COMMUNICATION TECHNIQUES vw 7/06

Therapeutic (Effective) Communication Techniques note: *indicates deepening techniques to elicit feelings
* Accepting “I can imagine how that might feel” “That’s understandable.” “It makes sense you might feel that way.”
* Attempting to translate Pt “My sister is so lazy!” RN “You sound angry that she doesn’t help.”
words into feelings Pt “I didn’t get the raise.” RN “That must have been discouraging.”

BRIEF self disclosure “I’m Filipino too. Tell me more about what is was like for you …”
followed by returning the “I experienced that too. My parents divorced when I was eighteen. Tell me more about how you coped …”
subject to the client’s issues
Broad openings “What would you like to talk about today?” “What would be helpful to discuss?”
Clarifying “I’m not sure I understand. Would you please explain?” “Help me to understand….”
Encouraging comparisons “How does this compare to the last time it happened?” “Have you had similar experiences?”
Encouraging descriptions “Are you hearing the voices again? What are the voices telling you?”
of perceptions “Tell me when you feel anxious.”
Encouraging expression “What are your feelings about that? “How did you feel when…” “Does this contribute to your distress?”
Exploring “Tell me more about…” “Would you describe that more fully?”
Focusing “This point seems worth looking at more closely…” “Let’s focus on your feelings rather than your husband’s.”
Forming a plan of action “Next time this happens, how might you handle it differently?”
“What could you do to let your anger out harmlessly?”
General leads [using minimal encouragement] “Yes, I see, …and after that?” “Go on (nodding)…uh huh…
Giving feedback [descriptive and focused on behavior that can be modified; specific; imparts well-timed information rather than
advice] In a family session, “When you raised your voice just now, your daughter looked scared.”
Giving recognition “This is the first time you brought up your own problems to discuss in group therapy today.” “Hello Ms. G.”
Giving/seeking information “Visiting hours are…” “Bipolar disorder is…” / “When did you stop taking your meds?”
* Making observations [noting unexpressed feelings in nonverbal behavior] “You seem tense.”
“You’re smiling yet you sound resentful.”
Offering self “I’m interested in what you think.” “Let’s spend a half hour together this morning.”
“I’ll stay here with you while you’re feeling so anxious.”
Open-ended questions “Tell me about your family.” “What….” “How….”
Paraphrasing/summarizing “And so what bothers you the most is….” “So far, we’ve discussed your plans to ….”
Placing the event in “Was this before or after…” “When did you first notice…?” “What seemed to lead up to….?”
time or sequence
Presenting reality “I understand the voices seem real to you, but I don’t hear them. The only voices I hear are yours and mine.”
“Your mother is not here. I’m a nurse.” “I see no one else in the room.”
Reflecting Pt “Do you think I should tell the doctor?” RN “Do you think you should?”
Pt “My brother spends all my money then has the nerve to ask for more.” RN “This causes you to feel angry?”
Restating Pt “I can’t sleep. I lie awake all night.” RN “You have difficulty sleeping.”
Suggesting collaboration “Perhaps together we can figure out…”
* Translating words into feelings Pt “I’m way out in the ocean.” RN “You seem to feel lonely or deserted.”
* Using active listening [Face pt; use open relaxed posture; lean toward pt; establish eye contact. No touching without permission.]
* Silence [gives client time to organize thoughts, think through a point, introduce another topic of greater concern]
Validating perceptions “It sounds like you’re talking about sad feelings. Is that correct?” “This is what I heard you say… Is that right?”
* Verbalizing the implied Pt “I can’t talk to you or anyone.” RN “Are you feeling no one understands?”
Voicing doubt “I’m not sure that’s possible. From my experience...” “I’m surprised your teacher would have said that to you.”
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Unclear, Nonspecific Communication

