Care of Clients with Maladaptive Patterns of

Behavior, Acute and Chronic

STUDENT ACTIVITY SHEET BS NURSING / THIRD YEAR
Session # 7

LESSON TITLE:THERAPEUTIC AND NONTHERAPEUTIC Materials:

COMMUNICATION Textbook, Notebook, Bondpaper, Pen and Paper
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can: References
Videbeck, S. L., (2014). Mental and Psychiatric
1. Discuss the need for therapeutic communication in the Health Nursing. 6th Edition. Lippincott, Williams
care of a patient with mental illness/disorder. and Wilkins. Philadelphia, PA.
2. Identify the essentials for effective therapeutic
communication.
3. Describe the goals of therapeutic communication. Townsend, M. C. & Morgan, K. I., (2018).
4. Identify therapeutic and non – therapeutic verbal Psychiatric Mental Health Nursing- Concepts of
communication skills. Care in Evidence-Based Practice. 9th Edition, FA
5. Explain the various therapeutic and nontherapeutic Davis Company. Philadelphia, PA.
communication techniques.

LESSON REVIEW / PREVIEW & HOOK ACTIVITY (20 minutes)

You are to answer the questions below:

Three Minute Paper

1. The students will be answering the following questions based on their own ideas/readings:
a. What is the importance of communication in caring for a client with a mental illness/disorder;

b. What do you think are the challenges in communicating with a client with a mental illness/disorder?

MAIN LESSON (1 hour)

You are to study and read your book about this lesson.

Therapeutic Communication
This refers to an 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. Skilled use of therapeutic communication
techniques helps the nurse understand and empathize with the client’s experience. All nurses need skills in therapeutic
communication to effectively apply the nursing process and to meet standards of care for their clients.

Goals of Therapeutic Communication

1. Establish a therapeutic nurse–client relationship.
2. Identify the most important client concern at that moment (the client-centered goal).

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 1 of 7
 3. Assess the client’s perception of the problem as it unfolded. This includes detailed actions (behaviors and
messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
4. Facilitate the client’s expression of emotions.
5. Teach the client and family necessary self-care skills.
6. Recognize the client’s needs.
7. Implement interventions designed to address the client’s needs.
8. Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution.

Essentials for Effective Therapeutic Communication

1. Ensure Privacy and Respect Boundaries – People feel more comfortable communicating when in a private setting
and with smaller distances from each other (3 – 6 feet)
2. Touch - Touching a client can be comforting and supportive when it is welcome and permitted. The nurse should
observe the client for cues that show if touch is desired or indicated.
3. Active Listening – refraining from other internal mental activities and concentrating exclusively on what the client
says
4. Active Observation - watching the speaker’s nonverbal actions as he or she communicates

Therapeutic Communication Techniques

TECHNIQUE EXAMPLE RATIONALE
Accepting—indicating reception “Yes.” “I follow what you said.” An accepting response indicates the
Nodding nurse has heard and followed the
train of thought. It does not indicate
agreement but is non-judgmental.
Facial expression, tone of voice, and
so forth also must convey acceptance
or the words will lose their meaning.
Broad openings—allowing the client “Is there something you’d like to talk Broad openings make explicit that the
to take the initiative in introducing the about?” “Where would you like to client has the lead in the interaction.
topic begin?” For the client who is hesitant about
talking, broad openings may stimulate
him or her to take the initiative.
Consensual validation— searching for “Tell me whether my understanding of For verbal communication to be
mutual understanding, for accord in it agrees with yours.” “Are you using meaningful, it is essential that the
the meaning of the words this word to convey that . . . ?” 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 “Was it something like . . . ?” “Have Comparing ideas, experiences, or
that similarities and differences be you had similar experiences?” relationships brings out many
noted 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 “Tell me when you feel anxious.” To understand the client, the nurse
perceptions—asking the client to “What is happening?” “What does the must see things from his or her
verbalize what he or she perceives voice seem to be saying?” perspective. 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 “What are your feelings in regard to . . The nurse asks the client to consider
client to appraise the quality of his or . ?” “Does this contribute to your people and events in light of his or her

