Therapeutic Communication

Therapeutic communication promotes understanding and can

help establish a constructive relationship between the nurse and the
client. Unlike the Social relationship, where there may not be a specific
purpose or direction, the theraoeutic helping relationship is clinet and
goal directed. A distinguished aspect of a therapeutic communication
is it’s application to long-term communication interactions. Therapeutic
Communication is is defined as face-to-face process of interacting that
focuses on advancing the physical and emotional well-being of a
patient.

Purposes:

• To gather data and information to determine the client’s

illness.

• To assess and modify the client’s behavior.

• To provide health education among clients.

Therapeutic Communication Techniques

Techniques Description Examples
Using Silence Accepting pauses or Sitting quietly and waiting
silences that may extend attentively until the client is
for several seconds or able to put thoughts and
minutes without feelings into words.
interjecting any verbal
response.
Providing Using statements or can you tell me how it’s for you?
General questions that (a) Perhaps you would like to talk
Leads encourage a client to about..
verbalize (b) put a topic Would it help to discuss your
for conversation and (c) feelings?
facilitate continued Where would you like to begin?
verbalization. And then what?
Being Making statements that Rate your pain on a scale 1-10.
specified and are specific rather than (specoific statement)
tentative general and tentative Are you in pain? (general
rather than absolute. statement)
Yoou seemed unconcerned
about your Diabetes. (tentative
 statement)
You dont care about your
diabetes anf you will never will.
(absolute statement)
Using open- Asking abroad questions I’d like to here more about that
ended that lead or invite the Tell me about...
question client to explore How have you been feeling late?
(elaborate, clarify, What brought you to the
describe, compare or hospital?
illustrate) thoughts or What is your opinion?
feelings. Open-ended You said you were frightened
questions specify only yesterday. How do you feel
the topic to be discussed now?
and invite answers that
are longer than one or
two words.

Using touch Providing appropriate Putting an arm over a clients

forms of touch to shoulder. Placing your hand over
reinforce caring feelings. the clients hand.
Because tactile contacts
vary considerably among
individuals, families and
cultures, the nurse must
be sensitive to the
differences in attitudes
and practices of clients
and self.
Restating or Actively listening for the Client: I couln’t manage to eat
Paraphrasing clients basic message any dinner last night not even
and then repeating those the dessert.
thoughts and feelings in Nurse: You had difficulty eating
similar words. This yesterday.
conveys that the nurse Client: Yes, I was very upset
has listened and after my family left.
understood the clients Client: I have trouble taking to
basic message and also strangers.
offers clients a clearer Nurse: You find it difficult taking
idea of what they have to people you do not know?
said.
Seeking A method of making the I’m puzzled.
clarification client’s broad over all I’m not sure I understand that .
 meaning of message Would you please say that
more understandable. It’s again?
used when paraphrasing Would you tell me more?
is difficult or when the
communication is
rambling or garbled. To
clarify the message or
confess confussion and
ask the client to repeat or
restate the message.
Perception A method similar to Client: My husband never gives
checking or calrifying that verifies the me any presents.
seeking meaning of specific Nurse: You mean he has never
consensual words rather than the given you a present for your B-
validation over all meaning of the day and Christmas?
message. Client: Well-not never. He does
gets me something for my B-day
and Christmas, but he never
thinks of giving me anything at
any other time.

Offering Self Suggesting one’s I’ll stay with you until your
presence, interest, or daughter arrives.
wish to understand the We can sit here quitely for a
client without making any while; we dont need to talk
demands or attaching unless u want to.
conditions that the client I’ll help you to dress to go home,
must comply with to if you like.
receive the nurse’s
attention.
Giving Prividingin a simple and Your surger is scheduled for
Information direct manner, specific 11am tomorrow
factual You will feel a pulling sensation
when a tube is remove from
your abdomen.
I do not know the answer to
that, but I will find out to Mr.
King, the nurse incharge.
Acknowledgi Giving recognition, in a You trimmed yor beard and
ng nonjudgemental way, of mustache and washed your hair
a change of behavior, an I noticed you keep squinting
effort the client has your eyes are you having
 made, or a contribution difficulty seeing?
to a communication.
Acknowledgement may
be with or without
understanding, verbal or
nonverbal.
Clarifying Helping the client clarify Client: I vomited this morning.
time or an event, situation or Nurse: was that after breakfast
sequence happening in relationship Client: I feel that I have been
to time. asleep for a weeks.
Nurse: You had your operation
Monday, and today is Tuesday.
Presenting Helping the client to That telephone ring came from
reality differentiate the real the program on television .
from the unreal I see shadows from the window
covering.
Your magazine is here in the
drawer. It has not been stolen.
Focusing Helping the client expand Client: My wife says she will look
on and develop a topic of after me, but I dont think she
important for the nurse can, what with the children to
to wait until the client care of, and they’re always after
finishes starting the main her about something-clothes,
concerns before homework, what’s for dinner
atempting to focus. that night.
Nurse: Sounds like you are
worried about how well she can
manage.
Reflecting Directing ideas, feelings, Client: What can I do?
questions or content Nurse: What do you think would
back to clients enable to be helpful?
them to explore their Client: Do you think I should tell
own ideas and feelings my husband?
about the situation. Nurse: You seem unsure about
telling your husband.
Summarizing Stating the main point of During past hour we have talk
and planning a discusion to clarify the about....
relevant points Tomorrow afternoon we have to
discussed. This technique explore this further
is useful at the end of an In a few days I’ll review what
interview or to review a you have learned about the
health teaching session. actions and effects of your
 It often acts as an insulin.
introduction to future Tomorrow, I will look at your
care planning. feeling journal.

