Chapter 4

Therapeutic
Communication Skills

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Therapeutic Communication
Defined
• Introduces element of empathy
• A feeling of comfort for the patient in the face
of frightening news regarding the patient’s
prognosis
• Specific and well-defined professional skills
• Patient is made to feel validated and
respected
• Foundation of all patient care
• Nontechnical language
• Technically accurate
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 The Communication Cycle
(Slide 1 of 4)
• Two or more individuals exchanging information
• Sending and receiving messages
• Five basic elements:
- Sender
- Message
- Channel or mode of communication
- Receiver
- Feedback
• See Figure 4-1: The communication cycle and
modes or channels of communication
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 The Communication Cycle
(Slide 2 of 4)
• The Sender
- Encoding or creating message to be sent
• The Message
- Content being communicated
- Must be understood clearly by receiver
• The Channel or Mode of Communication
- Speaking and listening
- Gestures or body language
- Writing

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 The Communication Cycle
(Slide 3 of 4)
• The Receiver
- Recipient of sender’s message
- Must decode (interpret) meaning of message
- Sensory skill in verbal communication is
listening
• Feedback
- After receiver has decoded message sent by
sender
- Receiver’s way of ensuring message that is
understood is same as message sent

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 The Communication Cycle
(Slide 4 of 4)
• Listening Skills
- A good listener is alert to all aspects, both
verbal and nonverbal
- Active listening – received message is
repeated a little differently for verification
- Health care listening goals
• Improve listening skills so patients are heard
accurately
• Listen either for what is not being said or for
information transmitted only by hints
• Determine how accurately message has been
received
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 Verbal and Nonverbal
Communication (Slide 1 of 5)
• Verbal Communication
- Takes place when message is spoken
- Involves both speaking and listening
- Majority in the health care is verbal
- The Five Cs of Communication
• Complete
• Clear
• Concise
• Coherent
• Courteous

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 Verbal and Nonverbal
Communication (Slide 2 of 5)
• Nonverbal Communication
- Body language
• Experts say 70% of communication is
nonverbal
• Unconscious body movements, gestures,
facial expression that accompany speech
• Kinesics is study of body language
• Body language learned first
• Body language influenced by primary
caregivers and culture
• Facial expressions are the most important
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 Verbal and Nonverbal
Communication (Slide 3 of 5)
• Nonverbal Communication (continued)
- Facial expression
• Eyes reflect feelings
• Staring is invasion of privacy
• Cultural influences
- Personal space
• Comfortable with others while communicating
• Handled differently by various cultures
• Beneficial to explain procedures that invade
another’s space

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 Verbal and Nonverbal
Communication (Slide 4 of 5)
• Nonverbal Communication (continued)
- Posture
• Relates to position of body or parts of body
• Involves at least half the body
- Position
• Physical stance of two individuals while
communicating
• Face-to-face communication
• Should enable observation of verbal and
nonverbal cues

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 Verbal and Nonverbal
Communication (Slide 5 of 5)
• Nonverbal communication (continued)
- Gestures and mannerisms
• “Talk” with hands
• Enhances spoken word
- Touch
• Communicates what cannot be expressed in
words
• Requires use of good judgment on part of
professional
• Linked closely to personal space
• Not all patients are comfortable with touch
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 Congruency in
Communication
• Verbal and nonverbal messages must agree
• Clustering - Grouping of nonverbal messages
into statements or conclusions
• Masking - Attempt to conceal or repress true
feeling or message
• Perception
- Conscious awareness of one’s own feelings
and the feelings of others
- Sense another’s attitudes, moods, feelings
- Follow perceptions with verbal validation
- Easily misinterpreted
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 Factors Affecting
Therapeutic Communication
• Barriers
- Age
- Economic
- Education and life experience
- Bias and prejudice
- Verbal roadblocks
- Health care professional should remain neutral
in regards to the patient’s condition,
empathetic and nonjudgmental

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 Roadblocks to
Therapeutic Communication
• See Table 4-1: Roadblocks to Communication
• Defense mechanisms
- Defined as behaviors that are used to protect the
ego from guilt, anxiety or loss of esteem
- Harmful when they result in a breakdown in
therapeutic communication
- Use is often subconscious to the person using
them
- See Quick Reference Guide: Defense
Mechanisms

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Barriers Caused by Cultural
and Religious Diversity
• Communication context
- Low-context
- High-context
• Caregiving expectations
• Time focus
- Future
- Present time
- Past time
• Attitude toward Western medicine

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 Human Needs as Barriers
• Maslow’s Hierarchy of Needs
- Considered the founder of humanistic
psychology
• Five levels
- Level 1 Survival or physiologic needs
- Level 2: Safety needs and security
- Level 3: Belongingness and love needs
- Level 4: Prestige and esteem needs
- Level 5: Self-actualization

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 Patients with Special Needs
• American Disabilities Act (ADA)
- Health care facilities must provide alternatives
to patients with language and hearing loss or
speech impairment
- English as a second language
- Audio challenged
- Visually challenged
- Mental cognition
• Environmental and time factors

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 Environmental Factors

• Noise or visual commotion that causes

distraction will be an barrier to affective
communication
• Physical barriers such as a computer or
desk should be avoided
• Position close to the patient at eye level,
but do not invade personal space
• Do not violate privacy issues

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 Establishing Multicultural
Communication
• Approximately one third of the population in
the United States is from another culture.
• Steps to build trust between the
professional and the patient:
- Risk/trust
- Empathy
- Respect
- Genuineness
- Active listening

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 Therapeutic Communication in Action (Slide 1 of 2)

• Professional must build an atmosphere of trust

by showing concern
• Be honest and genuine, sympathetic and
empathetic
• Interview techniques
- Closed questions - answered with simple yes
or no
- Open-ended questions - patient required to
verbalize more information
- Indirect statements: elicit response from
patient without patient feeling questioned
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 Therapeutic Communication in Action (Slide 1 of 2)

• Interview techniques
- Silence - Give patients time to put their feelings
and thoughts into words
- Feedback - words and nonverbal cues are
important; offer encouragement to patient to
continue
- Give recognition
- Offer comfort

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 Patient Coaching and Navigation (Slide of 1 of 2)

• Difficult to cover every agenda item within the 15-

minute visit
• Patient and provider discuss options for health
care, using coaching and navigation
• Coach - Primary objective is to educate the patient
regarding self-help management, must play a more
active role in their own health care
• Navigator - Works in conjunction with a home
health care team assisting with answering
questions regarding medications, scheduling
appointments and arranging community resources
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 Patient Coaching and
Navigation (Slide of 2 of 2)
• Qualifications as a coach or navigator
- Excellent listener
- Good communication skills
- Integrity
- Use planning, organization, and follow-up
techniques
• Medical Assistants are well suited for these
roles, but depends on the state regulations
and scope of practice

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