Therapeutic and Non-Therapeutic Communication

by: Lhynnelli

therapeitic relationship2 Quick Checklist for Effective Communication: (1) Open ended questions (2) Focus on feelings (3) State behaviors observed (4) Reflect, restate, rephrase verbalization of patient (5) Neutral responses

Effective Communication: (1) Appropriate (2) Simple (3) Adaptive (4) Concise (5) Credible

Therapeutic Technique

1. Offering Self

  • making self-available and showing interest and concern.
  • “I will walk with you”

2. Active listening

  • paying close attention to what the patient is saying by observing both verbal and non-verbal cues.
  • Maintaining eye contact and making verbal remarks to clarify and encourage further communication.

3. Exploring

  • “Tell me more about your son”

4. Giving broad openings

  • What do you want to talk about today?

5. Silence

  • Planned absence of verbal remarks to allow patient and nurse to think over what is being discussed and to say more.

6. Stating the observed

  • verbalizing what is observed in the patient to, for validation and to encourage discussion
  • “You sound angry”

7. Encouraging comparisons

  • · asking to describe similarities and differences among feelings, behaviors, and events.
  • · “Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?”

8. Identifying themes

  • asking to identify recurring thoughts, feelings, and behaviors.
  • “When do you always feel the need to check the locks and doors?”

9. Summarizing

  • reviewing the main points of discussions and making appropriate conclusions.
  • “During this meeting, we discussed about what you will do when you feel the urge to hurt your self again and this include…”

10. Placing the event in time or sequence

  • asking for relationship among events.
  • “When do you begin to experience this ticks? Before or after you entered grade school?”

11. Voicing doubt

  • voicing uncertainty about the reality of patient’s statements, perceptions and conclusions.
  • “I find it hard to believe…”

12. Encouraging descriptions of perceptions

  • asking the patients to describe feelings, perceptions and views of their situations.
  • “What are these voices telling you to do?”

13. Presenting reality or confronting

  • stating what is real and what is not without arguing with the patient.
  • “I know you hear these voices but I do not hear them”.
  • “I am Lhynnelli, your nurse, and this is a hospital and not a beach resort.

14. Seeking clarification

  • asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear.
  • “I am not familiar with your work, can you describe it further for me”.
  • “I don’t think I understand what you are saying”.

15. Verbalizing the implied

  • rephrasing patient’s words to highlight an underlying message to clarify statements.
  • Patient: I wont be bothering you anymore soon.
  • Nurse: Are you thinking of killing yourself?

16. Reflecting

  • throwing back the patient’s statement in a form of question helps the patient identify feelings.
  • Patient: I think I should leave now.
  • Nurse: Do you think you should leave now?

17. Restating

  • repeating the exact words of patients to remind them of what they said and to let them know they are heard.
  • Patient: I can’t sleep. I stay awake all night.
  • Nurse: You can’t sleep at night?

18. General leads

  • using neutral expressions to encourage patients to continue talking.
  • “Go on…”
  • “You were saying…”

19. Asking question

  • using open-ended questions to achieve relevance and depth in discussion.
  • “How did you feel when the doctor told you that you are ready for discharge soon?”

20. Empathy

  • recognizing and acknowledging patient’s feelings.
  • “It’s hard to begin to live alone when you have been married for more than thirty years”.

21. Focusing

  • pursuing a topic until its meaning or importance is clear.
  • “Let us talk more about your best friend in college”
  • “You were saying…”

22. Interpreting

  • providing a view of the meaning or importance of something.
  • Patient: I always take this towel wherever I go.
  • Nurse: That towel must always be with you.

23. Encouraging evaluation

  • asking for patients views of the meaning or importance of something.
  • “What do you think led the court to commit you here?”
  • “Can you tell me the reasons you don’t want to be discharged?

24. Suggesting collaboration

  • offering to help patients solve problems.
  • “Perhaps you can discuss this with your children so they will know how you feel and what you want”.

25. Encouraging goal setting

  • asking patient to decide on the type of change needed.
  • “What do you think about the things you have to change in your self?”

26. Encouraging formulation of a plan of action

  • probing for step by step actions that will be needed.
  • “If you decide to leave home when your husband beat you again what will you do next?”

