respect his or her
work?” wishes.
“This point seems The social worker encourages the client to
worth looking at concentrate his or her energies on a single point,
more closely.” which may prevent a multitude of factors or
“Of all the problems from overwhelming the client. It is also a
concerns you’ve useful technique when a client jumps from one
mentioned, which topic to another.
is most
troublesome?”
“What could you It may be helpful for the client to plan in advance
do to let your what he or she might do in the future similar
anger out situations. Making definite plans increases the
harmlessly?” likelihood that the client will cope more effectively
“Next time this in similar situation.
comes up, what
might you do to
handle it?”
“Go on.” General leads indicate that the social worker is
“And then?” listening and following what the client is saying
“Tell me about it.” without taking away the initiative for the
interaction. They also encourage the client to
continue if he or she is hesitant or uncomfortable
about the topic.
“My name is . . . “ Informing the client of facts increases his or her
“Visiting hours are knowledge about a topic or lets the client know
...“ what to expect. The social worker is functioning as
“My purpose of a resource person. Giving information also builds

Giving recognition -
acknowledging, indicating
awareness
Making observations -
verbalizing what the social
worker 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
being here is . . . “ trust with the client.
“Good morning, Greeting the client by name, indicating awareness
Mr. S. . . . “ of change, or noting efforts the client has made all
“You’ve finished show that the social worker recognizes the client as
your list of things a person, as an individual.
to do.”
“I notice that
you’ve combed
your hair.”
“You appear Sometimes clients cannot verbalize or make
tense.” themselves understood. Or the client may not be
“Are you ready to talk.
uncomfortable
when . . . “
“I notice that
you’re biting your
lip.”
“I’ll sit with you The social worker can offer her presence, interest
awhile.” and desire to understand. It is important that this
“I’ll stay here with offer is unconditional, that is, the client does not
you.” have to respond verbally to get the social worker’s
“I’m interested in attention.
what you think.”
“What seemed to Putting events in proper sequence helps both the
lead up to . . . ? social worker and client see them in perspective.
“Was this before The client may gain insight into cause-and-effect
or after . . . ? behavior and consequences, or the client may be
“When did this able to see that perhaps some things are not
happen?” related. The social worker may gain information
about recurrent patterns or themes in the client’s
behavior or relationships.
“I see no one else When it is obvious that the client is misinterpreting
in the room.” reality, the social worker can indicate what is real.
“That sound was a The social worker does this by calmly and quietly
car backfiring.” expressing the social worker’s perceptions of the
“Your mother is facts, not by way of arguing with the client or
not here; I am a belittling his or her experience. The intent is to
social worker.” indicate an alternative line of thought for the client
to consider, not to “convince” the client that he or
she is wrong.
Client: “Do you Reflection encourages the client to recognize and
think I should tell . accept his or her own feelings. The social worker
..? indicates that the client’s point of view has value,
Social worker: “Do and that the client has the right to have opinions,
you think you make decisions, and think independently.
should?”
Client: “My
brother spends all
my money and

Restating - repeating the
main idea expressed
Seeking information -
seeking to make clear that
which is not meaningful or
that which is vague
Silence - absence of verbal
communication, which
provides time for the
client to put thoughts or
feelings into words, to
regain composure, or to
continue talking
Suggesting collaboration -
offering to share, to strive,
to work with the client for
his or her benefit
Summarizing - organizing
and summing up that
which has gone before
Translating into feelings -
seeking to verbalize
client’s feelings that he or
she expresses only
indirectly
then has never to
ask for more.”
Social worker:
“This causes you
to feel angry?”
C: “I can’t sleep. I The social worker repeats what the client has said
stay awake all in approximately or nearly the same words the
night.” client has used. This restatement lets the client
SW: “You have know that he or she communicated the idea
difficulty effectively. This encourages the client to continue.
sleeping.” Or if the client has been misunderstood, he or she
C: “I’m really mad, can clarify his or her thoughts.
I’m really upset.”
SW: “You’re really
mad and upset.”
“I’m not sure that The social worker seek clarification throughout
I follow.” interactions with clients. Doing so can help the
“Have I heard you social worker to avoid making assumptions that
correctly?” understanding has occurred when it has not. It
helps the client to articulate thoughts, feelings, and
ideas more clearly.
Social worker says Silence often encourages the client to verbalize,
nothing but provided that it is interested and expectant. Silence
continues to gives the client time to organize thoughts, direct
maintain eye the topic of interaction, or focus on issues that are
contact and most important. Much nonverbal behavior takes
conveys interest. place during silence, and the social worker needs to
be aware of the client and his or her own nonverbal
behavior.
“Perhaps you and The social worker seeks to offer a relationship in
I can discuss and which the client can identify problems in living with
discover the others, grow emotionally, and improve the ability
triggers for your to form satisfactory relationships. The social worker
anxiety.” offer to do things with, rather than for the client.
“Have I got this Summarization seeks to bring out the important
straight?” points of the discussion and to increase the
“You’ve said that . awareness and understanding of both participants.
. .” It omits the irrelevant and organizes the pertinent
“During the past aspects of the interaction. It allows both client and
hour, you and I social worker to depart with the same ideas and
have discussed . . provides a sense of closure at the completion of
.” each discussion.
C: “I’m dead.” Often what the client says, when taken literally,
SW: “Are you seems meaningless or far removed from reality. To
suggesting that understand, the social worker must concentrate on
you feel lifeless?” what the client might be feeling to express himself
C: “I’m way out in or herself this way.
the ocean.”
SW: “You seem to