Deleting (leaving out the object of the verb) Pt “I’m afraid.” RN “Afraid of what in particular?”
Unspecified verbs (action verb needs to be more specific) Pt “He really frustrates me.” RN “How, exactly, does he frustrate you?”
Universal qualifiers (words that generalize a few Pt “I never do anything RN “Has there ever been a time that you
experiences into a multitude (all, every, never, right.” did do something right?”
always, nobody, only)
Necessity and possibility (statements that identify rules Pt “I have to take care of people.” RN “What would happen if you didn’t ….?”
or limits to a person’s behavior and that often Pt “I can’t do it.” RN “What stops you from doing it?”
indicate no choice (have to, must, can’t, unable, Pt “It’s impossible.” RN “What would need to happen to make
not possible, no one can) it possible?”

Nontherapeutic (Ineffective) Communication Techniques note: ∆ indicates most common errors

∆ Agreeing/disagreeing “You’re absolutely right.” “I don’t see any reason for you to feel that way.” Better, “I can see why
you might feel that way,” “Let’s discuss…”
Belittling expressed feelings “Everybody gets down in the dumps at times.” Better, “You must be very upset. Tell me…”
Challenging “You didn’t mean to say that to her, did you?” Better, “You must have been pretty angry to say that.”
“If you’re dead, why is your heart still beating?” Better, “That must be scary to see yourself as dead.”
∆ Changing the topic In reaction to patient saying “I don’t have anything to live for,” RN responds “Did you have visitors?”
Better, [stay with the feelings, use silence, explore, or ask to discuss later→seek supervision]
Close ended questions “Do….” “Is….” “Are….” Better, [use open ended questions/statements unless client very anxious]
Defending “No one here would lie to you.” “You have a very capable physician…” Better, “Let me answer your
questions and clarify some issues you have regarding your treatment.” “Let me find someone who can…”
∆ Giving advice “I think you should…” “If I were you…” Better, “What do you think you could do about that?”
∆ Giving approval/disapproval “That’s good. I’m glad that you…” Better, “You’ve spent time thinking about this/ sounds like you’ve
figured out ways to handle this/ etc.” “Let’s talk about your decision.”
Giving reassurance/false reassurance “I wouldn’t worry about that if I were you…” Better, “I see you’re really worried about this…”
Imposing personal values “That must have been wonderful to see your Mom today.” Better, “How did it go with your Mom today?”
Inappropriate self disclosure Following pt disclosure about abuse history, RN responds, “I was sexually abused by my dad. I never got
over it. I still have nightmares.” Better, [no disclosure; offer acceptance, translate words into feelings]
∆ Indicating the existence of “How did that make you feel?” Better, “How did you feel when that happened?”
an external source of power
Interpreting “What you really mean is…” “Unconsciously you’re saying…” Better, “Help me understand…”
Leading question “Do you drink because you’re depressed?” Better, “Tell me what you’re feeling when you need a drink.”
Parroting Repeating what the client is saying to the point of annoyance. Better, silence or other technique
Probing “Tell me how you really feel about your mother now that she’s dead.” Better, “Tell me about your mother.”
Rejecting “I don’t want to hear about…” Better, “Let’s look at that a little more closely.”
∆ Requesting an explanation “Why did you do that?” Better, “Describe what you were feeling just before that happened.”
“How did that come about?” “What was the reason…”
Testing “Do you know what kind of hospital this is?” “Do you still have the idea that…” Better, avoid testing.
Using babytalk, inappropriate familiarity “Come on, honey, open your mouth. This is yummy food.” Better, “Mrs. Smith, may I help you…”
Using cliches/stereotyped comments “Hang in there.” “Be strong.” “It’s for your own good…” Better, “This must be difficult for you.”
Using denial “Of course you’re somebody. Everybody is somebody.” Better, “You’re feeling no one cares?”

Fontaine, Karen. Mental Health Nursing, 5th Ed. NJ: Prentice Hall. 2003. p 64-66.
Videbeck, Sheila, Psychiatric Mental Health Nursing, 3rd Ed. NY: Lippincott, 2006. p. 111-115.