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 2 of 7
her experiences distress? 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 “Tell me more about that.” “Would you When clients deal with topics
subject or idea describe it more fully?” “What kind of superficially, exploring can help them
work?” 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 “This point seems worth looking at The nurse encourages the client to
point more closely.” “Of all the concerns concentrate his or her energies on a
you’ve mentioned, which is most single point, which may prevent a
troublesome?” 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 “What could you do to let your anger It may be helpful for the client to plan
the client to consider kinds of out harmlessly?” “Next time this in advance what he or she might do in
behavior likely to be appropriate in comes up, what might you do to future similar situations. Making
future situations handle it?” definite plans increases the likelihood
that the client will cope more
effectively in a similar situation.
General leads—giving “Go on.” “And then?” “Tell me about General leads indicate that the nurse
encouragement to continue it.” is listening and following what the
client is saying without taking away
the initiative for the interaction. They
also encourage the client to continue
if he or she is hesitant or
uncomfortable about the topic.
Giving information— making available “My name is . . .” “Visiting hours are . . Informing the client of facts increases
the facts that the client needs .” “My purpose in being here is . . . his or her knowledge about a topic or
lets the client know what to expect.
The nurse is functioning as a
resource person. Giving information
also builds trust with the client.
Giving recognition— acknowledging, “Good morning, Mr. S . . .” “You’ve Greeting the client by name,
indicating awareness finished your list of things to do.” “I indicating awareness of change, or
notice that you’ve combed your hair.” noting efforts the client has made all
show that the nurse recognizes the
client as a person, as an individual.
Such recognition does not carry the
notion of value, that is, of being
“good” or “bad.
Making observations— verbalizing “You appear tense.” “Are you Sometimes clients cannot verbalize or
what the nurse perceives uncomfortable when . . . ?” “I notice make themselves understood. Or the
that you’re biting your lip.” client may not be ready to talk.
Offering self—making oneself “I’ll sit with you awhile.” “I’ll stay here The nurse can offer his or her
available with you.” “I’m interested in what you presence, interest, and desire to
think.” understand. It is important that this
offer is unconditional, that is, the
client does not have to respond
verbally to get the nurse’s attention.

Reflecting—directing client actions, Client: “Do you think I should tell the Reflection encourages the client to
thoughts, and feelings back to client doctor . . . ?” recognize and accept his or her own

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 7
 Nurse: “Do you think you should?” feelings. The nurse indicates that the
Client: “My brother spends all my client’s point of view has value, and
money and then has nerve to ask for that the client has the right to have
more.” opinions, make decisions, and think
Nurse: “This causes you to feel independently.
angry?”
Restating—repeating the main idea Client: “I can’t sleep. I stay awake all The nurse repeats what the client has
expressed night.” said in approximately or nearly the
Nurse: “You have difficulty sleeping.” same words the client has used. This
Client: “I’m really mad, I’m really restatement lets the client know that
upset.” he or she communicated the idea
Nurse: “You’re really mad and upset.” effectively. This encourages the client
to continue. Or if the client has been
misunderstood, he or she can clarify
his or her thoughts.
Seeking information— seeking to “I’m not sure that I follow.” “Have I The nurse should seek clarification
make clear that which is not heard you correctly?” throughout interactions with clients.
meaningful or that which is vague Doing so can help the nurse to avoid
making assumptions that
understanding has occurred when it
has not. It helps the client to articulate
thoughts, feelings, and ideas more
clearly.

Nonverbal Communication Skills

Nonverbal communication is behavior that a person exhibits while delivering verbal content. It includes facial
expression, eye contact, space, time, boundaries, and body movements. Nonverbal communication is as important, if not
more so, than verbal communication. It is estimated that one-third of meaning is transmitted by words and two-thirds is
communicated nonverbally.

Non-Therapeutic Communication Techniques or Blocks to Therapeutic Communication

These are barriers to communication between the nurse and the client. Nurses should recognize and eliminate
the use of these patterns in their relationships with clients. Avoiding these barriers will maximize the effectiveness of
communication and enhance the nurse-client relationship.

Blocks To Therapeutic Communication

Technique Explanation Example

1. Belittling Statement tends to make light of the C-“I won’t leave here alive.”
patient’s fear and beliefs. Real feelings not
exploited. N-“That’s ridiculous. You
shouldn’t think that way.”

2. Disagreeing Response which indicates that the nurse C-“Why I am here? Nothing is
believe the patient to be incorrect. It being done to me and I’m not
generally relates to the cognitive rather than getting any better.”
affective domain
N-“You are getting better.”

3. Defending Used to repel a verbal attack. It conveys C-“I’ll have my light on for fifteen
anxiety in the nurse. I defends nurse’s ego minutes.”
but put patient on the defensive.
N-“I’m doing my best I can. You
are the patient I have.”

4. Stereotyped Common statement made without sincerity. C-“I’m really worried about my
responses Patient recognized this and won’t respond children.”

