THERAPEUTIC COMMUNICATION TECHNIQUES

THERAPEUTIC
COMMUNICATION TECHNIQUE
EXAMPLES RATIONALE
Acceptingindicating 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 epression! tone of "oice! and so forth also must con"ey acceptance or the words
will lose their meaning.
Broad Openingsallowing the client
to ta#e the initiati"e in introducing
the topic
Is there something you$d li#e to tal#
about%
&here would you li#e to begin%
'road openings ma#e eplicit that the client has the lead in the interaction.
For the client who is hesitant about tal#ing! broad openings may stimulate him(her to ta#e
the initiati"e.
Consensua !aidationsearching
for mutual understanding! for
accord in the meaning of the words
)ell me whether my understanding of
it agrees with yours.
Are you using this word to con"ey
that...%
For "erbal communication to be meaningful! it is essential that the words being used ha"e
the same meaning for both *all+ participants.
,ometimes words! phrases! or slang terms ha"e different meanings and can be easily
misunderstood.
Encouraging Co"parison as#ing
that similarities and differences be
noted
&as it something li#e...%
-a"e you had similar eperiences%
.omparing ideas! eperiences! or relationships brings out many recurring themes.
)he client benefits from ma#ing these comparisons because he or she might recall past
coping strategies that were effecti"e or remember that he or she has sur"i"ed a similar
situation.
Encouraging #escription o$
Perceptionsas#ing the client to
"erbali/e what he(she percei"es
)ell me when you feel anious.
&hat is happening%
&hat does the "oice seem to be
saying%
)o understand the client! the nurse must see things from his or her perspecti"e.
0ncouraging the client to describe ideas fully may relie"e the tension the client is feeling!
and he(she might be less li#ely to ta#e action on ideas that are harmful or frightening.
Encouraging E%pression as#ing
client to appraise the 1uality of
his(her eperiences
&hat are your feelings in regard to...%
2oes this contribute to your distress%
)he nurse as#s the client to consider people and e"ents in light of his or her own "alues.
2oing so encourages the client to ma#e his or her own appraisal rather than accepting the
opinion of others.
E%poringdel"ing further into a
subject or idea
)ell me more about that.
&ould you describe it more fully%
&hat #ind of wor#%
&hen clients deal with topics superficially! eploring can help them eamine3the issue
more fully.
Any problem or concern can be better understood if eplored in depth.
If the client epresses an unwillingness to eplore a subject! howe"er! the nurse must
respect his(her wishes.
&ocusingconcentrating on a single
point
)his point seems worth loo#ing at more
closely.
)he nurse encourages the client to concentrate his or her energies on a single point! which
may pre"ent a multitude of factors or problems from o"erwhelming the client.
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC
COMMUNICATION TECHNIQUE
EXAMPLES RATIONALE
4f all the concerns you$"e mentioned!
which is most troublesome%
It is also a useful techni1ue when a client jumps from one topic to another.
&or"uating a Pan o$ Action
as#ing the client to consider #inds
of beha"ior li#ely to be appropriate
in future situations
&hat could you do to let your anger
out harmlessly%
Net time this comes up! what might
you do to handle it%
It may be helpful for the client to plan in ad"ance what he or she might do in future
similar situations.
5a#ing definite plans increases the li#elihood that the client will cope more effecti"ely in
a similar situation.
'enera Leadsgi"ing
encouragement to continue
6o on.
And then%
)ell me about it.
6eneral leads indicate that the nurse is listening and following what the client is saying
without ta#ing away the initiati"e for the interaction.
)hey also encourage the client to continue if he or she is hesitant or uncomfortable about
the topic.
'i(ing In$or"ation ma#ing
a"ailable the facts that the client
needs
5y name is7
8isiting hours are7
5y purpose in being here is79
Informing the client of facts increases his(her #nowledge about a topic or lets the client
#now what to epect.
)he nurse is functioning as a resource person.
6i"ing information also builds trust with the client.
'i(ing Recognition ac#nowledging!
indicating awareness
6ood morning! 5r. ,7
You$"e finished your list of things to
do.
I notice that you$"e combed your hair.
6reeting the client by name! indicating awareness of change! or noting efforts the client
has made all show that the nurse recogni/es the client as a person! as an indi"idual.
,uch recognition does not carry the notion of "alue! that is! of being good or bad.
Ma)ing O*ser(ations "erbali/ing
what the nurse percei"es
You appear tense.
