What is Therapeutic Communication?

Therapeutic communication is an interpersonal interaction between the nurse and

the client during which the nurse focuses on the client’s specific needs to promote
an effective exchange of information. Skilled use of therapeutic communication
techniques helps the nurse understand and empathize with the client’s experience.

Goals of Therapeutic Communication

Therapeutic communication can help nurses to accomplish many goals:

 Establish a therapeutic nurse-client relationship.

 Identify the most important client concern at that moment (the client-
centered goal).
 Assess the client’s perception of the problem as it unfolds; this includes
detailed actions (behaviors and messages) of the people involved and the
client’s thoughts and feelings about the situation, others, and self.
 Facilitate the client’s expression of emotion.
 Teach the client and the family necessary self-care skills.
 Recognize the client’s needs.
 Implement interventions designed to address the client’s needs.
 Guide the client toward identifying the plan of action to a satisfying and
socially acceptable resolution.
Verbal Communication Skills

Verbal communication consists of the words a person uses to speak to one or more
listeners.

 Using concrete messages. The nurse should use words that are as clear as
possible when speaking to the client so that the client can understand the
message; in a concrete message, the words are explicit and need no
interpretation, the speaker uses nouns instead of pronouns; concrete
questions are clear, direct, and easy to understand.
 Using therapeutic communication techniques. The choice of technique
depends on the intent of the interaction and the client’s ability to
communicate verbally; overall, the nurse selects techniques that facilitate the
interaction and enhance communication between client and nurse.
 Avoiding nontherapeutic communication. In contrast, there are many
nontherapeutic techniques that nurses should avoid; these responses cut off
communication and make it more difficult for the interaction to continue.
 Interpreting signals or cues. To understand what a client means, the nurse
watches and listens carefully for cues; cues are verbal or nonverbal messages
that signal keywords or issues for the client; finding cues is a function of active
listening often, cue words introduced by the client can help the nurse to know
what to ask next or how to respond to the client.
Nonverbal Communication Skills
Therapeutic communication also involves nonverbal communication is behavior that
a person exhibits while delivering verbal content.

 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.
 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.
 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 the voice, can
indicate anger, fear, happiness, or deafness; tone 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; emphasis refers to accents on words or phrases that highlight the
subject, and speed is the number of words spoken per minute.
 Eye contact. The eyes have been called the mirror of the soul because they
often reflect our emotions; 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.

Therapeutic Communication Techniques

Choosing the appropriate therapeutic communication technique is critical in

establishing and maintaining the nurse-patient relationship. These techniques are
discussed below:

Therapeutic Communication
Example Rationale
Technique

“Yes.” An accepting response

Accepting.
“I understand what you said.” nurse has heard and
Indicating reception
Nodding train of thought.

Broad openings.
“Is there something you’d like to talk Broad openings make
Allowing the client to take the
about?”  the client has the
initiative in introducing the
“Where would you like to begin?” interaction.
topic.

Consensual validation. “Tell me whether my understanding of it For verbal communic

Therapeutic Communication
Example Rationale
Technique

Searching for mutual meaningful, the words

understanding, for accord in agrees with yours.” have the same meaning
the meaning of the words. participants.

Encouraging comparison. Comparing ideas, exp

“Was it something like…?”Have you had
Asking that similarities and relationships brings
similar experiences?
differences be noted. recurrent themes.

Encouraging description of
“Tell me when you feel anxious.” To understand the clie
prescriptions.
“Do tell me what is happening?” must see things
Asking the client to verbalize
“What does the voice seem to be saying?” perspective.
what they perceive.

Encouraging expression.  The nurse asks the clien

“What are your feelings regarding…?”
Asking the client to appraise people and events in
“Does this contribute to your distress?”
the quality of their experiences. own values.

Exploring. When clients deal

“Tell me more about that.” 
Delving further into a subject or superficially, exploring c
“Would you describe it more fully?”
idea. examine the issue more

The nurse encourages

concentrate their ene
Focusing. “This point seems worth looking at more
single point, preventing
Concentrating on a single point. closely.”
or problems from overw
client.

Formulating a plan of action.

Asking the client to consider It may be helpful for
“What could you do to let your anger out
the kinds of behavior likely to plan what they might
harmlessly?”
be appropriate in future similar situations.
situations.

General leads indicate t

General leads. “Go on.”   is listening and followi
Encouraging to continue. “And then?” client is saying without
the initiative for interacti

Informing the clien

Giving information. “My name is…”
increases their knowle
Making available the facts that “These are your medications…”  
topic or lets them kn
the client needs. “Visiting hours are…”
expect.

Giving recognition. “Good morning Mr…”   Greeting the client

Acknowledging, indicating “You’ve finished your list of things to do.” indicating awareness o
awareness. noting efforts the client
Therapeutic Communication
Example Rationale
Technique

show that the nurse re

client as a person, as an

Making observations.
“You appear tense.” Sometimes clients can
Verbalizing what the nurse
“Are you uncomfortable when..?” or make themselves und
perceives.

Offering self. The nurse can offer th

“I’ll sit with you awhile.”
Making oneself available. interest, and desire to u

Placing events in time or

Putting events in prop
sequence.
“What seemed to lead up to…?” helps both the nurse
Clarifying the relationship of
see them in perspective
events in time.

