Lesson 3

The Therapeutic Communication Process

The Communication Process

• Levels of Communication
– Intrapersonal
– Interpersonal
– Public
– Electronic
 Elements of the
Communication Process
• Referent
• Sender and Receiver
• Message
• Channels
• Feedback
• Interpersonal Variables
• Environment
Forms of Communication
• Verbal
– Uses spoken or written word
• Nonverbal
– Uses gestures, facial
expressions, touch, and other
forms
– Makes up majority of
communication
Verbal Communication
• Vocabulary
• Pace
• Intonation
• Clarity and brevity
• Timing and relevance
 Nonverbal
Communication

• Personal appearance
• Posture and gait
• Facial expression
• Eye contact
• Gestures
• Territoriality and
Personal space
 Factors Influencing the
Communication Process
• Development
• Gender
• Values and perceptions
• Personal space
– Intimate (touching to 1 ½ feet)
– Personal (1 ½ to 4 feet)
– Social (4 to 12 feet)
– Public (12 to 15 feet)
 B

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 Barriers to
Communication
• Need to recognize
• Major barriers
– Failure to listen
– Improperly decoding client’s
intended message
– Placing nurse’s needs above
client’s needs

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Education, Inc.
 Nurse-Client
Relationships
• Interpersonal relationship
• Therapeutic relationship
• Helping relationship

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Education, Inc.
 Helping Relationship
• Growth-facilitating process
• Achieve two basic goals:
– Help clients manage problems
in living
– Become better at helping
themselves in their everyday
lives

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Education, Inc.
Keys to Helping Relationships
• Development of trust
and acceptance
between nurse and
client
• Sincere interest in the
client’s welfare

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Inc.
FOUR PHASES OF THE HELPING
RELATIONSHIP
 Four Phases of the
Helping Relationship
• Pre-interaction
• Introductory
• Working (maintaining)
• Termination

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 Preinteraction Phase
• Begins before the nurse’s first
contact with the client.
• Reviews pertinent assessment
data and knowledge
• Considers potential areas of
concern
• Develops plans for interaction
 Introductory Phase
• Stage 1: Opening the
relationship
• Stage 2: Clarifying the
problem
• Stage 3: Structuring and
formulating the contract
 Working Phase
• Stage 1: Exploring and
understanding thoughts and
feelings
• Stage 2: Facilitating and taking
actions
 Termination Phase
• Prepare the client for
termination & separation on
initial contact.
• Evaluate progress &
achievement of goals.
• Nurse and client accept feelings
of loss
• Client accepts end of
relationship without feelings of
anxiety or dependence
THERAPEUTIC COMMUNICATION
 Therapeutic
Communication
• Attentive listening : SOLER
• Physical attending

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THERAPEUTIC COMMUNICATION
TECHNIQUES
 Using silence
Accepting pauses without
interjecting any verbal response

Therapeutic
Communication
Techniques
 Providing General Leads
Using statements that encourages
verbalization
“Perhaps you would like to talk
about…”

Therapeutic
Communication
Techniques
 Restating / Paraphrasing
C: “I have been overweight all my
life and never had any problems, I
don’t understand why I need to go
on a diet”
N: “You’re not convinced that you
need a diet because you have
stayed healthy“
Therapeutic
Communication
Techniques
 Clarifying

“I’m not sure I follow...”

“Before you go on, I want to
understand what you meant by...”

Therapeutic
Communication
Techniques
 Validating
C: “I’m afraid I can not go back to
work after this surgery”
N: “Tell me if I understood your
concern. You are worried that you
will not be able to return to your
usual way of life?”

Therapeutic
Communication
Techniques
 Giving Information
“Mr. Juan, Pedro will be having an
abdominal ultrasound today so we
can identify what cause his
abdominal pain. This is painless,
but he needs to drink lots of water
to make his bladder full.”

Therapeutic
Communication
Techniques
 Acknowledging
“I noticed that you are wearing
new clothes today.”

Therapeutic
Communication
Techniques
 Presenting Reality
“That sound came from the cat
who usually stays outside your
window”

Therapeutic
Communication
Techniques
 Focusing
“We have talked a lot about your
medication, now let us look more
closely at the trouble you are
having in taking them on time”

Therapeutic
Communication
Techniques
 Reflecting

C: “Everyone here ignores me”

N: “ignores you?”

Therapeutic
Communication
Techniques
 Summarizing
“You’ve told me a lot of things
about why you don’t like your
position at work and how sad
you’ve been. We’ve also come up
with some possible ways to make
things better, you’ve agreed to try
some of it and then let me know if
your need any help.”

Therapeutic
Communication
Techniques
NON THERAPEUTIC
COMMUNICATION TECHNIQUES
 Stereotyping

“Toddlers are brats”

Non-Therapeutic
Communication
Techniques
 Agreeing and Disagreeing

“You should not think of assisted

suicide, it is not right”

Non-Therapeutic
Communication
Techniques
 Defensive

“No one here would intentionally

lie to you”

Non-Therapeutic
Communication
Techniques
 Challenging

C: “I feel as if I’m dying”

N: “how can you say that when
your pulse is 80?”

Non-Therapeutic
Communication
Techniques
 Probing

N: “Why are you so anxious?”

Non-Therapeutic
Communication
Techniques
 False Reassurance

“Don’t worry, everything will be

all right.”

Non-Therapeutic
Communication
Techniques
 Rejecting

“I don’t want to discuss that. Let’s

talk about…..”

Non-Therapeutic
Communication
Techniques