Are you uncomfortable when7%
I notice that you$re biting your lip.
,ometimes clients cannot "erbali/e or ma#e themsel"es understood.
4r the client may not be ready to tal#.
O$$ering Se$ma#ing oneself
a"ailable
I$ll sit with you awhile.
I$ll stay here with you.
I$m interested in what you thin#.
)he nurse can offer his or her presence! interest! and desire to understand.
It is important that this offer is unconditional! that is! the client does not ha"e to
respond "erbally to get the nurse$s attention.
Pacing E(ent in Ti"e or Se+uence
clarifying the relationship of
e"ents in time
&hat seemed to lead up to...%
&as this before or after...%
&hen did this happen%
:utting e"ents in proper se1uence helps both the nurse and client to see them in
perspecti"e.
)he client may gain insight into cause3and3effect beha"ior and conse1uences! or the client
may be able to see that perhaps some things are not related.
)he nurse may gain information about recurrent patterns or themes in the client$s
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC
COMMUNICATION TECHNIQUE
EXAMPLES RATIONALE
beha"ior or relationships.
Presenting Reait,offering for
consideration that which is real
I see no one else in the room.
)hat sound was a car bac#firing.
Your mother is not here; I am a nurse.
&hen it is ob"ious that the client is misinterpreting reality! the nurse can indicate what is
real.
)he nurse does this by calmly and 1uietly epressing the nurse$s perceptions or the facts
not by way of arguing with the client or belittling his or her eperience.
)he intent is to indicate an alternati"e line of thought for the client to consider! not to
con"ince the client that he or she is wrong.
Re$ectingdirecting client actions!
thoughts! and feelings bac# to
client
Cient- 2o you thin# I should tell the
doctor...%
Nurse-2o you thin# you should%
Cient- 5y brother spends all my
money and then has ner"e to as# for
more.
Nurse- )his causes you to feel angry%
<eflection encourages the client to recogni/e and accept his or her own feelings.
)he nurse indicates that the client$s point of "iew has "alue! and that the client has the
right to ha"e opinions! ma#e decisions! and thin# independently.
Restatingrepeating the main idea
epressed
Cient- = can$t sleep. I stay awa#e all
night.
Nurse- You ha"e difficulty sleeping.
Cient- I$m really mad! I$m really
upset.
Nurse- You$re really mad and upset.
)he nurse repeats what the client has said in approimately or nearly the same words the
client has used.
)his restatement lets the client #now that he or she communicated the idea effecti"ely.
)his encourages the client to continue.
4r if the client has been misunderstood! he or she can clarify his or her thoughts.
See)ing In$or"ation see#ing to
ma#e clear that which is not
meaningful or that which is "ague
I$m not sure that I follow.
-a"e I heard you correctly%
)he nurse should see# clarification throughout interactions with clients.
2oing so can help the nurse to a"oid ma#ing assumptions that understanding has occurred
when it has not.
It helps the client to articulate thoughts! feelings! and ideas more clearly.
Sienceabsence of "erbal
communication! which pro"ides time
for the client to put thoughts or
feelings into words! regain
composure! or continue tal#ing
Nurse says nothing but continues to
maintain eye contact > con"eys
interest.
,ilence often encourages the client to "erbali/e! pro"ided that it is interested and
epectant.
,ilence gi"es the client time to organi/e thoughts! direct the topic of interaction! or
focus on issues that are most important.
5uch non"erbal beha"ior ta#es place during silence! and the nurse needs to be aware of
the client and his or her own non"erbal beha"ior.
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC
COMMUNICATION TECHNIQUE
EXAMPLES RATIONALE
Suggesting Coa*oration offering
to share! to stri"e! to wor# with the
client for his or her benefit
:erhaps you and I can discuss and disco"er
the triggers for your aniety.
?et$s go to your room! and I$ll help you find
what you$re loo#ing for.
)he nurse see#s to offer a relationship in which the client can identify problems in li"ing
with others! grow emotionally! and impro"e the ability to form satisfactory relationships.
)he nurse offers to do things rather than for! the client.
Su""ari.ingorgani/ing and
summing up that which has gone
before
-a"e I got this straight%
You$"e said that7
2uring the past hour! you and I ha"e
discussed7
,ummari/ation see#s to bring out the important points of the discussion and to increase
the awareness and understanding of both participants.
It omits the irrele"ant and organi/es the pertinent aspects of the interaction.