Presenting reality. When it is obvious that

Offering for consideration that “I see no one else in the room.” misinterpreting reality, t
which is real. indicate what is real.

Reflecting.
Client: “Do you think I should tell the Reflection encourages
Directing client actions,
doctor?” recognize or accept
thoughts, and feelings back to
Nurse: “Do you think you should?” feelings.
the client.

Restating. Client: “I can’t sleep. I stay awake all The nurse repeats wh

Repeating the main idea night.” has said in approximat
expressed. Nurse: “You have difficulty sleeping.” words the client has use

Seeking information.
Seeking to make clear that “I’m not sure that I follow. Could you tell The nurse should seek
which is not meaningful or that me more?” through interactions wit
which is vague.

Silence.
The absence of verbal
Silence often encourag
communication allows the The nurse says nothing but continues to
to verbalize, provided
client to put thoughts or make eye contact and conveys interest.
interesting and expectan
feelings into words, regain
composure, or continue talking.

The nurse seeks t

Suggesting collaboration. relationship in which t
Offering to share, to strive, to “Perhaps you and I can discuss and identify problems in
work with the client for their discover the triggers for your anxiety.” others, grow emoti
benefit. improve the ability
satisfactory relationship
Therapeutic Communication
Example Rationale
Technique

Summarization seeks to
Summarizing.
“So, in summary…” important points of th
Organizing and summing up
“Have I got this straight?” and increase both
that which has gone before.
awareness and understa

Translating into feelings.

Client: “I’m dead.” Often what the client
Seeking to verbalize client’s
Nurse: “Are you suggesting that you feel taken literally, seems m
feelings that they express only
lifeless?” far removed from reality
indirectly.

Client: “I can’t talk to you or anyone. It’s a

Verbalizing the implied. Putting into words wh
waste of time.”
Voicing what the client has has implied or said ind
Nurse: “Do you feel that no one
hinted or suggested. to make the discussion l
understands?”

Voicing doubt.
Another means of re
Expressing uncertainty about
“Isn’t that unusual?”Really?” distortions of reality i
the reality of the client’s
doubt.
perception.

Open-ended comments.
Unfinished sentences prompt
the client to continue. “Tell me more about your pain.” Allows the client to
Questions that cannot be “Tell me about your family.” content is relevant.
answered with a one-word
answer.

Client: “Whenever I talk to my doctor, I

Clarifying. It prevents nurses f
feel so upset.”
It makes the meaning of the assumptions about
Nurse: “Tell me what is making you
client’s message clear. message.
upset?”

Confronting. Client: “I am so angry at her!” (Stated

Nurse’s verbal response to while smiling). Encourages client to
incongruence between client’s Nurse: “You said you are angry, yet you potential areas for chan
words and actions. are smiling?”

Setting limits. Nurse: “It seems that you are feeling Establishing behavioral p
Stating expectations for unsure of how to behave right now.”
appropriate behavior. Client: “What do you mean?”
Nurse: “Well, you are asking me a lot of
personal questions. The reason you are
here is that you have some health issues
and problems. Tell me more clearly what
brought you here to the clinic so I can
 Therapeutic Communication
Example Rationale
Technique

help you.?”

Non-Therapeutic Communication

Non-Therapeutic communication involves words, phrases, actions, and tones that

make patients feel uncomfortable, increase their stress, and worsen their mental
and even physical wellbeing.

Non-Therapeutic
Examples Rationale
Responses

“I would not worry about

Reassuring Indicating that there is no cause of anxiety.
that.”

On the other hand, offering unnecessary approva

Giving approval “That’s good!”
the behavior being praised is the only acceptable

Refusing to consider or showing contempt for

Rejecting “Let’s not discuss that!”
ideas or behavior.

Disapproving “That’s bad!” Denouncing the client’s ideas or behavior.

“That’s right!”
Agreeing Indicating accord with the client.
“I agree!”

“I definitely disagree with

Disagreeing what you’re saying!” Opposing to client’s idea.
“I don’t believe that!”

“I think you should…”

Advising Telling the client what to do.
“Why don’t you…”

Persistent questioning the client. It is invasive, u

“Tell me more about your for most clients, and a threat to their right to
Probing love story from the day confidentiality. Probing the client with questions
you fell in love!” relevant to their health care and health-related
never appropriate.
Non-Therapeutic
Examples Rationale
Responses

Indicating the
“Who told you that you Attributing the source of thoughts, feelings, and
existence of an
were God?!” others or outside influence.
external source.

Client: “I have nothing to

live for. I wish I were
Belittling feelings
dead!” Misjudging the degree of client’s discomfort.
expressed.
Nurse: “Everybody gets
down in the dumps!”

Client: “I’m nothing!”

Using denial Refusing to admit that problem exists.
Nurse: “Don’t be silly!”

“What you really mean

is….” Seeking to make conscious that which is uncons
Interpreting
“Unconsciously, you’re the client the meaning of his experiences.
saying….”

Client: “I’d like to die!”

Introducing an
Nurse: “Did you have Changing the subject.
unrelated topic
visitors this weekend?”