Verbalizing the implied -
voicing what the client has
hinted at or suggested
Voicing doubt - expressing
uncertainty about the
reality of the client’s
perceptions
Nontherapeutic Communication Techniques
Advising - telling the client
what to do
Agreeing - indicating
accord with the client
Belittling feelings
expressed - misjudging
the degree of the client’s
discomfort
feel lonely or
deserted.”
C: “I can’t talk to Putting into words what the client has implied or
you or anyone. It’s said indirectly tends to make the discussion less
a waste of time.” obscure. The social worker should be as direct as
SW: “Do you feel possible without being unfeelingly blunt or obtuse.
that no one The client may have difficulty communicating
understands?” directly. The social worker should take care to
express only what is fairly obvious; otherwise, the
social worker may be jumping to conclusions or
interpreting the client’s communication.
“Isn’t that Another means of responding to distortions of
unusual?” reality is to express doubt. Such expression permits
“Really?” the client to become aware that others do not
“That’s hard to necessarily perceive events in the same way or
believe.” draw the same conclusions. This does not mean the
client will alter his or her point of view, but at least
the social worker will encourage the client to
consider or re-evaluate what has happened. The
social worker agreed nor disagreed; however, he or
she has no let the misperceptions and distortions
pass without comment.
“I think you Giving advice implies that only the social worker
should . . .” knows what is best for the client.
“Why don’t you . .
.“ Approval indicates the client is “right” rather than
“That’s right.” “wrong.” This gives the client the impression that
“I agree.” he or she is “right” because of agreement with the
social worker. Opinions and conclusions should be
exclusively the client’s. When the social worker
agrees with the client, there is no opportunity for
the client to change his mind without being
“wrong.”
C:”I have nothing When the social worker tries to equate the intense
to live for . . . I and overwhelming feelings of the client has
wish I was dead.” expressed to “everybody” or to the social worker’s
SW: “Everybody own feelings, the social worker implies that the
 gets down in the discomfort is temporary, mild, self-limiting, or not
dumps,” or “I’ve very important. The client is focused on his or her
felt that way own worries and feelings; hearing the problems or
myself.” feelings of other is not helpful.
Challenging - demanding “But how can you Often the social worker believes that if she can
proof from the client be president of challenge the client to prove unrealistic ideas, the
the Philippines?” client will realize there is no “proof” and then will
“If you’re dead, recognize reality. Actually, challenging causes the
why is your heart client to defend the delusions or misperceptions
beating?” more strongly than before.
Defending - attempting to “This agency has a Defending what the client has criticized implies that
protect someone or fine reputation.” he has no right to express impressions, opinions, or
something from verbal “I’m sure your feelings. Telling the client that his or her criticism is
attack father has your unjust or unfounded does not change the client’s
best interest in feelings but only serves to block further
mind.” communication.

Disagreeing - opposing “That’s wrong.” Disagreeing implies the client is “wrong.”