It allows both client and nurse to depart with the same ideas and pro"ides a sense of
closure at the completion of each discussion.
Transating into &eeings see#ing
to "erbali/e clients feelings that he
or she epresses only indirectly
Cient- I$m dead.
Nurse- Are you suggesting that you
feel lifeless%
Cient- I$m way out in the ocean.
Nurse- You seem to feel lonely or
deserted.
4ften what the client says! when ta#en literally! seems meaningless or far remo"ed from
reality.
)o understand! the nurse must concentrate on what the client might be feeling to epress
himself(herself this way.
!er*ai.ing t/e I"pied "oicing
what the client has hinted at or
suggested
Cient- = can$t tal# to you or anyone.
It$s a waste of time.
Nurse- 2o you feel that no one
understands%
:utting into words what the client has implied or said indirectly tends to ma#e the
discussion less obscure.
)he nurse should be as direct as possible without being unfeelingly blunt or obtuse.
)he client may ha"e difficulty communicating directly.
)he nurse should ta#e care to epress only what is fairly ob"ious; otherwise the nurse
may be jumping to conclusions or interpreting the client$s communication.
!oicing dou*tepressing
uncertainty about the reality of the
client$s perceptions
Isn$t that unusual%
<eally%
)hat$s hard to belie"e.
Another means of responding to distortions of reality is to epress doubt.
,uch epression permits the client to become aware that others do not necessarily
percei"e e"ents in the same way or draw the same conclusions.
)his does not mean the client will alter his or her point of "iew! but at least the nurse will
encourage the client to reconsider or ree"aluate what has happened.
)he nurse neither agreed nor disagreed; howe"er! he or she has not let the
misperceptions and distortions pass without comment.
THERAPEUTIC COMMUNICATION TECHNIQUES
TEST I IDENTIFICATION THERAPEUTIC COMMUNICATION TECHNIQUES
1. _______ - indicating receptin
!. _______ - a""#ing t$e c"ient t ta%e t$e initiati&e in intrd'cing t$e tpic
(. _______ - )earc$ing *r +'t'a" 'nder)tanding, *r accrd in t$e +eaning *
t$e #rd)
-. _______ - a)%ing t$at )i+i"aritie) and di**erence) .e nted
/. _______ - a)%ing t$e c"ient t &er.a"i0e #$at $e1)$e percei&e)
2. _______ - a)%ing c"ient t apprai)e t$e 3'a"it4 * $i)1$er e5perience)
6. _______ - de"&ing *'rt$er int a )'.7ect r idea
8. _______ - cncentrating n a )ing"e pint
9. _______ - a)%ing t$e c"ient t cn)ider %ind) * .e$a&ir "i%e"4 t .e
apprpriate in *'t're )it'atin)
1:. _______ - gi&ing enc'rage+ent t cntin'e
11. _______ - +a%ing a&ai"a."e t$e *act) t$at t$e c"ient need)
1!. _______ - ac%n#"edging, indicating a#arene))
1(. _______ - &er.a"i0ing #$at t$e n'r)e percei&e)
1-. _______ - +a%ing ne)e"* a&ai"a."e
1/. _______ - c"ari*4ing t$e re"atin)$ip * e&ent) in ti+e
12. _______ - **ering *r cn)ideratin t$at #$ic$ i) rea"
16. _______ - directing c"ient actin), t$'g$t), and *ee"ing) .ac% t c"ient
18. _______ - repeating t$e +ain idea e5pre))ed
19. _______ - )ee%ing t +a%e c"ear t$at #$ic$ i) nt +eaning*'" r t$at #$ic$ i)
&ag'e
!:. _______ - a.)ence * &er.a" c++'nicatin, #$ic$ pr&ide) ti+e *r t$e c"ient
t p't t$'g$t) r *ee"ing) int #rd), regain c+p)'re, r cntin'e ta"%ing
!1. _______ - **ering t )$are, t )tri&e, t #r% #it$ t$e c"ient *r $i) r $er
.ene*it
!!. _______ - rgani0ing and )'++ing 'p t$at #$ic$ $a) gne .e*re
!(. _______ - )ee%ing t &er.a"i0e c"ient) *ee"ing) t$at $e r )$e e5pre))e) n"4
indirect"4
!-. _______ - &icing #$at t$e c"ient $a) $inted at r )'gge)ted
!/. _______ - e5pre))ing 'ncertaint4 a.'t t$e rea"it4 * t$e c"ient;) perceptin)
!2.