Barriers to Communication

Aspects or conditions in a workplace that interfere with effective

exchange of ideas or thoughts. Such barriers include (1) status
differences, (2) gender differences, (3) cultural differences, (4)
prejudices, and (5) the organizational environment.

Barriers to Communication
Technique Description Examples
Stereotyping Offering generalizedand Two years old are brats.
oversimplified beliefs about Women are complainers.
groups of people that are Men dont cry.
based on experiences too Most people dont have any
limited to be valid. These pain after this type of
responses categorize clients surgery.
uniqueness as individual.
Agreeing and Akin to judgemental Client: I dont think Dr.
Disagreeing response, agreeing and Broad is a very good
disagreeing imply that the Doctor. He doesnt seem
client is either right or intersted to his patients.
wrong and that the nurse is Nurse: Dr. Broad os head of
in a position to judge this. a Department of Surgery
These responses deter and is an excellent
clients from thinking surgeon.
through their position and
may cause a client to
become defensive.
Being Atempting to protect a Client: Those night nurses
defensive person or health care must sit around and talk all
services from negative night. They didn’t answer
comment. These responses my call light for over an
prevent client to express hour.
true concerns. Nurse: I’ll have you know
we literally ran around
onnights. You’re not the
only client you know.
Challenging Giving a response that Client: I feel nauseated
make clients prove their after that red pill.
statement or point of view. Nurse: Surely you dont
This responses indicate that think I gave you the wrong
the nurse is failing to pill?
consider the clients Client: I feel as if I’m dying.
feelings, making the clienr Nurse: How you feel that
feel it necessary to defend a way when your pilse got
position. 60?
Client: I believe my
husband doesnt love me.
Nurse: You can’t say that,
Why he visits you
everyday?
Probing Asking for information Client: I was speeding
chiefly out of curiosity along the street and didn’t
rather than with the intent see the stop sign.
to assist the client. These Nurse: Why were you
responses are considered speedy?
prying and violate the Client: I didn’t ask the
clients privacy. Asking doctor when he was here.
WHY” is often probing and Nurse: Why didn’t you?
places the client in a
defensive position.
Testing Asking the questions that Who do you think you are?
make the client admit to Do you think, I’m not busy?
something. These
responses permit the client
only limited answers and
often meet the nurse’s need
rather than the client’s.
Rejecting Refusing to discuss certain I dont want to discuss that.
topics with the client. These Lets talk about...
responses often make client I can’t talk now. I’m on my
feel that the nurse is way for cofee break.
rejecting not only their
communication but also the
client themselves.

Changing Directing the Client: I’m separated from

Topics and communication into areas my wife. Do you think I
subjects of self-interest rather than should have sexual relation
 considering the clients with another woman?
concerns is often a self Nurse: I see that you’re 36
protective response to a and that you like
topic that causes anxiety. gardening. This sunshines
These responses imply that is good for my roses. I have
what the nurse considers beautiful rose garden.
important will be discussed
and the clients should be
not discuss certain topics.
Unwarranted Using Cliches or comforting You’ll feel beter soon.
reassurance statements of advice as a I’m sure everything will
means to reassure the turn out alright.
client. These response block Dont worry.
the fears, felings and other
thought of the client.
Passing Giving opinions and Thats good. (bad)
judgement approving or disapproving You should’nt do that.
responses imply that the That’s not good enough.
client must think as the What you did was wrong
nurse thinks fostering (right)?
clients dependents.
Giving Telling the client what to Client: Should I move from
common do. These responses deny my home to nursing home?
advice the clients right to be an Nurse: If I were you, I’d go
equal partner. Note that to a nuring home, where
giving expert rather than you’ll get your meals
common advice is cooked for you.
therapeutic.

Cognitive Impairements:

Any disorders that impairs cognitive functioning (eg.

Cerebrovascular disease, Alzheimers disease, and Brain tumors or
injuries) may afect the clients ability to use and understand language.
These clients may develop total loss of speech, impaired articulation or
the inability to find or name words.
The nurse assessess wether these clients respond when ask a
question and, If so, assesess the following: Is the client speech hesitant
or fluent? Does the client use words correctly? Can the client
comprehend instructions as evidenced by following directions? Can the
client repeat words or phrases? In adition, the client the nurse asesess
the the clients ability to understant writen words: can the client follow
the written directions? Can the client respond correctly by pointing a
writen word? Can the client read aloud? Can the client recognize words
or leters of unable to read a whole sentence? The nurse use large
clearly writen words when trying to establish abilities in this area.

Physically Impairements:

Speech difficulties and disorders are those that are related to an

individual’s ability to verbally communicate. In some cases speech
difficulties and disorders are in and of themselves, however, in some
cases these difficulties and disorders are the result of an associated
condition or impairment.

For some individuals it is a physical impairment such as a cleft

lip, cleft palate or vocal cord disorder that results in the speech
difficulties, which makes verbal communication inefficient. In theory, if
these impairments are treated or corrected then the speech difficulty
will improve or even disappear, however in reality the prognosis for
each individual will be unique.