therapeutic communication.drjma

Therapeutic

Communication Dr. James Malce Alo,

RN,MAN,MAP,PHD

WHAT IS THERAPEUTIC

COMMUNICATION?

Interpersonal interaction between the

nurse and client during which the nurse

focuses on the client’s specific needs to

promote an effective exchange of

information.

Therapeutic Communication

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 helps the nurse

understand and emphatize with the

client’s experience

Goals of Therapeutic

Communication

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

emotions.

Teach the client and family necessary

self-care skills.

Recognize the client’s needs.

Guide the client toward identifying a

plan of action to a satisfying and socially

acceptable situation.

Communication

is the process that people use to

exchange information.

Messages are simultaneously sent and

received on two levels:

1) verbally through the use of words and

2) nonverbally by behaviors that

accompany the words (Balzer Riley, 2000).

Verbal communication

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

1. Content - the literal words that a person speaks.

2. Context is the environment in which communication occurs and can include the time and the physical, social, emotional, and cultural environment (Weaver, 1996).

Nonverbal communication

is the behavior that accompanies verbal content such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance from the listener.

Nonverbal communication can indicate the speaker’s thoughts, feelings, needs, and values that the speaker acts out mostly unconsciously.

Congruent message

is when content and process agree.

For example, a client says, “I know I haven’t

been myself. I need help.” She has a sad

facial expression and a genuine and

sincere voice tone.

Incongruent message

content and process disagree—when

what the speaker says and what he or she

does do not agree.

Therapeutic communication can help

nurses to accomplish many goals:

Establish a

therapeutic nurse–

client relationship

Identify

Assess

Facilitate

Teach

Recognize

Guide

Proxemics is the study of distance zones between people

during communication.

four distance zones:

Intimate zone (0 to 18 inches between people):

parents with young children.

Personal zone (18 to 36 inches): family and

friends who are talking.

Social zone (4 to 12 feet): in social, work, and

business settings.

Public zone (12 to 25 feet): speaker and an

audience, small groups, and other informal

functions (Hall, 1963).

Touch Functional-professional touch is used in

examinations or procedures.

Social-polite touch is used in greeting, such as a handshake.

Friendship-warmth touch involves a hug in greeting, an arm thrown around the shoulder of a good friend, or the back slapping some men use to greet friends and relatives.

Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.

Sexual-arousal touch is used by lovers.

Active listening

means refraining from other internal

mental activities and concentrating

exclusively on what the client says.

Active observation

means watching the speaker’s nonverbal

actions as he or she communicates

Conditions Affecting

Communication

Values

Attitudes

Beliefs

Perceptions

Culture or Religion

Social Status

Gender

Age or developmental level

Environment

Enhancing Communication Silence

Support/reassurance

Sharing Observations

Acknowledge feelings

Broad – open ended statements

Information giving

Interpretation

Restating Reflecting Clarification Confrontation Offering

Alternatives Voicing doubt Role-playing Use of Humor – use

cautiously/discretely

Non-therapeutic

communication

Advising

Agreeing

Belittling feelings

Challenging

Defending

Disagreeing

Disapproving

Probing

THERAPEUTIC COMMUNICATION

TECHNIQUES TCT Examples Rationale

Accepting—

indicating

reception

“Yes.”

“I follow what you

said.”

Nodding

An accepting response

indicates the nurse has

heard and followed the train

of thought. It does not

indicate agreement but is

nonjudgmental. Facial

expression, tone of voice, and

so forth also must convey

acceptance or the words will

lose their meaning.

Broad

openings—

allowing

the client to take

the

initiative in

introducing

the topic

“Is there

something you’d

like to talk

about?”

“Where would

you like to

begin?”

Broad openings make

explicit that the client has

the lead in the interaction.

For the client who is

hesitant about talking,

broad openings may

stimulate him or her to take

the initiative.

Consensual

validation—

searching for

mutual

understanding,

for accord

in the meaning

of the

words

“Tell me whether

my

understanding

of it agrees with

yours.”

“Are you using

this word to

convey that . . .

?”