TEST II MATCHIN< T=PE THERAPEUTIC COMMUNICATION TECHNIQUES
A. Accepting
>. >rad Opening)
C. Cn)en)'a" ?a"idatin
D. Enc'raging C+pari)n
E. Enc'raging De)criptin *
Perceptin)
F. Enc'raging E5pre))in
<. E5p"ring
H. Fc')ing
I. Fr+'"ating a P"an * Actin
@. <enera" Aead)
B. <i&ing In*r+atin
A. <i&ing Recgnitin
M. Ma%ing O.)er&atin)
N. O**ering Se"*
O. P"acing E&ent in Ti+e r
Se3'ence
P. Pre)enting Rea"it4
Q. Re*"ecting
R. Re)tating
S. See%ing In*r+atin
T. Si"ence
U. S'gge)ting C""a.ratin
?. S'++ari0ing
C. Tran)"ating int Fee"ing)
D. ?er.a"i0ing t$e I+p"ied
=. ?icing d'.t
THERAPEUTIC COMMUNICATION TECHNIQUES
1. EEEEEEE F=e).G
!. EEEEEEE F1 can;t )"eep. I )ta4 a#a%e a"" nig$t.G HC5I F=' $a&e di**ic'"t4 )"eeping.G
HN5I
(. EEEEEEE FD 4' t$in% I )$'"d te"" t$e dctr...JGHC5I GD 4' t$in% 4' )$'"dJG
HN5I
-. EEEEEEE F1 can;t ta"% t 4' r an4ne. It;) a #a)te * ti+e.G HC5I FD 4' *ee" t$at
n ne 'nder)tand)JG HN5I
/. EEEEEEE FAnd t$enJG
2. EEEEEEE FAre 4' 'nc+*rta."e #$enKJ F
6. EEEEEEE FAre 4' ')ing t$i) #rd t cn&e4 t$at...JG
8. EEEEEEE FDe) t$i) cntri.'te t 4'r di)tre))JG
9. EEEEEEE FD'ring t$e pa)t $'r, 4' and I $a&e di)c'))edK F
1:. EEEEEEE F< n.G
11. EEEEEEE F<d +rning, Mr. SKF
1!. EEEEEEE FHa&e I gt t$i) )traig$tJG
1(. EEEEEEE FHa&e I $eard 4' crrect"4JG
1-. EEEEEEE FHa&e 4' $ad )i+i"ar e5perience)JG
1/. EEEEEEE FI *""# #$at 4' )aid.G
12. EEEEEEE FI ntice t$at 4';re .iting 4'r "ip.G
16. EEEEEEE FI ntice t$at 4';&e c+.ed 4'r $air.G
18. EEEEEEE FI )ee n ne e")e in t$e r+.G
19. EEEEEEE FI;"" )it #it$ 4' a#$i"e.G
!:. EEEEEEE FI;"" )ta4 $ere #it$ 4'.G
!1. EEEEEEE FI;+ dead.L HC5I FAre 4' )'gge)ting t$at 4' *ee" "i*e"e))JG HN5I
!!. EEEEEEE FI;+ intere)ted in #$at 4' t$in%.G
!(. EEEEEEE FI;+ nt )'re t$at I *""#.G
!-. EEEEEEE FI;+ rea""4 +ad, I;+ rea""4 'p)et.G HC5I F=';re rea""4 +ad and 'p)et.G HN5I
!/. EEEEEEE FI;+ #a4 't in t$e cean.G HC5I F=' )ee+ t *ee" "ne"4 r de)erted.G HN5I
!2. EEEEEEE FI) t$ere )+et$ing 4';d "i%e t ta"% a.'tJG
!6. EEEEEEE FI)n;t t$at 'n')'a"JG
!8. EEEEEEE FAet;) g t 4'r r+, and I;"" $e"p 4' *ind #$at 4';re "%ing *r.G
!9. EEEEEEE FM4 .rt$er )pend) a"" +4 +ne4 and t$en $a) ner&e t a)% *r +re.G HC5I
FT$i) ca')e) 4' t *ee" angr4JG HN5I
(:. EEEEEEE FM4 na+e i)KG
(1. EEEEEEE FM4 p'rp)e in .eing $ere i)KL
(!. EEEEEEE FNe5t ti+e t$i) c+e) 'p, #$at +ig$t 4' d t $and"e itJG
((. EEEEEEE FO* a"" t$e cncern) 4';&e +entined, #$ic$ i) +)t tr'."e)+eJG