the client’s ideas “I definitely Consequently, the client feels defensive about his
disagree with . . . “ or her point of view or ideas.
“I don’t believe
that.”
Disapproving - “That’s bad.” Disapproval implies that the social worker has the
denouncing the client’s “I’d rather you right to pass judgment on the client’s thoughts or
behavior or ideas wouldn’t . . . ” actions. It further implies that the client is expected
to please the social worker.
Giving approval - “That’s good.” Saying what the client thinks or feels is “good”
sanctioning the client’s “I’m glad that . . . implies that the opposite is “bad.” Approval, then,
behavior or ideas “ tends to limit the client’s freedom to think, speak,
or act in a certain way. This can lead to the client’s
acting in a particular way just to please the social
worker.
Giving literal responses - C: “They’re Often the client is at loss to describe his or her
responding to a figurative looking in my feelings, so such comments are the best he can do.
comment as though it head with a Usually, it is helpful for the social worker to focus
were a statement of fact television on the client’s feelings in response to such
camera.” statements.
SW: “Try not to
watch television,”
or “What
channel?”
Indicating the existence “What makes you The social worker can ask, “What happened?” or
of an external source - say that?” “what events led you to draw such a conclusion?”
attributing the source of “What makes you But to question, “What made you think that?”
thoughts, feelings, and do that?” implies that the client was made or compelled to
behavior to others or to “Who told you think in a certain way. Usually, the social worker
outside influences that you were a does not intend to suggest that the source is
prophet?” external, but that is often what the client thinks.
Interpreting - asking to “What you really The client’s thoughts and feelings are his or her
make conscious that mean is . . . “ own, not to be interpreted by the social worker or
which is unconscious, “Unconsciously for hidden meaning. Only the client can identify or
telling the client the you’re saying . . . “ confirm the presence of feelings.
meaning of his experience
Introducing an unrelated C: “I’d like to die.” The social worker takes the initiative for the
topic - changing the SW: “Did you have interaction away from the client. This usually
subject visitors last happens because the social worker is
evening?” uncomfortable, doesn’t know how to respond, or
has a topic she would rather discuss.
Making stereotyped “It’s for your own Social conversations contains many clichés and
comments - offering good.” much meaningless chitchat. Such comments are of
meaningless clichés or “Keep your chin no value in the social worker-client relationship.
trite comments up.” Any automatic responses lack the social worker’s
“Just have a consideration or thoughtfulness.
positive attitude
and you’ll be
better in no time.”
Probing - persistent “Now tell me Probing tends to make the client feel used or
questioning of the client about this invaded. Clients have the right not to talk about
problem. You issues or concerns if they choose. Pushing and
know I have to probing by the social worker will not encourage the
find out.” client to talk.
“Tell me your
psychiatric
history.”

Reassuring - indicating “I wouldn’t worry Attempts to dispel the client’s anxiety by implying
there is no reason for about that.” that there is not sufficient reason for concern
anxiety or other feelings “Everything will completely devalue the client’s feelings. Vague
of discomfort be all right.” reassurances without accompanying facts are
“You’re coming meaningless to the client.
along just fine.”
Rejecting - refusing to “Let’s not discuss . When the social worker rejects any topic, she
consider or showing ..“ closes it off from exploration, in turn, the client
contempt for the client’s “I don’t want to may feel personally rejected along with his ideas.
ideas or behaviors hear about . . . “
Requesting an “Why do you think There is a difference between asking the client to
explanation - asking the that?” describe what is occurring or has taken place and
client to provide reasons “Why do you feel asking him to explain why. Usually, a “why”
for thoughts, feelings, that way?” question is intimidating. In addition, the client is
behaviors, events unlikely to know “why” and may become defensive
trying to explain himself.
Testing - appraising the “Do you know These types of questions force the client to try yo
client’s degree of insight what kind of recognize his problems. The client’s
agency this is?” acknowledgement that he or she doesn’t know
“Do you still have these things may meet the social worker’s needs
the idea that . . . but is not helpful for the client.
?“
Using denial - refusing to C: “I’m nothing.” The social worker denies the client’s feelings or the
admit that a problem SW: “Of course seriousness of the situation by dismissing his
exists you’re something comments without attempting to discover the
- everybody’s feelings or meaning behind them.
something.”
C: “I’m dead.”
SW: “Don’t be
silly.”

NONVERBAL COMMUNICATION SKILLS

Nonverbal communication is behavior that a person exhibits while delivering verbal content. It includes
facial expression, eye contact, space, time boundaries, and body movements. Nonverbal communication
is as important, if not more so, than verbal communication. It is estimated that one third of meaning is
transmitted by words and two thirds is communicated nonverbally. The speaker may verbalize what he
or she believes the listener wants to hear, whereas nonverbal communication conveys the speaker’s
actual meaning. Nonverbal communication involves the unconscious mind acting out emotions related
to the verbal content, the situation, the environment, and the relationship between the speaker and
listener.

Knapp and Hall (2002) listed ways in which nonverbal messages accompany verbal messages:

 Accent: using flashing eyes or hand movements

 Complement: giving quizzical looks, nodding
 Contradict: rolling eyes to demonstrate that the meaning is the opposite of what one is saying
 Regulate: taking a deep breath to demonstrate readiness to speak, using “and uh” to signal the
wish to continue speaking
 Repeat: using nonverbal behaviors to augment the verbal message such as shrugging after
saying “Who knows?”
 Substitute: using culturally determined body movements that stand in for words such as
pumping the arm up and down with a closed fist to indicate success

FACIAL EXPRESSION
The human face produces the most visible, complex, and sometimes confusing nonverbal
messages. Facial movements connect with words to illustrate meaning; this connection
 demonstrates the speaker’s internal dialogue. Facial expressions can be categorized into
expressive, impassive, and confusing:
 An expressive face portrays the person’s moment-by-moment thoughts, feelings, and needs.
These expressions may be evident even when the person does not want to reveal his emotions.
 An impassive face is frozen into an emotionless deadpan expression similar to mask.
 A confusing facial expression is one that is the opposite of what the person wants to convey. A
person who is verbally expressing sad or angry feelings while smiling is exhibiting a confusing
facial expression.

