Therapeutic Technique
for me”.
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
“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”.
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.
Counseling Skills
As a student, your counseling education is about developing
and expanding upon the counseling skills that will best help
your clients. These are some of the most important
counseling techniques you are likely to use in your counseling
sessions.
Listening/Observing: Listening is one of the most valuable
counseling skills in the therapeutic relationship. It can be used
in three ways:
Attending: Attending is the ability to be physically present for
the client. It means giving them your undivided attention and
making appropriate eye contact, mirroring body language,
and nodding. These attending behaviors show your client that
you care. In fact, according to Kevin J. Drab External link ,
approximately 80% of communication takes place non-
verbally.
Active listening: Active listening occurs when you are
listening with all of your senses. According to the Perinatal
Mental Health Project External link , active listening involves might also be used to help the counselor relate better with
listening with your body, heart, ears, eyes, and mouth. their client.
Verbal listening: This is a form of showing you are listening
through the words that you use. These verbal cues are used
to show attention and to encourage more exploration from
the client. This can be as simple as ‘yes’, or ‘go on’. It can also
be in the form of paraphrasing or repeating a word of
emotion that the client has just said.
Asking Questions: Questions are helpful in the therapeutic
environment because they allow you to learn more about
your client. The type of questions that you ask will set the
tone of the session and the entire counseling process.
Questions occur in two forms.
Closed: A closed question is the practice of asking a question
that can be answered as a ‘yes’ or ‘no’. Closed questions
should generally be avoided in the counseling relationship, as
they do not encourage deeper exploration.
Open: An open question is necessary to gather information.
An open question is one that cannot be answered with a
simple ‘yes’ or ‘no’ and it requires reflection or exploration on
the client’s end. Every open question should be intentional
and therapeutic. According to Susan Mills of the Nielsen
Norman Group External link , the best open ended questions
begin with ‘how’ and ‘what’.
Reflection: Reflections are used in the counseling process to
accurately describe the client’s state External link from their
verbal or nonverbal cues.
Feelings reflections: Reflections allow clients to hear the
feelings they have just expressed. Sometimes you have to
look for the descriptive feeling in a client’s statement. It can
also be helpful to look at a client’s nonverbal feeling cues.
Restating/Rephrasing: Restating and rephrasing can build a
stronger client therapist relationship. Rephrasing a client’s
statement allows you to better understand what a client has
just said and to gain further clarity, if you have gotten it
wrong.
Affirmation: Affirmation is a form of encouragement that is
used to affirm behaviors or life choices. Affirmation is
important for empowering clients External link . A few
common affirmations include affirming progress that a client
has made toward a goal or encouraging a client to do what is
important to them.
Empathy: Empathy is the ability to put yourself in someone
else’s shoes. It is much more than sympathy in that you are
able to show your understanding of your clients feeling
surrounding an experience.
Genuineness: Begin genuine is creating congruence between
yourself and your words. Every therapist is different and will
provide a different therapeutic process. It is important to
remain genuine in all counseling techniques and verbal and
nonverbal cues.
Unconditional Positive Regard: Demonstrating unconditional
positive regard is the idea of accepting your client for who
they are. It is a means of expressing warmth External link and
respect.
Counselor Self-Disclosure: This is a tricky counseling skill to
maneuver. A general rule to follow is to only share personal
information that is beneficial to the therapeutic process. It