(-. EEEEEEE FPe$ap) 4' and I can di)c')) and di)c&er t$e trigger) *r 4'r an5iet4.G
(/. EEEEEEE FRea""4JG
(2. EEEEEEE FTe"" +e a.'t it.G
(6. EEEEEEE FTe"" +e +re a.'t t$at.G
(8. EEEEEEE FTe"" +e #$en 4' *ee" an5i').G
(9. EEEEEEE FTe"" +e #$et$er +4 'nder)tanding * it agree) #it$ 4'r).G
-:. EEEEEEE FT$at )'nd #a) a car .ac%*iring.G
-1. EEEEEEE FT$at;) $ard t .e"ie&e.G
-!. EEEEEEE FT$i) pint )ee+) #rt$ "%ing at +re c")e"4.G
-(. EEEEEEE F?i)iting $'r) areK F
--. EEEEEEE FCa) it )+et$ing "i%e...J F
-/. EEEEEEE FCa) t$i) .e*re r a*ter...JG
-2. EEEEEEE FC$at are 4'r *ee"ing) in regard t...JG
-6. EEEEEEE FC$at c'"d 4' d t "et 4'r anger 't $ar+"e))"4JG
-8. EEEEEEE FC$at de) t$e &ice )ee+ t .e )a4ingJG
-9. EEEEEEE FC$at i) $appeningJG
/:. EEEEEEE FC$at %ind * #r%JG
/1. EEEEEEE FC$at )ee+ed t "ead 'p t...JG
/!. EEEEEEE FC$en did t$i) $appenJG
/(. EEEEEEE FC$ere #'"d 4' "i%e t .eginJG
/-. EEEEEEE FC'"d 4' de)cri.e it +re *'""4JG
//. EEEEEEE F=' appear ten)e.G
/2. EEEEEEE F=';&e )aid t$atK F
/6. EEEEEEE F='r +t$er i) nt $ereM I a+ a n'r)e.G
/8. EEEEEEE G=';&e *ini)$ed 4'r "i)t * t$ing) t d.G
/9. EEEEEEE Ndding
2:. EEEEEEE N'r)e )a4) nt$ing .'t cntin'e) t +aintain e4e cntact N cn&e4) intere)t
THERAPEUTIC COMMUNICATION TECHNIQUES
TEST I ANSCER SHEET THERAPEUTIC COMMUNICATION TECHNIQUES
1. Accepting
!. >rad Opening)
(. Cn)en)'a" ?a"idatin
-. Enc'raging C+pari)n
/. Enc'raging De)criptin * Perceptin)
2. Enc'raging E5pre))in
6. E5p"ring
8. Fc')ing
9. Fr+'"ating a P"an * Actin
1:. <enera" Aead)
11. <i&ing In*r+atin
1!. <i&ing Recgnitin
1(. Ma%ing O.)er&atin)
1-. O**ering Se"* S'gge)ting C""a.ratin
1/. S'++ari0ing
12. Tran)"ating int Fee"ing)
16. ?er.a"i0ing t$e I+p"ied
18. ?icing d'.t
19.
!:. P"acing E&ent in Ti+e r Se3'ence
!1. Pre)enting Rea"it4
!!. Re*"ecting
!(. Re)tating
!-. See%ing In*r+atin
!/. Si"ence
!2. S'gge)ting C""a.ratin
!6. S'++ari0ing
!8. Tran)"ating int Fee"ing)
!9. ?er.a"i0ing t$e I+p"ied
(:. ?icing d'.t
ANSCER SHEET - TEST II MATCHIN< T=PE THERAPEUTIC COMMUNICATION TECHNIQUES
1. A
!. R
(. Q
-. D
/. @
2. M
6. C
8. F
9. ?
1:. @
11. A
1!. ?
1(. S
1-. D
1/. A
12. M
16. A
18. P
19. N
!:. N
!1. C
!!. N
!(. S
!-. R
!/. C
!2. >
!6. =
!8. U
!9. Q
(:. B
(1. B
(!. I
((. H
(-. U
(/. =
(2. @
(6. <
(8. E
(9. C
-:. P
-1. =
-!. H
-(. B
--. D
-/. O
-2. F
-6. I
-8. E
-9. E
/:. <
/1. O
/!. O
/(. >
/-. <
//. M
/2. ?
/6. P
THERAPEUTIC COMMUNICATION TECHNIQUES
/8. A /9. A