Facial expressions often can affect the listener’s response. Strong and emotional facial
expressions can persuade the listener to believe the message. For example, by appearing
perplexed and confused, a client could manipulate the social worker into staying longer than
scheduled. Facial expressions such as happy, sad, embarrassed, or angry usually have the same
meaning across cultures, but the social worker should identify the facial expression and ask the
client to validate the social worker’s interpretation of it - for instance, “You’re smiling, but I
sense you are very angry”
Frowns, smiles, puzzlement, relief, fear, surprise and anger are common facial
communication signals. Looking away, not meeting the speaker’s eyes and yawning indicate that
the listener is disinterested, lying, or bored. To ensure the accuracy of information, the social
worker identifies the nonverbal communication and checks its congruency with the content. An
example is “Mr. Santiago, you said everything is fine today, yet you frowned as you spoke. I
sense that everything is not really fine” (verbalizing the implied).

BODY LANGUAGE

Body language (gestures, postures, movements, and body positions) is a nonverbal form
of communication. Closed body positions, such as crossed legs or arms folded across the chest,
indicate that the interaction might threaten the listener who is defensive or not accepting. A
better, more accepting body position is to sit facing the client with both feet on the floor, knees
parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle. This
open posture demonstrates unconditional positive regard, trust, care, and acceptance. The
social worker indicates interest in and acceptance of the client by facing and slightly leaning
toward him while maintaining nonthreatening eye contact.
Hand gestures add meaning to the content. A slight lift of the hand from the arm of a
chair can punctuate or strengthen the meaning of words. Holding both hands with palms up
while shrugging the shoulders often means “I don’t know.” Some people use many hand
gestures to demonstrate or act out what they are saying whereas others use very few gestures.
The positioning of the social worker and client in relation to each other is also
important. Sitting beside or across from the client can put the client at ease, whereas sitting
behind a desk (creating a physical barrier) can increase the formality of the setting and may
decrease the client’s willingness to open up and communicate freely. The social worker may
wish to create a more formal setting with some clients, however, such as those who have
difficulty maintaining boundaries.

VOCAL CUES
 Vocal cues are nonverbal sound signals transmitted along with the content: voice
volume, tone, pitch, intensity, emphasis, speed and pauses augment the sender’s message.
Volume, the loudness of voice, can indicate whether someone is relaxed, agitated, or bored.
Pitch varies from shrill and high to low and threatening. Intensity is the power, severity, and
strength behind the words, indicating the importance of the message. Emphasis refers to
accents on words or phrases that highlight the subject or give insight on the topic. Speed is the
number of words spoken per minute. Pauses also contribute to the message, often adding
emphasis or feeling.
The high-pitched rapid delivery of a message often indicates anxiety. The use of
extraneous words with long tedious descriptions is called circumstantiality. Circumstantiality
can indicate the client is confused about what is important or is a poor historian. Slow, hesitant
responses can indicate that the person is depressed, confused and searching for the correct
words, having difficulty finding the right words to describe an incident or reminiscing. It is
important for the social worker to validate these nonverbal indicators rather than to assume
that she knows what the client is thinking or feeling (e.g., “Mr. Jose, you sound anxious. Is that
how you’re feeling?).

EYE CONTACT

The eyes have been called the mirror of the soul because they often reflect our
emotions. Messages that the eyes give include humor, interest, puzzlement, hatred, happiness,
sadness, horror, warning, and pleading. Eye contact, looking into the other person’s eyes during
communication, is used to assess the other person and the environment and to indicate whose
turn it is to speak; it increases during listening but decreases while speaking. Although
maintaining good eye contact is usually desirable, it is important that the social worker doesn’t
“stare” at the client.

SILENCE

Silence or long pauses in communication may indicate many different things. The client
may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client
is thoughtfully considering the question before responding. At times, the client may seem to be
“lost in his own thoughts” and not paying attention to the social worker. It is important to allow
the client sufficient time to respond, even if it seems like a long time. It may confuse the client if
the social worker “jumps in” with another question or tries to restate the question differently.
Also, in some cultures, verbal communication is slow with many pauses, and the client may
believe the social worker is impatient or disrespectful if she does not wait for the client’s
response.