Therapeutic Communication

Techniques of Therapeutic Communication

 Introduce yourself, and explain the purpose of the interview.

 Choose a quiet, private setting.
 choose a location with easy access to an exit in case the patient's behavior
becomes inappropriate or threatening.
 Sit a comfortable distance from the patient at an angle that allow for eye
contact.
 Start the interview with a wide, empathetic statement :You look anxious; tell
me what's bothering you today."
 Use a proper assessment tool to guide you with collecting your information
 Listen carefully to the patient and respond with sensitivity.
 Use a quiet, nonthreatening tone of voice.
 Note coping mechanisms that the patient may be using.
 Be aware for signs that the patient's behavior is escalating or that
the patient is becoming agitated to protect yourself from unsafe
situation.
 Keep in mind the effect of a patient's background, beliefs, and
values to the response to illness and adaptation to care.
 Pay attention to the communication barriers, such as, hearing or
speech impairment, and language unwillingness to talk.
 Use therapeutic communication techniques to assist with forming a
trust relationship.
 Therapeutic Example
Description
Technique

“What happened
involves showing interest in what patients have to next?”
say, acknowledging that you’re listening and
Active Listening
understanding, and engaging with them
throughout the conversation..

At times, it’s useful to not speak at all. Deliberate

silence can give both nurses and patients an
opportunity to think through and process what
Using Silence
comes next in the conversation. It may give
patients the time and space they need to broach a
new topic.
 “Yes, I hear what you
Acceptance isn’t necessarily the same thing are saying.”
as agreement; it can be enough to simply
make eye contact and say, “Yes, I hear what
Accepting you are saying.” Patients who feel their
nurses are listening to them and taking them
seriously are more likely to be receptive to
care.

“I noticed you took all

Recognition acknowledges a patient’s of your medications
behavior and highlights it. For example, today”
Giving Recognition saying something such as “I noticed you took
all of your medications today” draws
attention to the action and encourages it.
 I’ll sit with you her
Offering to self and sit with patients for a few
for a while. I would
Offering Self minutes is a powerful way to create a caring
like to spend some
connection.
time with you.
giving patients a broad opening such as “What would you
Giving Broad
“What’s on your mind today?” or “What would like to talk about?”
Openings/Open-
you like to talk about?” can be a good way to
Ended
allow patients an opportunity to discuss what’s
Questions
on their mind.
Saying something such as “I’m not sure I “I’m not sure I
understand. Can you explain it to me?” helps understand.
Seeking Can you explain it to
nurses to ensure they understand what’s actually
Clarification me?”
being said and can help patients process their
ideas more thoroughly.
 When did this happen?
What seemed to lead up
Placing the It forces patients to think about the sequence to….?
Event in Time of events and may encourage them to remember
or Sequence something they otherwise wouldn’t.

You seem upset. You are

Observations about the appearance, demeanor, or
Making trembling
behavior of patients can help draw attention to
Observations
areas that may indicate a problem.

What does that look like

Phrases such as “What do you hear now?” or
Encouraging to you?”
“What does that look like to you?” give patients a
Descriptions of
prompt to explain what they’re perceiving without
Perception
casting their perceptions in a negative light.
 By encouraging them to make Was it something like…..? Have you
comparisons to situations they have had a similar experience?
Encouraging
coped with before, nurses can help
Comparisons
patients discover solutions to their
problems.
Ending a summary with a phrase such “Does that sound correct?”
as “Does that sound correct?” gives
Summarizing
patients explicit permission to make
corrections if they’re necessary.
Patient: “What do you think I should
Nurses can ask patients what they
do about telling my employer about
think they should do, which my illness?” Nurse: “What have you
Reflecting encourages them to be accountable for been thinking about this situation?”
their own actions and helps them Patient: “Everyone ignores me”.
come up with solutions themselves.
Nurse: “Ignores you?”
 Let’s stop and look more
closely at your feelings about
Patients don’t always have an objective managing your medications
perspective on what is relevant to their case,
Focusing
but as impartial observers, nurses can more
easily pick out the topics on which to focus.

You said you wanted to attend

the support group but you
Nurses should only apply this technique after stayed in your room all day.
they have established trust. In some
Confronting situations, it can be vital to the care of
patients to disagree with them, present them
with reality, or challenge their assumptions.
 Really? That’s hard to believe.
Isn’t that unusual.
Voicing doubt can be a gentler way to
call attention to incorrect or
Voicing Doubt
delusional ideas and perceptions of
patients.

This technique can keep patients in a
more positive state of mind.
Offering Hope and
However, it is important to tailor
Humor
humor to the patient’s sense of
humor.
I believe you will find a way
to face your situation because
I have seen how you interact
with your children in this
situation.
 Non-Therapeutic Techniques:

Ⅹ Defending – Your doctor is very good.

Ⅹ Requesting an explanation – Why did you do that?
Ⅹ Reflecting – You are not suppose to talk like that!
Ⅹ Literal responses – If you feel empty then you should eat more.
Ⅹ Looking too busy.
Ⅹ Appearing uncomfortable in silence.
Ⅹ Being opinionated.
Ⅹ Avoiding sensitive topics
Ⅹ Arguing and telling the client is wrong
Ⅹ Having a closed posture-crossing arms on chest
Ⅹ Making false promises – I’ll make sure to call you when you get
home.
Ⅹ Ignoring the patient – I can’t talk to you right now
Ⅹ Making sarcastic remarks
Ⅹ Laughing nervously
Ⅹ Showing disapproval – You should not do those things.