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 7
 anymore N-“I know exactly how you are
going through”

5. Changing the Different subject is introduced to prevent C-“I will have ECT tomorrow. I
subject talking about the topic that causes anxiety. hope I will get better.”

N-“Are these your drawings? You

are good in arts.”

6. False Some reassuring statements are not sincere C-“Why are my parents not
Reassurance and make patient loss confidence to the visiting me?”
nurse.
N-“Don’t worry, they will soon
visit you one of these days.”

7. Giving advice Tells the patient what the nurse thinks the C-“What will I do if I’ll be
patient should do. This suggests that some discharged?”
pressure is being placed on the patient to
accept a prescribed course of action. If N-“I’m sure you’ll do if you just
advice is accepted and situation is stay home.”
unimproved the nurse is to be blamed by the
patient.

8. Agreeing It closes communication and belittles C-“I’m afraid the doctor won’t
patient’s concern. It shows no understanding discharge me tomorrow.”
of patient’s feeling and leaves no room for
further discussion. N-“I’m sure you are correct. I
doubt he will let you go home
soon.”

9. Focusing on self Responding in a way that focuses attention N-“ I have a rich and adorable
to the nurse instead of the client. boyfriend. His name is Michael”.

CHECK FOR UNDERSTANDING (20 minutes)

The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question. This is a graded activity equivalent to 20 points: 1 Point
for the correct answer and 1 Point for the correct rationale. Erasures or any alterations are not allowed.

Multiple Choice. Direction: Encircle the letter of the correct answer and write the rationale.

RATIONALIZATION ACTIVITY - During Face – to - Face Interaction with the Students

The instructor will lead the activity and calls a student to stand and give the answer to 1 question in the CFU. Students
who are able to answer correctly get to choose the student who will answer the next question, however, when the student
is unable to give the correct answer, the instructor chooses another student to answer.

1. When a nurse asks the client questions that seek to go deeper into a particular topic or idea is utilizing which
therapeutic communication technique:
A. Exploring C. Restating
B. General Leads D. Seeking Information

RATIONALE:

2. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
A. Reflecting C. Making observations
B. Formulating a plan of action D. Giving recognition

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 5 of 7
RATIONALE:

3. Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a
“general lead”?
A. “Do you know why you are here?”
B. “Are you feeling depressed or anxious?”
C. “Yes, I see. Go on.”
D. “Can you chronologically order the events that led to your admission?”

RATIONALE:

4. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and
medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad
opening?
A. “What occurred prior to the rape, and when did you go to the emergency department?”
B. “What would you like to talk about?”
C. “I notice you seem uncomfortable discussing this.”
D. “How can we help you feel safe during your stay here?”

RATIONALE:

5. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic
communication technique used by the nurse is an example of making observations?
A. “You appear to be talking to someone I do not see.”
B. “Please describe what you are seeing.”
C. “Why do you continually look in the corner of this room?”
D. “If you hum a tune, the voices may not be so distracting.”

RATIONALE:

6. When interviewing a client, which nonverbal behavior should a nurse employ?

A. Maintaining indirect eye contact with the client
B. Providing space by leaning back away from the client
C. Sitting squarely, facing the client
D. Maintaining open posture with arms and legs crossed

RATIONALE:

7. In terminating the therapeutic relationship with Mario prior to his discharge, Nurse Arianne should do one of the
following:
A. Discourage discussion of past relationship
B. Focus less and less on the expression of feelings as termination of relationship nears
C. Allow him to express his feelings about leaving the hospital
D. Discuss opportunities for future relationship

RATIONALE:

8. When the nurse asks the client to make a brief comparison of his/her actions, the therapeutic technique being
employed is:
A. Giving Recognition C. Offering Self
B. Encouraging Comparison D. Restating

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 6 of 7
 RATIONALE:

9. A male nurse is caring for a client. The client states, “You know, I’ve never had a male nurse before.” The nurse’s best
reply would be:
A. “Does it bother you to have a male nurse?”
B. “There aren’t many of us; we’re a minority.”
C. “How do you feel about having a male nurse?”
D. “You sound upset. Would you prefer a female nurse?”

RATIONALE:

10. When formulating goals of care for the client with a mental illness/disorder, these must be:
A. Nurse – centered C. Client-centered
B. Nurse manager – centered D. Family-centered

RATIONALE:

LESSON WRAP - UP (20 Minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: MICROLECTURE
The instructor will ask the students to choose and recite an outcome sentence. The following are the outcome
sentences:

I learned………

I was surprised…….

I’m beginning to wonder……..

I rediscovered……………..

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 7 of 7