27. Encouraging decisions

  • asking patients to make a choice among options.
  • “Given all these choices, what would you prefer to do.

28. Encouraging consideration of options

  • asking patients to consider the pros and cons of possible options.
  • “Have you thought of the possible effects of your decision to you and your family?”

29. Giving information

  • providing information that will help patients make better choices.
  • “Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore”.

30. Limit setting

  • discouraging nonproductive feelings and behaviors, and encouraging productive ones.
  • “Please stop now. If you don’t, I will ask you to leave the group and go to your room.

31. Supportive confrontation

  • acknowledging the difficulty in changing, but pushing for action.
  • “I understand. You feel rejected when your children sent you here but if you look at this way…”

32. Role playing

  • practicing behaviors for specific situations, both the nurse and patient play particular role.
  • “I’ll play your mother, tell me exactly what would you say when we meet on Sunday”.

33. Rehearsing

  • asking the patient for a verbal description of what will be said or done in a particular situation.
  • “Supposing you meet these people again, how would you respond to them when they ask you to join them for a drink?”.

34. Feedback

  • pointing out specific behaviors and giving impressions of reactions.
  • “I see you combed your hair today”.

35. Encouraging evaluation

  • asking patients to evaluate their actions and their outcomes.
  • “What did you feel after participating in the group therapy?”.

36. Reinforcement

  • giving feedback on positive behaviors.
  • “Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak”.

Avoid pitfalls:

  1. Giving advise
  2. Talking about your self
  3. Telling client is wrong
  4. Entering into hallucinations and delusions of client
  5. False reassurance
  6. Cliché
  7. Giving approval
  8. Asking WHY?
  9. Changing subject
  10. Defending doctors and other health team members.

Non-therapeutic Technique

1. Overloading

  • talking rapidly, changing subjects too often, and asking for more information than can be absorbed at one time.
  • “What’s your name? I see you like sports. Where do you live?”

2. Value Judgments

  • giving one’s own opinion, evaluating, moralizing or implying one’s values by using words such as “nice”, “bad”, “right”, “wrong”, “should” and “ought”.
  • “You shouldn’t do that, its wrong”.

3. Incongruence

  • sending verbal and non-verbal messages that contradict one another.
  • The nurse tells the patient “I’d like to spend time with you” and then walks away.

4. Underloading

  • remaining silent and unresponsive, not picking up cues, and failing to give feedback.
  • The patient ask the nurse, simply walks away.

5. False reassurance/ agreement

  • Using cliché to reassure client.
  • “It’s going to be alright”.

6. Invalidation

  • Ignoring or denying another’s presence, thought’s or feelings.
  • Client: How are you?
  • Nurse responds: I can’t talk now. I’m too busy.

7. Focusing on self

  • responding in a way that focuses attention to the nurse instead of the client.
  • “This sunshine is good for my roses. I have beautiful rose garden”.

8. Changing the subject

  • introducing new topic
  • inappropriately, a pattern that may indicate anxiety.
  • The client is crying, when the nurse asks “How many children do you have?”

9. Giving advice

  • telling the client what to do, giving opinions or making decisions for the client, implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility.
  • “If I were you… Or it would be better if you do it this way…”

10. Internal validation

  • making an assumption about the meaning of someone else’s behavior that is not validated by the other person (jumping into conclusion).
  • The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.

Other ineffective behaviors and responses:

  1. Defending – Your doctor is very good.
  2. Requesting an explanation – Why did you do that?
  3. Reflecting – You are not suppose to talk like that!
  4. Literal responses – If you feel empty then you should eat more.
  5. Looking too busy.
  6. Appearing uncomfortable in silence.
  7. Being opinionated.
  8. Avoiding sensitive topics
  9. Arguing and telling the client is wrong
  10. Having a closed posture-crossing arms on chest
  11. Making false promises – I’ll make sure to call you when you get home.
  12. Ignoring the patient – I can’t talk to you right now
  13. Making sarcastic remarks
  14. Laughing nervously
  15. Showing disapproval – You should not do those things.

What Do You Think?