For verbal communication

to be meaningful, it is

essential that the words

being used have the

same meaning for both (all)

participants.

Sometimes words, phrases,

or slang terms

have different meanings

and can be easily

misunderstood.

Encouraging

comparison—

asking that

similarities

and differences

be noted

“Was it

something like . .

. ?”

“Have you had

similar

experiences?”

Comparing ideas,

experiences, or relationships

brings out many recurring

themes. The client

benefits from making these

comparisons

because he or she might

recall past coping

strategies that were

effective or remember

that he or she has survived a

similar situation

Encouraging

description of

perceptions—

asking the

client to

verbalize what

he

or she perceives

“Tell me when

you feel

anxious.”

“What is

happening?”

“What does the

voice seem

to be saying?”

Encouraging the client to

describe ideas fully may

relieve the tension the client

is feeling, and he or she

might be less likely to take

action on ideas that are

harmful or frightening.

Encouraging

expression—

asking client to

appraise the

quality of his or her

experiences

“What are your

feelings in regard to .

. . ?”

“Does this contribute

to your distress?”

consider people and

events in light of his or

her own values. Doing

so encourages the

client to make his or

her own appraisal

rather than accepting

the opinion of others.

Exploring—delving

further into a

subject or idea

“Tell me more about

that.”

“Would you describe

it more fully?”

“What kind of

work?”

help them examine

the issue more fully.

Any problem or

concern can be

better understood if

explored in depth. If

the client expresses an

unwillingness to

Explore a subject,

however, the nurse

must respect his or

her wishes.

Focusing—

concentrating

on a single

point

“This point seems

worth

looking at more

closely.”

“Of all the concerns

you’ve mentioned,

which is most

troublesome?”

encourages the client to

concentrate his or her

energies on a single point,

which may prevent a

multitude of factors or

problems from

overwhelming the client. It is

also a useful technique

when a client jumps from

one topic to another.

Formulating a

plan of

action—

asking the

client to

consider kinds

of behavior

likely to be

appropriate

“What could you do

to let your anger out

harmlessly?”

“Next time this comes

up, what might you

do to handle it?”

helpful for the client to plan

in advance what he or she

might do in future similar

situations.

Making definite plans

increases the likelihood

that the client will cope

more effectively in a similar

situation.

General leads—

giving

encouragement

to continue

“Go on.”

“And then?”

“Tell me about

it.”

indicate that the nurse is

listening and following what

the client is saying without

taking away the initiative for

the interaction.

Giving

information—

making available

the facts that the

client needs

“My name is .”

“Visiting hours

are . . .”

“My purpose in

being here is .”

Informing the client of facts

increases his or her

knowledge about a topic or

lets the client know

what to expect.

Giving

recognition—

acknowledging,

indicating

awareness

“Good morning,

Mr. S . . .”

“You’ve finished

your list of

things to do.”

“I notice that

you’ve

combed your

hair.”

Greeting the client by name,

indicating awareness

of change, or noting efforts

the client has

made all show that the nurse

recognizes the

client as a person, as an

individual.

Making

observations—

verbalizing what the

nurse perceives

“You appear tense.”

“Are you

uncomfortable

when . . . ?”

“I notice that you’re

biting your lip.”

Sometimes clients

cannot verbalize or

make themselves

understood. Or the

client may not be

ready to talk.

Offering self—

making oneself

available

“I’ll sit with you

awhile.”

“I’ll stay here with

you.”

“I’m interested in

what you think.”

The nurse can offer

his or her presence,

interest, and desire

to understand.

Placing event in time

or sequence—

clarifying the

relationship of

events in time

“What seemed to

lead up to . . . ?”

“Was this before or

after . . . ?”

“When did this

happen?”

Putting events in

proper sequence

helps both the

nurse and client to

see them in

perspective.

Presenting reality—

offering for

consideration that

which is real

“I see no one else in

the room.”

“That sound was a

car backfiring.”

“Your mother is not

here; I am a nurse.”

When it is obvious

that the client is

misinterpreting

reality, the nurse can

indicate what is real.

Thank YOU!

- Dr. James Malce Alo